Meritain Health Insurance Review, Pros and Cons, Coverage, How to Apply

Choosing the right health insurance plan is an important decision that requires careful consideration of your needs, budget, and the coverage options available. Meritain Health is a private health insurance company that provides group and individual health plans to employers and employees across the United States.

In this comprehensive review, we’ll provide an overview of Meritain Health insurance, including the pros and cons, types of plans offered, cost, how to enroll, and what current customers have to say about their experiences. Read on for everything you need to know to decide if Meritain Health is the right health insurance provider for you.

About Meritain Health Insurance

Meritain Health is a nationwide health insurance company that offers group and individual health plans, along with other products like dental, vision, life, disability, and supplemental insurance. They provide coverage to over 2.6 million members across the United States.

Meritain Health was founded in the 1970s and was formerly known as Aetna Financial Services. The company was acquired by Aetna in the 1990s. In 2019, Meritain Health became an independent company after being acquired by Equian, a health analytics company.

Meritain Health insurance plans are available to both large and small employers. They do not offer plans on the Health Insurance Marketplace exchange. Instead, you must have coverage through an employer that uses Meritain Health or directly purchase an individual plan from them.

Pros and Cons of Meritain Health Insurance

Pros of Meritain Health Insurance

• Large Provider Network: Meritain Health offers access to one of the largest provider networks in the U.S. This makes it easy to find doctors and facilities that accept your plan.
• National Coverage: They provide coverage in all 50 states, making it a good option for employers with locations across the country.
• Customizable Plans: Employers can choose from a range of plan types and coverage options to build a plan that fits their budget and benefits needs. This includes HMOs, PPOs, HSAs, HRAs, and more.
• Member Resources: Meritain Health offers online resources to help members search for providers, view claims, access wellness tools, and more through their member portal.
• Strong Financial Backing: Previously being owned by Aetna provided financial stability. Their acquisition by Equian also lends financial support.

Cons of Meritain Health Insurance

• No Individual Plans on Exchanges: Meritain Health does not offer plans on the government health insurance exchanges. You must buy an individual plan directly.
• Pre-Authorization Required for Some Services: Some plans may require you to get pre-approval for certain medical services in order for them to be covered. This can delay care in some cases.
• Prior Claim Issues: Some customers have complained about claims being denied or inaccurate bills being sent after care. However, the company has worked to improve processes.
• No Rating from Accreditors: Meritain Health insurance plans are not rated or accredited by groups like JD Power, NCQA, BBB, etc. Making comparisons can be difficult.

Limited Plan Information Online: Specific details on health plans like deductibles, copays, etc. are not readily available online without logging in or contacting them.

Plans and Coverage Offered by Meritain Health Insurance

Meritain Health offers a range of group and individual health insurance plans with options to customize coverage and features. Here are some of the main plans offered:

• HMO Plans – With a Health Maintenance Organization (HMO) plan from Meritain Health, you select a primary care provider who coordinates your care and refers you to specialists in their network. Out-of-network care is usually not covered except in emergencies. HMOs offer lower premiums but less flexibility.
• PPO Plans – A Preferred Provider Organization (PPO) plan allows you to see any provider without referrals. You pay less when you use in-network providers and more for out-of-network care. PPOs have higher premiums but more flexibility.
• POS Plans – POS plans are similar to PPOs. They pay some benefits for out-of-network care but generally cover in-network care only after you meet a deductible. Your copays and coinsurance is usually lower when you stay in-network.
• HSA Plans – These high deductible health plans can be paired with a health savings account (HSA) to allow pre-tax savings for medical costs. The plans cover services after you pay the full deductible unless required preventive care.
• FSA/HRA Options – Many Meritain Health plans allow you to pair coverage with flexible spending accounts (FSA) or health reimbursement arrangements (HRA) funded by your employer to save on out-of-pocket costs.

Meritain Health plans cover all of the essential health benefits required by law, including preventive services, mental health services, prescription drugs, and more. They have options to add dental, vision, life insurance, short-term disability, and other supplemental plans.

How to Apply for Meritain Health Insurance

Since Meritain Health does not offer plans on the health insurance exchanges, you cannot directly enroll in coverage as an individual. Here are the main ways to get Meritain Health insurance:

• Through an Employer – The most common way to enroll is by signing up for a group plan offered by your employer. You can select coverage options and add dependents during open enrollment periods.
• Short-Term Plans – In some states, Meritain Health sells short-term health insurance plans that offer temporary coverage for 3-12 months. This requires an application and underwriting.
• COBRA – If you lose employer coverage, you may be eligible to keep your Meritain Health plan for 18-36 months under COBRA. You pay the full premium cost.
• Student Plans – Some colleges and universities provide Meritain Health plans to students. Check with your school to see if they offer coverage options.
• Direct Purchase – In some states, you may be able to directly buy an individual major medical health plan from Meritain Health without employer sponsorship.

Be sure to contact Meritain Health directly or speak with your employer’s benefits administrator to learn about your options and how to enroll if eligible. Individual plan availability varies by state.

Meritain Health Insurance Reviews and Customer Satisfaction

Meritain Health insurance gets mixed reviews from customers online. Here is an overview of what current and past members say about their policies:

Positive Feedback

• Large provider networks make finding in-network doctors easy
• Responsive customer service representatives
• Easy to use online portal and mobile app
• Good options for employer group plans

Negative Feedback

• Claims denied unexpectedly resulting in high out-of-pocket costs
• Billing errors and problems reaching resolution
• Pre-authorization requirements delaying care
• Lack of plan details and transparency online
• Difficulty resolving issues with providers being out-of-network unexpectedly

While experiences vary, many of the negative reviews are from several years ago. Recent reviews indicate Meritain Health has improved its claims processing accuracy and customer service response times. But some issues remain around surprise out-of-network bills and pre-authorization delays according to customers.

It’s a good idea to carefully evaluate your plan details if considering Meritain Health insurance. Check to make sure your preferred providers are in-network and understand the pre-authorization rules to avoid unexpected costs.

Meritain Health Insurance Alternatives

Meritain Health is one of many nationwide providers of group and individual health insurance. Here are some top alternatives to consider:

• Aetna – Offers plans directly to individuals and employers, with broad provider networks and features like telehealth and wellness programs.
• UnitedHealthcare – The largest health insurer in the U.S. with plans available through employers or individual exchanges. Known for tools to estimate costs.
• Cigna – Provides health plans to employers and individuals with a focus on whole-person health and wellness incentives.
• Humana – Focuses coverage on small businesses and individuals including Medicare Advantage and Part D prescription plans. Strong online resources.
• Blue Cross Blue Shield – Offers many employer-sponsored and individual health plans with one of the largest provider networks. Availability varies by state.

When comparing options, look at monthly premium costs, deductibles, coinsurance rates, copays for services, and provider network access in your area. Consider perks like wellness programs and telehealth access. Enrollment options will depend on your situation.

Conclusion

Meritain Health insurance provides group and individual health coverage to millions of Americans through employer-sponsored plans or direct purchase in some states. The pros include large provider networks and customizable group plan options for employers. Downsides exist around unexpected claim denials and billing issues, though reviews indicate some recent improvements.

Ultimately whether Meritain Health is the right health insurance provider for you depends on your specific coverage needs, budget, and plan availability in your state and county. Compare all options including employer plans, Marketplace plans, and alternatives like those mentioned above. Thoroughly review benefits details before enrolling to ensure you understand your coverage and out-of-pocket costs.