Aetna vs. Anthem Insurance: Everything You Need to Know

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.

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.

Get Personalized Health Insurance Quotes Here

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

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.

Get Personalized Health Insurance Quotes Here

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

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• Aetna. "2021 MLR Experience year Rebate Pools." Accessed Oct. 14, 2022.
• Beere & Purves. "Anthem Provides Update on 2021 MLR Rebates." Accessed Oct. 14, 2022.
• JD Power "2022 U.S. Commercial Member Health Plan Study," Pages 2-25. Accessed Oct. 14, 2022.
• JD Power. "2022 U.S. Medicare Advantage Study." Accessed Oct. 14, 2022.
• ConsumerAffairs. “Aetna Health Insurance.” Accessed Oct. 14, 2022.
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