I can attest to the fact that Aetna does cover flu shots now.

Flu shots are required to be covered in all U.S. insurance per the ACA. The point was that Aetna was requiring the more expensive (for them!) visit to a doctor's office for them to cover it and wouldn't cover it happening at a pharmacy.

When I had Atena they did cover pharmacy flu shot but only at one specific pharmacy. It's been years but if my memory serves right think I had to go to CVS to get the flu shot rather than my usual Walgreens.

The ACA states that your insurance provider must spend 80% of their premiums on health care. The doctor is more expensive, so the health insurance provider is allowed to keep more nominal dollars.

Although true, I doubt that's the reason since stuff like this was common pre-ACA.

The truth is that everything that a payer pays for is done through contracts. Payers will often default to a specific provider because the contract covers it and they don't have a contract for other providers.

In terms of the cost, back-end rebates often bring it down. Also, this particular contract may cost more for a flu shot, but save them even more for other procedures.

probably not more expensive for them... to go to your doctors office, you need to make an appointment, take time off work, etc.

To go to a pharmacy, you can stop by on your way home or do it on the weekend.

By making it inconvenient, you reduce the number of people getting a flu shot... and I would bet that more people drop out from the inconvenience, than the extra amount it costs aetna when you go to the doctors office.

But if just one of the people insured by Aetna ended up in the hospital due to complications from the flu due to not getting a flu shot, the amount of money they'd have to pay for the hospital stay would pay for hundreds of flu shots.

The insurance provider doesn't care how much it costs. The ACA states that the insurance provider must spend 80% on services. So as far as they're concerned, the higher the costs of healthcare the more money they get to keep. They just can't let costs skyrocket faster than they're able to increase your premiums.

The market is a horrible contrivance, and insurance is fundamentally unworkable in a market, unlike actual services and products where you know what you're getting and when you'll need it…

But that said, do you have even the tiniest bit of evidence that insurers actually do what you're saying in order to keep their costs up per ACA requirements??

There's all sorts of shenanigans in the industry, but your speculation sounds far-fetched. Remember Hanlon's Razor…

Occam's razor is a better fit here. In a world where they have to return any cost savings to the insured, what is the incentive to reduce costs?

In theory, competitive rate setting for premiums. Hasn't worked out that way in many places though.

This is the fundamental flaw in the ACA. It did nothing to increase competition. In fact, increased regulation pushed some competitors out of the market. I can't tell whether this was a fool's errand or an intentional destruction of the market, pushing us towards socialization.

I'm sure Atena has/had a ton of different plans (especially in different states). Theres PPOs, HMOs, POSes, EPOs, high deductible, etc. so any general comments about what Atena does and doesn't cover won't always apply.

And I do like that the pharmacy is next to the docs office.