Texas health plan · 2025

Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 · 58840TX0110085

Aetna Health Inc. (a TX corp.) offers this marketplace health insurance plan (Plan ID 58840TX0110085) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: HMO CSR: Limited Cost Sharing Plan Variation Issuer: Aetna Health Inc. (a TX corp.)
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 81.88%. Expect to pay roughly 18.12% of covered costs out of pocket, based on issuer reporting.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$290 – $1437

Before subsidies

Estimate after subsidies

Deductible

$2,995

$5990 per group

See deductible details

Max out-of-pocket

$8,995

$17990 per group

Review MOOP rules

Office visits

Primary care No Charge
Specialist $10.00
HSA Not eligible

Drug tiers

Generic No Charge
Preferred brand $20.00

View formulary tiers

$398 / mo before subsidies

≈ $4773 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1321 / mo before subsidies

≈ $15846 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1620 / mo before subsidies

≈ $19439 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$996 / mo before subsidies

≈ $11954 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

25.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Texas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

25.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 58840TX0110085
Coverage year 2025
State Texas
Issuer Aetna Health Inc. (a TX corp.)
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 58840TX0110085-03
Available variants

Standard Off Exchange Plan · 58840TX0110085-00

Standard On Exchange Plan · 58840TX0110085-01

Open to Indians below 300% FPL · 58840TX0110085-02

Open to Indians above 300% FPL · 58840TX0110085-03
Last plan update Wed, 02 Oct 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Texas 68413
PCPs in Texas 7059
Telehealth support Data pending
Nationwide providers 74056
68,413 doctors statewide 7,059 PCPs 433 OB/GYN

Provider network(s)

Providers Texas All US states
All 68413 74056
PCP 7059 7361
Allergy 48 51
OB/GYN 433 458
Dentists 7408 7963

Drug coverage overview

3,319 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-GENERIC-NON-PREFERRED-BRAND 2,428
ZERO-COST-SHARE-PREVENTIVE-DRUGS 421
NON-PREFERRED-BRAND-SPECIALTY-DRUGS 258
PREFERRED-BRAND 212
Prior authorization Drugs
Required 586
Not Required 2,733
Step therapy Drugs
Required 186
Not Required 3,133
Quantity limits Drugs
Has Limit 960
No Limit 2,359

Customer highlights

What stands out for members

  • Issuer: Aetna Health Inc. (a TX corp.) · Plan ID 58840TX0110085 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 58840TX0110085-03 (Open to Indians above 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Coverage is limited to 35 visits per year for Physical Therapy, Occupational Therapy, and Chiropractic Care combined.

Exclusions: nan

Diabetes Education

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: nan

Home Health Care Services

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual services from designated telemedicine providers. If this is an HSA plan, deductible applies.

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Age and frequency schedules may apply.

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual services from designated telemedicine providers.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Coverage is limited to 35 visits per year Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic combined. Benefit limits are separate for rehabilitation and habilitation services.

Exclusions: nan

Rehabilitative Speech Therapy

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Coverage is limited to 35 visits per year Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic combined. Benefit limits are separate for rehabilitation and habilitation services.

Exclusions: nan

Specialist Visit

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: No coverage for non-urgent care.

X-rays and Diagnostic Imaging

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Dialysis

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: nan

Durable Medical Equipment

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Emergency Room Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 25.00% Coinsurance after deductible

nan

Exclusions: No coverage for non-emergency use of the emergency room.

Emergency Transportation/Ambulance

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 25.00% Coinsurance after deductible

nan

Exclusions: nan

Hospice Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

The cost sharing that displays applies to outpatient office visits only. All other outpatient services may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Coverage is limited to 35 visits per year Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic combined. Benefit limits are separate for rehabilitation and habilitation services.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: nan

Skilled Nursing Facility

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 25.0 Days per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Transplant

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Member cost share based on place and type of service. Network benefits must be received within the Institutes of Excellence (IOE) transplant network.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Member cost sharing applies to postnatal care.

Exclusions: nan

Routine Eye Exam for Children

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

Coverage is limited to 1 exam every 12 months through the end of the month in which the member turns 19.

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Age and frequency schedules may apply.

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.

Exclusions: nan

Non-Preferred Brand Drugs

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.

Exclusions: nan

Preferred Brand Drugs

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.

Exclusions: nan

Specialty Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

Coverage details pending

Certain nutritional and diet counseling services are available to aid in weight reduction due to obesity, diabetes self management training, autism benefits, and for adults at higher risk of chronic disease.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

Covered only to correct conditions resulting from an accidental injury, gross anatomical defect present at birth or needed for the treatment of an illness.

Exclusions: nan

Eye Glasses for Children

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

Coverage is limited to 1 set of frames and 1 set of contact lenses or eyeglass lenses per year, through the end of the month in which the member turns 19.

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Health care services that are needed to keep, learn, or improve your skills and functioning for daily living which may include physical therapy, occupational therapy, and speech therapy. Please refer to the plan policy documents for detailed information.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Covered when medically necessary during an inpatient stay.

Exclusions: nan

Reconstructive Surgery

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

Foot care for diabetics is covered.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Member cost share based on place and type of service.

Exclusions: Excludes any non-surgical or non-diagnostic services or supplies.

Variant attributes

Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 · Variant 58840TX0110085-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

58840TX011

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

58840TX0110085-03

Plan Marketing Name

Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7

Plan Variant Marketing Name

Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

81.88%

Issuer ID

58840

Issuer Marketplace Marketing Name

Aetna CVS Health

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

TXN009

Out of Country Coverage

No

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Except for Emergencies

Service Area ID

TXS011

State Code

TX

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$1,800

SBC Scenario, Having a Baby, Copayment

$20

SBC Scenario, Having a Baby, Deductible

$2,995

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$300

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$50

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,900

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$17990 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$8995 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$8,995

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

25.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$17990 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$8995 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$8,995

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

TXF005

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2024-10-02 01:01:28

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Plan Effective Date

2025-01-01

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Specialist Requiring a Referral

Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.

Plan ID

58840TX0110085

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$5990 per group

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$2995 per person

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

$2,995

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$5990 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$2995 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$2,995

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

Yes

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Texas?

Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 (58840TX0110085) is a Gold HMO from Aetna Health Inc. (a TX corp.) in Texas for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7?

No, out-of-country services are not covered for this plan.

Does Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Except for Emergencies

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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