California health plan · 2025

Plan 5 · 20523CA0110035

Aetna Health of California, Inc. offers this marketplace health insurance plan (Plan ID 20523CA0110035) 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: Silver Plan type: HMO CSR: Standard Silver On Exchange Plan Issuer: Aetna Health of California, Inc.
Telehealth Data pending HSA eligible No Dental Not listed Vision Not listed
View issuer site

Issuer actuarial value: 71.59%. Expect to pay roughly 28.41% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 71.69% (28.31% member share on average). Learn about AV methodology.

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

See plan search for live pricing

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$8700

N/A

Review MOOP rules

Office visits

Primary care See benefits
Specialist See benefits
HSA Not eligible

Drug tiers

Generic See drug coverage
Preferred brand See drug coverage

View formulary tiers

Issuer profile See benefits
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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 California). 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.
  • Standard Silver On Exchange Plan 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.

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 20523CA0110035
Coverage year 2025
State California
Issuer Aetna Health of California, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 20523CA0110035-01
Available variants

Standard On Exchange Plan · 20523CA0110035-01

Open to Indians below 300% FPL · 20523CA0110035-02

Open to Indians above 300% FPL · 20523CA0110035-03

73% AV Silver Plan · 20523CA0110035-04

87% AV Silver Plan · 20523CA0110035-05

94% AV Silver Plan · 20523CA0110035-06
Last plan update Fri, 28 Nov 2025 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 California 26854
PCPs in California 1495
Telehealth support Data pending
Nationwide providers 30395
26,854 doctors statewide 1,495 PCPs 58 OB/GYN

Provider network(s)

Providers California All US states
All 26854 30395
PCP 1495 1571
Allergy 17 17
OB/GYN 58 63
Dentists 3 4

Drug coverage overview

3,285 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 2,692
PREFERRED-BRAND-SPECIALTY-DRUGS 370
PREFERRED-BRAND 223
Prior authorization Drugs
Required 563
Not Required 2,722
Step therapy Drugs
Required 165
Not Required 3,120
Quantity limits Drugs
Has Limit 929
No Limit 2,356

Customer highlights

What stands out for members

  • Issuer: Aetna Health of California, Inc. · Plan ID 20523CA0110035 · 2025 filing.
  • Disease management programs available: Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 20523CA0110035-01 (Standard On Exchange Plan) currently displayed.
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Variant attributes

Plan 5 · Variant 20523CA0110035-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Silver On Exchange Plan

HIOS Product ID

20523CA011

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

20523CA0110035-01

Plan Marketing Name

Silver 70 HMO

Plan Variant Marketing Name

Silver 70 HMO

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

71.59%

Issuer ID

20523

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

CAN004

Out of Country Coverage

No

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Except for Emergencies

Service Area ID

CAS004

State Code

CA

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.7169

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

30.00%

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

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

30.00%

SBC Scenario, Having a Baby, Coinsurance

$1400

SBC Scenario, Having a Baby, Copayment

$400

SBC Scenario, Having a Baby, Deductible

$5400

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1900

SBC Scenario, Having Diabetes, Deductible

$50

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$1000

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Specialty Drug Maximum Coinsurance

$250

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

per person not applicable | per group not applicable

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

Not Applicable

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

$8700 per person | $17400 per group

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

$8700

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

per person not applicable | per group 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

CAF001

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

Additional attributes

Issuer-provided metadata for this variant.

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family

per person not applicable | per group not applicable

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

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family

$50 per person | $100 per group

Drug EHB Deductible, In Network (Tier 1), Individual

$50

Drug EHB Deductible, Out of Network, Family

per person not applicable | per group not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

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

EHB Percent of Total Premium

100%

First Tier Utilization

100%

Import Date

01-13-2025

HSA Eligible

No

IsItANewPlan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Medical EHB Deductible, Combined In/Out of Network, Family

per person not applicable | per group not applicable

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

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family

$5400 per person | $10800 per group

Medical EHB Deductible, In Network (Tier 1), Individual

$5400

Medical EHB Deductible, Out of Network, Family

per person not applicable | per group not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

01/01/2025

Plan Type

HMO

QHP/Non QHP

On the Exchange

Source Name

SERFF

Specialist Requiring a Referral

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

Plan ID

20523CA0110035

Unique Plan Design

Yes

Version Number

1

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 California?

Plan 5 (20523CA0110035) is a Silver HMO from Aetna Health of California, Inc. in California 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 Plan 5 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 Plan 5 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 coverage is not listed for this plan.

Does Plan 5 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 Plan 5?

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

Is there out-of-country coverage for Plan 5?

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

Does Plan 5 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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