Aetna CVS Health Intends to Enter CA Individual Health Insurance Marketplace

Aetna CVS Health announced that it plans to enter California’s individual health insurance marketplace.

“With millions of Americans being uninsured or underinsured, our plans provide quality care, at an affordable price and the ability to conveniently access this care using virtual technology and in-person care in their communities,” said Kyu Rhee, MD, chief medical officer at Aetna. “By bridging the gap between people and the support and services they need, we can offer a human-centered approach where, when and how they need us.”

The payer will launch the health plan with its Aetna CVS Health co-branded insurance product in certain counties. Specifically, the plan will be available in the counties of Sacramento, El Dorado, Placer, Yolo, and greater Fresno, including Kings and Madera.

The health plan covers a range of services, including pediatric, ambulatory, and emergency care, hospitalization, prescription drugs, preventive care, wellness services, chronic disease management, maternal healthcare, and more. 

The primary goals of the health plan include delivering quality care through Aetna’s primary care providers, specialists, and hospitals.

Fresno members will have access to Sant Physicians hospital and Sacramento members will have access to Nivano physicians. Additionally, members will have access to care through Aetna’s telehealth options as well as physical care sites like Minute Clinics and HealthHUBs.

The health plan also aims to make care affordable for members through zero-dollar virtual care and walk-in clinic care, as long as the providers are in-network.

“We’re ensuring more Californians and Americans can get access to Aetna’s quality care,” said Jeff Hermosillo, California market president at Aetna. “We are uniquely positioned to work with the member to achieve better outcomes, across health plans, MinuteClinic, CVS HealthHUB, CVS Pharmacy or any of our virtual care options.”

Another goal of the health plans is to make care convenient for members.

“We understand that everyone has their own unique circumstances and making health care simple, easy and affordable is how we are meeting them where they are on their journey,” added Hermosillo.

Aetna tries to do this by offering access to virtual care all day, every day. Also, members can visit any of the 1,100 CVS Minute Clinics across the US.

These efforts continue Aetna’s focus on mental healthcare and virtual care from 2021. That year, Aetna launched a virtual-first health plan and introduced eight state individual and family health plans on the Affordable Care Act marketplace. The payer reported that members engaged in 157,000 MinuteClinic visits and 19 million virtual care visits in 2021.

Aetna announced that it would be re-entering the Affordable Care Act individual health insurance marketplace in its 2020 fourth quarter earning results. Payer executives cited market stabilization and the rectification of certain structural problems as reasons for re-entry. The payer re-entered officially on January 1, 2022.

Prior to the payer’s announcement about entering California’s individual health insurance marketplace, CVS Health said that it would offer virtual primary care solutions to both Aetna members and CVS Caremark clients. The service mirrors its MinuteClinic care.