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Memorial Hermann ACO Medical Plan Explained
There are two Memorial Hermann plan options
The Basic plan offers lower premiums each month but has higher deductible and co–insurance amounts. This means you will pay more when you need health care. If you don’t visit the doctor often and use the plan mostly for preventive care, the Basic option maybe right for you.
The Plus plan has higher premiums than the Basic plan, but the deductible and coinsurance amounts are lower. This means more of your expenses will be covered when you need care. If you think you will visit the doctor often and need more care, the Plus option may be right for you.
Important: The Memorial Hermann ACO plan pays benefits ONLY when you receive care from the Memorial Hermann ACO network providers. If you seek care outside the network, you will pay the full cost of care out of your own pocket.
Both plan options include prescription drug benefits administered by Express Scripts. You meet a separate prescription drug deductible each year and then pay the appropriate copay for your prescriptions.
The Memorial Hermann ACO network
The Memorial Hermann ACO network is a healthcare system with:
- More than 700 primary care doctors
- More than 3,000 specialists
- 12 acute care hospitals
- 62 walk-in clinics
- 86 urgent care centers
Memorial Hermann physician groups and hospitals are located in and around Houston and surrounding areas.
MEMORIAL HERMAN ACO MEDICAL PLAN COMPARISON
- Kelsey ACO PCP and specialist copays do not count toward the annual deductible but do apply toward the annual out-of-pocket maximum
- Free if you are enrolled in an HISD medical plan
- Pre-certification may be required
- OBGYN Specialists are tiered.
- Copay applies after pharmacy deductible has been met
- Preventive services are not subject to the deductible
- The copays in the Kelsey plans are not subject to the deductible
If footnote is not shown on this chart it does not apply to this plan option.
For Memorial Hermann's Phased Approach to Safely Resume Elective Services view this PDF
Quality and Value from Memorial Hermann
How to Find an In-Network Provider in the Memorial Hermann ACO Medical Plan
To find a Memorial Hermann provider, click here >
Who is Memorial Hermann?
- 110-year-old, not-for-profit, community-owned health system
- 320+ unique sites of care
- 2.3 million annual patient encounters
- 3,200 clinically integrated providers through Memorial Hermann Accountable Care Organization
- Largest PCP network in Houston
- Over 26,000 employees
- Donates more to the United Way than all other healthcare providers in Houston area combined
Memorial Hermann Accountable Care Network coverage area map >
Focus on providing convenient physical and virtual care options. Different levels and types of care to promote appropriate usage based on individual needs. Everyday Well delivers secure access to your health care anytime, anywhere. Easily access Everyday Well on your computer, tablet, and smart phone with the Everyday Well app or by visiting EverydayWell.com.
Experience Everyday Well online or download the app on Google Play and App Store
Everyday Well offerings:
- Primary Care
- Convenient Care Center
- Urgent Care
- 24-hour ER
- Virtual Care
- House Calls
- Nurse Health Line
Everyday Well FAQ's
How can I join Everyday Well?
Do I have to be a Memorial Hermann patient to use Everyday Well?
How do I log in to the Everyday Well site?
Who do I call for help with Everyday Well?
Memorial Hermann Care Management Team
Multidisciplinary care team provides personalized care plans – including care coordination, navigation, social work, and health coaching – for patients in the ACO identified as at high risk for experiencing adverse health outcomes by our risk stratification tools, including those with:
- Complex chronic conditions
- Multiple hospital admissions or re-admissions
- Multiple ER visits
- Increased utilization of healthcare services
- Referrals from primary care providers
- Complex pharmacy needs
- High risk transitions between care sites
Aetna Whole Health - Memorial Hermann Accountable Care Network plans
Memorial Hermann Accountable Care Network plans are a new way of looking at health care. We’ve designed these health benefits and insurance plans to improve the quality of your care, provide a better experience for you and your family, and save you money. You’ll have access to a special network of primary care doctors, specialists and hospitals focused on you. Led by a primary care doctor you choose, your care team will work with you to:
- Help keep you healthy or improve your health, not just treating you when you’re sick or injured
- Better coordinate your care and keep tabs on your prescriptions, lab results, health history, and more
- Spot problems and build personalized care plans to treat you
- Encourage you to play an active and informed role in your health and health care decisions
Aetna Whole Health FAQ's
How are the Aetna Whole Health — Memorial Hermann Accountable Care Network plans different from other plans?
How does it work?
Why should I choose a primary care doctor when I enroll?
How do I find a primary care doctor?
Do I need to see my primary care doctor for referrals?
How can I manage my health care on the go?
How can I get the Aetna Mobile app?
What if I’m not at home and need care?
How can I use my benefits effectively?
What if I’m in the middle of care or treatment with a doctor outside the Aetna Whole Health — Memorial Hermann Accountable Care Network?