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About Innovation Health
Innovation Health is a recent partnership between Inova, a large health care system in northern Virginia, and Aetna, one of the largest health insurance companies in the U.S. The system was launched in 2012 in the hopes of creating a connection between the insurance company and the providers to keep medical costs down on all sides.
Inova traces its roots back to the 1950s when a community hospital was opened in Fairfax Falls, VA. The hospital grew into a health care system comprising several facilities under the name Fairfax Hospital Association. The Association officially changed its name to Inova Hospitals in 1991.
Aetna is a hundred years older than Inova, going back to the 1850s when it was founded as a life insurance company. In the 1990s, Aetna began to shift towards health insurance, buying out several large companies. Today they are one of the largest healthcare companies in the nation, and a Fortune 500 company ranked at number 43 for 2017. They offer a wide variety of insurance plans including individual and family plans, group plans, and Medicare.
Innovation Health was launched in 2012. It is a system that offers incentives to the insurance company as well as the provider to ensure costs are kept low and members get affordable insurance options with access to the Inova provider network. Plans are not quite HMO but are strongly focused on obtaining in network care from the Inova providers. They have a selection of plans available for individuals and for groups.
Innovation Health Plans
The Innovation Health website does not provide detailed plan information without going through the quoting process. Since it was not open enrollment time when this review was prepared, the website also required that we enter a qualifying life event to apply for insurance out of the enrollment period.
For the purpose of accessing plan information and rates, we entered “loss of employer coverage” as a qualified event, and then requested information based on a 30-year-old in Fairfax County, Virginia.
The results returned seven plans, two of which are intended specifically for members with diabetes. One plan is specifically designed for people with mental health conditions. Plans come at all levels: catastrophic, bronze, silver, and gold.
The Leap Catastrophic plan has a $7,150 individual deductible and $14,300 family deductible in-network. These deductibles are also the out of pocket maximu so that in-network services are covered in full after they are met. Primary care visits have a $20 copay for the first four visits, and $0 after that, and do not require that the deductible be met first. All out-of-network care is covered at 50% after the $20,000 individual and $40,000 family out of network deductible is met. Prescription drugs are also covered at 100% after the deductible is met.
The Leap Bronze plan is very similar to the catastrophic plan. The deductibles are slightly lower at $7,050 individual and $14,100 family for in-network care, and again, deductibles are also the out of pocket maximum. Out-of-network the deductible is $20,000 individual and $40,000 family – in fact, this is true across the board on the Leap plans. Under this plan, nearly all services are paid out of pocket until the deductible is met, including all office visits. The prescription coverage offers a $5 copay for generic drugs, with all others covered at 100% after the deductible.
The Leap Silver Basic plan brings the in-network deductible down a little, to $6,075 individual and $12,150 family, which like the rest is also the out of pocket maximum. The out-of-network is the same as the other plans previously mentioned. Primary care visits have a $10 copay, specialist visits $0 after the deductible is met. Prescriptions are covered with the same copay as the Bronze plan.
The Leap Silver Diabetes plan is designed for those needing ongoing diabetes care. Deductibles are $6,300 individual and $12,600 family and are also the out of pocket maximum. Copays are $5 for primary care and $100 for specialist visits. Prescription coverage on this plan has lower costs to assist with diabetes treatment needs. Tier 1 prescriptions have a $5 copay, Tier 2 a $50 copay, while the remaining Tiers are covered at 100% after the deductible.
Leap Silver Plus has in-network deductibles of $5,050 individual and $10,100 family. Like all of the preceding plans, these are the out of pocket maximum for in-network care, and out-of-network is covered with the same deductibles and 50% coinsurance after deductible that all the plans offer. Copays are $5 for a primary care visit and $0 for specialists after the deductible. Prescriptions have the same coverage as the Silver Basic and Bronze plans.
Leap Silver Healthy Minds is a plan designed for those living with mental illness. Like the Diabetes plan, it offers better coverage for office visits and has the same copays as the Diabetes plan. Deductibles are a bit lower, however, at $5,600 individual and $11,200 family for in-network care. Again, these are also the out of pocket limits for this plan, and out-of-network care is the same as all other plans. Prescription drug coverage is the same as the Silver Basic and Bronze plans.
Surprisingly, our search returned only one Gold plan, and it is the Leap Gold Diabetes plan. This plan has the lowest deductibles at $2,835 individual and $5,670 family, however, unlike the other plans, that is not the out of pocket maximum for coverage. Out-of-network care is covered with the same deductibles and coinsurance as the other plans. The primary care copay is $5, and the specialist visit copay is $100. Prescription drugs are covered with a $5 copay for Tier 1, a $50 co pay for Tier 2, and $0 after deductible for Tier 3. There is a 50% coinsurance after deductible for specialty drugs.
Innovation Health Rates
Rates were returned along with the plan descriptions when we ran our request for plan information. The plans start at $181.06 for the Catastrophic plan based on the sample member information we entered. They rise steadily from there, up to the Gold Diabetes plan, which came in at $351.96.
Since this is a local provider with a limited coverage area, we are unable to offer a comparison to the rate quotes we usually run. The rates seem reasonable, but not the low cost we would expect from a plan that promises to work to drive down healthcare costs, a reduction that should be passed on to consumers. We are also surprised that the range of rates given the fact that, outside of the Gold plan, there is not a large drop in deductible amounts among all of the plans, and not a large difference in the copays, either. That begs the question of what members are really paying for with the pricier plans.
Since the health insurance company partners directly with the providers, we would expect that claims would be quick and relatively simple. As with most health insurance companies, there is little information regarding claims on the website, since they are processed directly.
Ratings and Consumer Reviews
Innovation Health does not currently have its own Better Business Bureau (BBB) page, and it is rare to find reviews of the system directly. This is partially due to the fact that this is a new partnership, and partially due to it being a partnership at all.
Reviews may appear about either Aetna or Inova that relate to Innovation Health, but it would not create an accurate picture to count all Aetna complaints against Innovation, nor to count all Inova complaints in the same way.
Looking at the BBB records for Inova leads to further complexity, as each hospital and medical center has its own page. We did pull the BBB file for Aetna to create a general picture of their reputation. They have an A+ rating with 609 complaints in the past three years, 212 of which have been closed the past 12 months. For a company with 22 million members, this is not a high complaint volume.
You can read our full review of Aetna here.
We will likely see more information on Innovation Health over time when the system is better established.
The Bottom Line
Innovation Health may be a good choice for those who do not mind a small network of providers and are ok with a plan that is heavy on paying towards the deductible rather than many different copays. The system is new and unique, and time will be needed to see if it really makes a difference in health care costs, particularly for members rather than just for the companies.
For a list of companies that we recommend, visit our Best Insurance Companies page.