Aetna vs. Anthem Insurance

Aetna and Anthem are similar in many ways, as both health insurance companies have expansive networks, a large number of available plan structures and top customer satisfaction ratings in a select few regions. The main thing separating them is their availability, with Aetna operating throughout the entire country, while Anthem plans are only available in 14 states.

As a result, Aetna is likely to be the right pick for a greater number of people than Anthem, although either insurer could be a solid fit for you if you live in one of the states where both companies sell health insurance coverage.

Read on to see more Aetna vs. Anthem comparisons and to get a closer look at what each health insurance carrier has to offer.

Aetna History

Aetna started off selling fire and life insurance policies in the early 1800s and then added health insurance plans toward the turn of the century. The company has made its mark on several notable moments in United States history including writing life insurance policies for the first seven American astronauts in 1963.^[1]

Aetna also boasts several firsts for the United States health insurance industry such as paying out the first Medicare claim in 1966.^[1] In 2018, Aetna became part of CVS Health following an acquisition worth nearly $80 billion.^[2]

Click here to read our full Aetna review.

Anthem History

While it has existed under many different names, Anthem has been providing health insurance coverage in the United States since the 1940s. Anthem Insurance Company merged with WellPoint Health Networks in 2004 to form WellPoint, Inc. However, in 2014, the corporation reverted its name to Anthem, Inc.^[3]

Then, the company changed its name again in 2022 and remains Elevance Health to this day, although it still sells health plans under the Anthem Blue Cross Blue Shield brand name.^[4] As of 2019, Anthem is the largest of all the for-profit managed health care companies that are part of the Blue Cross Blue Shield Association.^[3]

Click here to read our full Anthem review.

Aetna vs. Anthem: A Quick Glance

Aetna Pros and Cons

Anthem Pros and Cons

Aetna vs. Anthem: Plan Structures

Aetna and Anthem both broadly offer the same kinds of major medical and supplemental health insurance plans, so you may be able to treat either company as a one-stop shop for all of your health coverage needs in certain service areas.

Aetna vs. Anthem: Plan Availability

Aetna has a sizable advantage over Anthem when it comes to availability because Aetna operates in all 50 states and the District of Columbia. However, keep in mind that not all of Aetna’s coverage types are available throughout the entire nation. For example, Aetna sells Medicare Part D plans in all of its service areas but only offers Medicaid plans in 16 states.^[5][6]

In contrast, Anthem does not sell coverage outside of the following 14 states:^[7]

 

Aetna vs. Anthem: In-Network Providers

Although Aetna and Anthem both have exceptionally large networks, Anthem has about half a million more in-network providers than Aetna. Since it is part of the Blue Cross Blue Shield Association, Anthem’s network includes over 1.7 million doctors and hospitals.^[8] Meanwhile, Aetna’s network includes over 5,700 hospitals, over 700,000 primary care physicians and specialists and a grand total of around 1.2 million health care providers overall as of 2021.^[9]

Aetna vs. Anthem: Cost

Health insurance costs can vary dramatically based on your circumstances, so you may want to collect quotes directly from Aetna and Anthem to figure out which insurance provider would be cheaper for you. In general, Marketplace benchmark plans cost $477 per month and Medicare Advantage plans cost $18.50 per month on average in 2024.^[10][11]

When you shop for coverage through the Health Insurance Marketplace or your state’s equivalent exchange, your premiums will be based solely on the following five factors:^[12]

• Age
• Location
• Tobacco use
• Whether you have an individual or family plan
• Plan category

Aetna vs. Anthem: Coverage Limits

Similarly, it is difficult to pinpoint an average coverage limit among all plans from either Aetna or Anthem. Nevertheless, you should note that, under the Affordable Care Act (ACA), health insurance companies cannot place annual or lifetime limits on the following essential health benefits:^[13][14]

• Ambulatory patient services
• Emergency services
• Hospitalization
• Pregnancy, maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services (including dental and vision care for children)

Aetna vs. Anthem: Policy Management

Regardless of whether you opt for Aetna or Anthem, you’ll be able to manage your health insurance policy via phone call, online portal or mobile app. The insurers’ mobile apps come with many features, allowing you to pull up your identification card, track your deductible, access telehealth and more.

Both the Aetna Health app and Anthem’s Sydney Health app have received outstanding ratings across thousands of online reviews. That said, Aetna’s Medicaid plan members have apparently encountered more difficulty using the Aetna Better Health app, leading to worse ratings across a smaller number of reviews than the core Aetna Health app.

Aetna vs. Anthem: Medical Loss Ratio

The ACA requires all insurance companies that sell individual or small group health insurance to maintain a medical loss ratio (MLR) of 80% or higher, meaning they must spend at least 80% of the revenue they collect from premiums on covering health care or otherwise improving the customer experience for their policyholders. Insurers who sell large group health insurance are held to an even higher standard, with a mandatory minimum MLR of 85%.^[21]

At the end of each year, insurance carriers are required to pay out rebates to policyholders in affected markets if they have failed to meet these MLR standards on average across the previous three years.^[21]

Aetna has not officially reported any MLR rebates for 2024 and its parent company, CVS Health, finished 2023 with a three-year rolling average MLR of 85%.^[22][23] That said, Aetna is expected to pay out MLR rebates in Maine this year, according to a document filed by the state’s Bureau of Insurance.^[24] Meanwhile, Elevance Health has comfortably exceeded federal MLR requirements, with a three-year rolling average of 87.3% as of the end of 2023.^[25][26][27]

Aetna vs. Anthem: Enrollment Process

If you would like to sign up for an Aetna or Anthem health plan through the Health Insurance Marketplace, you must generally do so during open enrollment, which lasts from November 1 to January 15 in most states.^[28] However, you should keep the following Medicare open enrollment dates in mind instead if you are interested in buying a Medicare Advantage plan:^[29]

Even outside of these periods, you can still enroll in a new health plan if you become eligible for a special enrollment period due to a qualifying life event like the following:^[30]

• Getting married, divorced or separated
• Giving birth to or adopting a child
• Changing or losing your job
• Moving to a new home
• Losing your existing health coverage due to the death of a family member
• Aging out of your parents’ health plan by turning 26
• Becoming a United States citizen
• Leaving prison

Aetna vs. Anthem: Policyholder Experience

Aetna has slightly higher customer satisfaction ratings than Anthem on online review platforms like Best Company and the Better Business Bureau, although neither company is particularly well-reviewed across the board. Nevertheless, a 2024 study from J.D. Power indicates that Aetna is the best-rated commercial health insurer in Ohio and the East South Central region, while Anthem is the top carrier in Colorado and the Northeast region.^[31]

How To File Claims With Aetna and Anthem

Aetna and Anthem both allow plan members to submit insurance claim forms online, although you should note that you will likely only need to file a claim yourself if you receive care out of network.^[36][37] In-network providers will usually file a claim for you.