Aetna vs. Anthem Insurance: Everything You Need to Know

Aetna ranked higher for policyholder experience but Anthem has its strengths, too. Find out how each company compares in availability, network size and more.

Compare Health Insurance Rates in Your Area

After comparing Aetna, a CVS Health company, and Anthem, we’ve determined that Aetna is the superior option because health plans are available in more states and studies suggest that Aetna offers a better member experience. Anthem is still a strong contender since members can access the largest U.S. health insurance provider network, thanks to Anthem’s subsidiary status under the Blue Cross Blue Shield Association.

Keep reading to see which company offers the best health insurance plan for you.

Note: Anthem rebranded to Elevance Health, as of June 2022. We will still refer to the company as Anthem throughout the article.

Aetna Vs Anthem: Quick Glance

Comparison

Aetna

Anthem

Plan Structures

HMO, PPO, CDHP, EPO, FSA, HMO-POS, Indemnity, HSA, Medicaid, Medicare, POS

HMO, PPO, CDHP, EPO, FSA, HMO-POS, Indemnity, HSA, Medicaid, Medicare, POS

Availability

50 states

14 states (varies by plan type)

Coverage Limit

Varies

Varies

Deductible

Varies

Varies

Maximum Annual Benefit

Varies

Varies

Waiting Period

Varies

Varies

Providers In-Network

1.2 million

1.7 million

Covers Telehealth

Available in all states except New Jersey and North Carolina

Yes

Policy Management

Mobile app, online account, phone

Mobile app, online account, phone

Aetna Pros and Cons

Pros

Cons

Network of 1.2 million providers

Medicare Advantage Plans unavailable in some states

Score higher for overall customer satisfaction for commercial health and Medicare Advantage plans

Slightly smaller network than Anthem

Mental health televideo services available in all 50 states

 

>> Click here to read our full review of Aetna.

Anthem Pros and Cons

Pros

Cons

Leverages Blue Cross Blue Shield Association network of 1.7 million healthcare providers

Availability in only 14 states (fewer states for some plans)

Confusing subsidiary names

 

>> Click here to read our full review of Anthem.

Get Health Insurance Quotes From Top Carriers

Aetna Vs Anthem: Plan Structures

The selection of plan structures available is similar for Aetna and Anthem. Whether you’re buying an individual or family plan through the health insurance marketplace or switching to a Medicare Advantage plan, Aetna or Anthem can provide the coverage you’re seeking. However, availability can be a concern with Anthem.

Plan

Aetna

Anthem

Individual & Family

Medicare Advantage

Medicaid

Dental

Vision

Employer Group

Aetna Vs Anthem: Plan Availability

Aetna easily outperforms Anthem in availability. Aetna sells Medicare Advantage plans in select counties throughout all 50 states, plus the District of Columbia, whereas Anthem serves only 14 states.

Consumers can purchase an Anthem individual/family plan or Medicare Advantage plans in the following 14 states.

  • California
  • Connecticut
  • Indiana
  • Maine
  • New Hampshire
  • New York
  • Virginia
  • Colorado
  • Georgia
  • Kentucky
  • Missouri
  • Nevada
  • Ohio
  • Wisconsin

Medicaid coverage through Anthem is even more limited. Anthem serves Medicaid members in only seven states:

  • Indiana
  • Kentucky
  • Virginia
  • Nevada
  • Wisconsin
  • California
  • New York

Keep in mind that Anthem health plans may be available in your state but will not always carry “Anthem” in the name. For example, Anthem underwrites policies in Nevada as Rocky Mountain Hospital and Medical Service, Inc. or HMO Colorado, Inc. In Ohio, Anthem plans are sold by Community Insurance Company.

Anthem’s availability is limited but consumers should remember that Anthem is a subsidiary of the larger Blue Cross Blue Shield (BCBS) Association, which sells health plans nationwide. If Anthem is unavailable in your state, you may find a BCBS health plan.

AetnaVs Anthem: In-Network Providers

Anthem wins when it comes to provider network size. As a subsidiary of the giant BCBS Association, Anthem customers have access to more than 1.7 million doctors and hospitals nationwide.

Don’t think Aetna’s network is small, however. Aetna’s group of healthcare providers holds 1.2 million healthcare providers and over 5,700 hospitals.

Aetna Vs Anthem: Cost

Average costs can vary by company and plan since different people have different health histories and coverage needs. When calculating your premiums, your health insurance company will consider the following rating factors:

  • Age
  • Health habits (e.g., smoking, drinking)
  • State
  • Deductible
  • Health plan
  • Health insurance company

Costs will also depend on your plan category or tier. Both Aetna and Anthem use the conventional categories of bronze, silver and gold.

  • Bronze: Plan with a low monthly premium, but higher out-of-pocket costs (e.g., deductible, copay, coinsurance).
  • Silver: Plan with average monthly payments. Out-of-pocket costs are lower than a bronze plan but higher than a gold plan.
  • Gold: Plan with higher monthly payments, but lower out-of-pocket costs.

Aetna Vs Anthem: Coverage Limits

Similar to policy costs, cover limits will also vary since each individual has their own health concerns, budget and coverage needs. For example, a young and relatively healthy person may want to buy a health plan with a low monthly premium and higher out-of-pocket costs because they don’t visit the doctor often and can save on copays.

We recommend reviewing your health history and talking to your health insurance provider to customize your policy to meet your needs.

Aetna Vs Anthem: Policy Management

Aetna and Anthem both allow members to manage their policies via online portal, mobile app or by calling a representative. If you want to skip hold times, the online portal function and mobile app let consumers:

  • Find doctors
  • Review their coverage
  • Track spending
  • Compare costs
  • Manage claims

Aetna and Anthem offer a mobile app for policy management and a separate app solely for Medicaid plans. Anthem’s mobile app for policy management is called Sydney Health on Google Play and the Apple App Store.

As for the consumer experience for each company’s mobile app, Aetna and Anthem were rated similarly. The only exception is the less-than-favorable average rating for the Aetna Medicaid app on the Apple App store.

Company

Google Play Rating

Apple App Store Rating

Aetna

4.6/5

3.3/5 (app for Medicaid users only)

4.6/5

1.8/5 (Medicaid)

Anthem

4.8/5

4.7/5 (Medicaid)

4.8/5

4.7/5 (Medicaid)

Aetna Vs Anthem: Medical Loss Ratio

Established under the Affordable Care Act, the medical loss ratio (MLR) requires that health insurance companies spend 80% to 85% of customer premiums on improving medical care quality. Companies are required to refund the difference via rebates to their customers if spending does not meet this minimum threshold.

Aetna has not announced any MLR rebates to be issued in 2022. In 2021, Aetna issued MLR rebates for group health insurance plans in the District of Columbia, plus several states:

  • Arizona
  • Florida
  • Kansas
  • Louisiana
  • Maryland
  • Mississippi
  • Nevada
  • North Carolina
  • Ohio
  • Oklahoma
  • Texas
  • Virginia
  • Washington

Anthem recently announced that MLR rebates will be issued for the year 2020 in 13 states:

  • California
  • Colorado
  • Connecticut
  • Georgia
  • Indiana
  • Kentucky
  • Maine
  • Missouri
  • Nevada
  • New Hampshire
  • New York
  • Ohio
  • Wisconsin

Aetna Vs Anthem: Enrollment Process

Consumers can enroll for an Aetna or Anthem health insurance plan during ACA open enrollment from November 1, 2022 to January 15, 2023.

If you’re shopping for a Medicare Advantage plan, you can sign up during two different enrollment periods each year.

October 15–December 7

  • Switch from Original Medicare to an MA plan
  • Switch from one MA plan to another MA plan
  • Join a Medicare drug plan or switch to another Medicare drug plan
  • Drop Medicare drug coverage completely

January 1–March 31

  • Switch from one MA plan to another MA plan
  • Drop your MA plan and return to Original Medicare

Enrolling in a health plan is still possible outside the specified enrollment periods, but only if you’ve recently experienced a qualifying event, such as:

  • Change in marital status
  • Having or adopting a child
  • Moving to a new address
  • Losing health coverage
  • Change in employment status
  • Death of someone who shares your health plan
  • Household income falls below the federal poverty level
  • Becoming a U.S. citizen

Aetna Vs Anthem: Policyholder Experience

Customer satisfaction analyses and consumer reviews signal that Aetna offers a more favorable policyholder experience than Anthem.

Aetna scored higher than Anthem for overall customer satisfaction for commercial group health plans. A 2022 study of commercial health plans by J.D. Power rated health insurance companies across multiple regions based on billing and payment, cost, coverage and benefits, customer service, communication and provider choice. Aetna ranked among the top companies in more regions than the Anthem brand. In the regions where both companies made the list, Aetna scored higher more frequently.

Aetna ranked higher than Anthem for MA plans, as well. In a 2022 study of MA plans by J.D. Power that ranked companies on a 1,000-point scale, Aetna (796) scored higher than Anthem (791). This study used the same evaluation criteria as the commercial member health study mentioned above.

SmartFinancial looked at consumer reviews across different rating platforms and found that Aetna was received more favorably.

Company

Aetna

Anthem

Consumer Affairs

3.95/5

3.2/5

BestCompany

3.0/5

1.5/5

BBB

1.05/5

N/A

Get Health Insurance Quotes From Top Carriers

How To File Claims With Aetna and Anthem

In-network providers will usually file claims with your insurance company on your behalf without you needing to take any action. However, there are some cases where you may have to pay out of pocket, such as when you see a provider outside your network or if the facility charges you upfront. To learn more about filing a claim for reimbursement from Aetna or Anthem, you can call the number on your health insurance card.

Aetna makes it simple for members to file a claim electronically. Anthem members will need to request a reimbursement claim form or download it from their forms library and follow the instructions for filing the paperwork.

Aetna History

In 1850, Aetna Insurance Company created a fund to sell life insurance. In 1953, the life and health divisions of Aetna separated. The company’s first president was Eliphalet A. Bulkeley took the name “Aetna” from an 11,000-foot volcano in Sicily, Italy, the most active volcano in Europe.

Anthem History

In 2004, WellPoint Health Networks Inc and Anthem, Inc. merged and became the nation’s leading health benefits company. In December 2014, WellPoint Inc. changed its corporate name to Anthem, Inc. Anthem companies offer health insurance plans and related services like dental, vision, behavioral health, life insurance and disability insurance benefits as well as long-term care insurance and flexible spending accounts. Anthem has about 40 million members and is ranked 33rd on the Fortune 500.

FAQs

Is Aetna a good plan?

Aetna was ranked among the best health insurance companies for overall customer satisfaction for commercial health insurance plans and Medicare Advantage plans in multiple regions according to 2022 J.D. Power studies.

Is Anthem the same as Blue Cross?

Anthem is a subsidiary of the Blue Cross Blue Shield Association. In some locations, you may see both companies listed in the company name, such as “Anthem Blue Cross in Colorado.”

Is Aetna a good Medicare provider?

In a 2022 J.D. Power study of Medicare Advantage providers, Aetna ranked 796 out of 1,000 for overall customer satisfaction, which is a couple of points below the industry average (809).

Key Takeaways

  • Aetna offers various health plans nationwide, while Anthem individual, family and Medicare Advantage plans in only 14 states.
  • As a subsidiary of the Blue Cross Blue Shield Association, Anthem’s network of 1.7 million providers is larger than Aetna’s network.
  • Anthem ranked higher in overall customer satisfaction and average consumer ratings.

Find health insurance at an affordable price. SmartFinancial makes it easy to find the best health plan within your budget. Just enter your zip code below or call 855.214.2291 to receive your free health insurance quotes in minutes.

Sources

Get a Free Health Insurance Quote Online Now.

health

Looking for Health Insurance?

Compare rates from dozens of companies in less than 3 minutes.

Compare Health Insurance Rates for Free

Answer a few questions and let Penny find the best rates in your area.