Virginia health plan · 2025

Silver 5 Advanced: HMO Aetna network · 93187VA0070033

Aetna Health Inc. (a PA corp.) offers this marketplace health insurance plan (Plan ID 93187VA0070033) 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: 87% AV Level Silver Plan Issuer: Aetna Health Inc. (a PA corp.)
Telehealth Data pending HSA eligible No Dental Not listed Vision Not listed
View issuer site

Issuer actuarial value: 87.62%. Expect to pay roughly 12.38% of covered costs out of pocket, based on issuer reporting.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 27 Jan 2026 06:37 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

$675

N/A

See deductible details

Max out-of-pocket

$3,045

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 Virginia). 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.
  • 87% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

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  • 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 93187VA0070033
Coverage year 2025
State Virginia
Issuer Aetna Health Inc. (a PA corp.)
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 93187VA0070033-05
Available variants

Standard On Exchange Plan · 93187VA0070033-01

Open to Indians below 300% FPL · 93187VA0070033-02

Open to Indians above 300% FPL · 93187VA0070033-03

73% AV Silver Plan · 93187VA0070033-04

87% AV Silver Plan · 93187VA0070033-05

94% AV Silver Plan · 93187VA0070033-06
Last plan update Fri, 26 Dec 2025 00:00 GMT
Last HealthPorta import Tue, 27 Jan 2026 06:37 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, 27 Jan 2026 06:37 GMT).

All providers in Virginia N/A
PCPs in Virginia N/A
Telehealth support Data pending
Nationwide providers N/A
N/A doctors statewide N/A PCPs N/A OB/GYN

Provider network(s)

['PREFERRED']

Providers Virginia All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

3,326 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 422
NON-PREFERRED-BRAND-SPECIALTY-DRUGS 263
PREFERRED-BRAND 213
Prior authorization Drugs
Required 586
Not Required 2,740
Step therapy Drugs
Required 185
Not Required 3,141
Quantity limits Drugs
Has Limit 965
No Limit 2,361

Customer highlights

What stands out for members

  • Issuer: Aetna Health Inc. (a PA corp.) · Plan ID 93187VA0070033 · 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 93187VA0070033-05 (87% AV Silver Plan) currently displayed.
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Variant attributes

Silver 5 Advanced: HMO Aetna network · Variant 93187VA0070033-05

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

87% AV Level Silver Plan

HIOS Product ID

93187VA007

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

93187VA0070033-05

Plan Marketing Name

Silver 5 Advanced: HMO Aetna network

Plan Variant Marketing Name

Silver 5 Advanced: HMO Aetna network

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

87.62%

Issuer ID

93187

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

VAN004

Out of Country Coverage

No

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Except for Emergencies

Service Area ID

VAS004

State Code

VA

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$2,300

SBC Scenario, Having a Baby, Copayment

$100

SBC Scenario, Having a Baby, Deductible

$675

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$600

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$600

SBC Scenario, Treatment of a Simple Fracture, Copayment

$100

SBC Scenario, Treatment of a Simple Fracture, Deductible

$675

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

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

30.00%

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

$3045 per person | $6090 per group

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

$3,045

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

VAF006

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

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

1/13/2025

HSA Eligible

No

IsItANewPlan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Plan Effective Date

1/1/2025

Plan Type

HMO

QHP/Non QHP

Both

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

93187VA0070033

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

per person not applicable | per group not applicable

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

Not Applicable

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

$675 per person | $1350 per group

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

$675

TEHBDedOutofNetFamily

per person not applicable | per group not applicable

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

Not Applicable

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 Virginia?

Silver 5 Advanced: HMO Aetna network (93187VA0070033) is a Silver HMO from Aetna Health Inc. (a PA corp.) in Virginia 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 Silver 5 Advanced: HMO Aetna network 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 Silver 5 Advanced: HMO Aetna network 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 Silver 5 Advanced: HMO Aetna network 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 Silver 5 Advanced: HMO Aetna network?

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 Silver 5 Advanced: HMO Aetna network?

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

Does Silver 5 Advanced: HMO Aetna network 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, 27 Jan 2026 06:37 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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