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Helping you transition from Medicaid

Plan options and resources for you

You’re in the right place to learn more about Banner|Aetna individual & family plans. Here, you can find helpful resources, answers to your questions and more.  

Medicaid eligibility FAQs 

Have questions? Find helpful answers and resources.

Medicaid eligibility

Understanding Medicaid eligibility

Where can I find Medicaid coverage updates?

You can learn more about your state’s eligibility requirements on the Medicaid website.

What is Medicaid redetermination?

This is the process that states use to ensure that Medicaid enrollees continue to be eligible for Medicaid coverage. This is also called "renewal," "redetermination" or "recertification" review.

Here’s how it works: Your state will send you a renewal letter 30 to 45 days before your renewal date to recertify your Medicaid eligibility.

  • If you complete your recertification and still qualify, you don't need to do anything else. You’ll remain a Medicaid enrollee.
  • If you don’t complete your recertification by the renewal date, you will be disenrolled from Medicaid. You will need to reapply.
  • If you complete your recertification and don’t qualify, you will be disenrolled from Medicaid. You can apply for a Banner|Aetna individual & family plan.

Coverage options

Other health coverage is available to you

What‘s the difference between Medicaid and ACA coverage?

Both Medicaid and ACA coverage provide health insurance to millions of Americans. However, these two types of coverage are often confused. We’ll explain some of the differences here.

Medicaid 

Medicaid is a federal government program operated by the States. It provides health insurance to eligible low-income adults, children, pregnant women and people with disabilities. The coverage is based on financial need. Medicaid is different in each state. That means your eligibility depends on where you live.

ACA plans 

Affordable Care Act (ACA) plans are offered through the Health Insurance Marketplace® and private health insurance companies, like us. Anyone who is a U.S. citizen, national or lawfully present, can get ACA coverage, no matter your income. And you can’t be denied coverage, or charged more for coverage, for a previous health problem. For more eligibility information, check out this quick guide to the Health Insurance Marketplace

ACA plans are a great option for you if:

  • You don’t qualify for Medicaid coverage 
  • You recently lost your Medicaid coverage
  • You don’t have health coverage through your job

ACA plans cost more than Medicaid. The great news is financial help is available to make your ACA plan more affordable. In fact, you may be able to qualify for a $0 or low plan premium.* 

What do Affordable Care Act (ACA) plans cover?

Every ACA health plan covers a minimum of 10 essential benefits. This includes prescription drugs, maternity and newborn care, mental health and more. 

Find the full list of covered essential benefits.

Shopping for plans

We can help you shop for a health plan today

How do I know which plan is right for my budget?

Every ACA plan is assigned a metal tier: Platinum, Gold, Silver or Bronze. All plans offer the same quality of care. The metal tier is based on how you and your plan split the costs. Understanding plan levels and costs can help you pick the right plan for you.

Will I qualify for a subsidy?

When you apply for an Affordable Care Act (ACA) plan, you may qualify for a premium tax credit. This can lower your monthly premium or even give you a $0 monthly premium.* Other assistance may also be available. You can visit the Health Insurance Marketplace® to check if you might be eligible for a lower monthly premium before you shop.

Connect with us. We’re here to help.

Speak with a licensed agent

Count on us. We’ll help answer all of your questions so you can choose the best plan for your health care needs.

1-844-383-6131 (TTY:711)
Call Monday – Friday, 8 AM to 9 PM ET.

Notes

* FOR $0 PLAN PREMIUM: Exclusions and limitations apply.

 

Transforming health care, together

Banner|Aetna aims to offer access to more efficient and effective member care at a more affordable cost. We join the right medical professionals with the right technology, so members benefit from quality, personalized health care designed to help them reach their health ambitions.

Contact us

Health benefits and health insurance plans are offered, underwritten, and/or administered by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. (Banner|Aetna). Banner|Aetna is an affiliate of Banner Health and of Aetna Life Insurance Company and its affiliates (Aetna). Each insurer has sole financial responsibility for its own products. Aetna and Banner Health provide certain management services to Banner|Aetna. Aetna, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.

On-Demand Virtual Care with 98point6 by Transcarent

Banner|Aetna offers access to 98point6 by Transcarent, a virtual care solution that enables members to connect to care anytime, anywhere via secure in-app messaging.

Treatment is provided by a U.S.-based care team, including board-certified doctors, who can diagnose and treat over 1,000 conditions, outline care options, prescribe* medication, and order labs or imaging when appropriate—all through the convenience of a mobile app.

Key Features:

  • Audio, video, and Spanish translation support available as needed
  • Access to care plans and lab results directly within the app
  • Referrals to in-network resources and specialists
  • Care is available in all 50 states and Washington D.C.
  • 24/7/365 access with an average wait time of under 2 minutes—no appointment required.

Available to enrolled Banner|Aetna members and covered dependents age 1+* in an eligible plan.

Cost: Low-to-no-cost per visit*, depending on plan details.

*FOR ENROLLED MEMBERS AND COVERED DEPENDENTS AGE 1+: 98point6 by Transcarent is available to members age 1-17 when an adult parent or guardian is also enrolled in the plan. Access to 98point6 by Transcarent is not included in all plans.

*FOR LOW-TO-NO-COST WITH 98POINT6 BY TRANSCARENT: Members enrolled in a health savings account (HSA) or qualified high-deductible health plan (HDHP) must pay the applicable cost-share for virtual care visit until their deductible is met, after which services will be provided at no cost-share. All other health plan members pay $0 per virtual care visit regardless of whether their deductible has been met. Please refer to your plan documents for your applicable cost-share amounts.

*FOR 98POINT6 BY TRANSCARENT PRESCRIBING: 98point6 by Transcarent providers do not prescribe controlled substances (such as opioids), lifestyle medications (such as Viagra and Propecia) or weight loss medications (Wegovy or Ozempic). 98point6 by Transcarent and Transcarent Clinic clinicians are independent contractors and are neither agents nor employees of Banner|Aetna or plans administered by Banner|Aetna, and does not guarantee that a prescription will be written. Transcarent Clinic providers will not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. Clinicians reserve the right to deny care for potential misuse of services

This material is for information only. An application must be completed to obtain coverage. Rates and benefits vary by location. Providers are independent contractors and are not agents of Banner|Aetna. Provider participation may change without notice.

Health insurance plans contain exclusions and limitations.