Aetna vs. Blue Cross Blue Shield Insurance

After comparing Aetna and Blue Cross, we found that Blue Cross was slightly better than Aetna for its larger in-network size, availability and selection of health care plans. A study also found that Blue Cross ranked higher than average for customer satisfaction in multiple regions.

Aetna and Blue Cross are among the largest insurance companies with millions of members nationwide. By sharing the costs of hospital stays, doctor visits, prescription drugs and more, these two health care companies help individuals, families and employees access the necessary medical services needed to thrive.

Aetna vs. Blue Cross: Quick Glance

	Aetna	Blue Cross
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	50 states
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	Yes (not available in all states)	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	Slightly smaller network than Blue Cross
Excellent financial strength rating	Below average customer satisfaction rating in several regions in 2022 J.D. Power study
	Medicare Advantage Plans unavailable in some states

Click to read our full Aetna review.

Blue Cross Pros and Cons

Pros	Cons
Network of 1.7 million providers	Medicare Advantage Plans unavailable in some states
Above average customer satisfaction rating in most regions in 2022 J.D. Power study
Superior financial strength rating

Click to read our full Blue Cross review.

Aetna vs. Blue Cross: Plan Structures

Health plan structure selections are generally the same between Aetna and Blue Cross. Customers can choose HMO, PPO, POS or another type of plan, whether they sign with Aetna or Blue Cross. Vision and dental insurance are also available from both companies.

Each health insurance provider offers individual/family plans and group plans through employers. Aetna, however, only recently started selling individual and family plans but it is a hybrid-branded insurance product under Aetna and CVS health.

Plan	Aetna	Blue Cross Shield
Individual & Family	✓	✓
Medicare	✓	✓
Medicaid	✓	✓
Dental	✓	✓
Vision	✓	✓
Small Business	✓	✓

Aetna vs. Blue Cross: Plan Availability

Aetna and Blue Cross health insurance plans are sold in all 50 states plus Washington, D.C. However, some plans, coverages, costs and limits will vary by location.

For example, Medicare Advantage (MA) plans are not available in certain states. Aetna MA plans are sold in 46 of 50 states, plus Washington D.C. Blue Cross does not sell MA plans in the following states:

• Alaska
• Mississippi
• Wyoming

Standalone prescription drug coverage (Medicare Part D plans) are not sold by Blue Cross in the below states, either:

• Alaska
• Delaware
• Hawaii
• Louisiana
• Maryland
• Mississippi
• Oregon
• Washington

Aetna vs. Blue Cross: In-Network Providers

Aetna and Blue Cross each have a large provider network, which may lower costs by reducing the need for customers to seek medical service outside the plan network.

Aetna’s network extends to 1.2 million health care providers, which includes over 5,700 hospitals and over 700,000 primary care doctors and specialists. Blue Cross boasts an even larger network of 1.7 million healthcare providers.

Aetna vs. Blue Cross: Cost

Health insurance osts will vary for every individual since so many factors go into your premium, including:

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

Aetna vs. Blue Cross: Coverage Limits

Coverage limits will vary per policy, whether you buy a health plan through Aetna or Blue Cross. Different coverage limits will apply for a PPO plan versus an HMO plan but annual limits may also differ for tiers within the same policy type.

For example, a level one PPO plan may cover up to $15,000 for in-network services or up to $25,000 for a level two PPO plan with a $3,000 out-of-pocket maximum for either tier.

Similarly, a Blue Shield California Basic PPO plan may not even have an overall limit but it may enforce limits on specific services, like the number of physician office visits per year and daily dollar limits for hospital stays.

Therefore, choosing the right health plan that works with your current health condition and budget is essential.

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Aetna vs. Blue Cross: Policy Management

Aetna and Blue Cross members can manage their health insurance plans by mobile app, online portal or by speaking with a representative. To speak with an agent by phone, you will need to contact your local branch, which may have a different contact number and hours of operation.

The mobile app can be especially useful for managing your policy. With a swipes of your thumb, you can access the following actions:

• Compare costs
• Find doctors, hospitals, dentists, and other providers
• View status on open claims
• Track spending
• Compare costs and research drug prices
• Pay your bill

Aetna vs. Blue Cross: Medical Loss Ratio

Established under the 2010 Affordable Care Act, medical loss ratio (MLR) measures how much of customer premiums are used to improve the quality of care delivered. Insurance companies are generally required to spend at least 80% to 85% of premium dollars on medical care improvements. When MLRs fall short of 80%, the difference should be refunded in the form of a rebate, or partial refund to their customers.

For example, Blue Shield of California’s MLR was 79% in 2019 — just 1% shy of the minimum required 80%. Therefore, the insurance company will refund 1% of premiums ($35.2 million) in the form of rebates to its policyholders.

In 2020, Aetna issued rebates in the District of Columbia plus the below 13 states:

• California
• Georgia
• Kansas
• Kentucky
• Louisiana
• Maryland
• Mississippi
• Missouri
• Nevada
• North Carolina
• Texas
• Virginia
• Washington

Aetna vs. Blue Cross: Enrollment Process

 The open enrollment period for an individual or family plan for 2022 from Aetna or Blue Cross ended on January 15, 2022.

An exception to the enrollment period is if you recently experienced a qualifying event. If you were recently married, for example, then Aetna or Blue Cross may allow you to buy a health plan or edit your health insurance coverage outside the enrollment period.

Qualifying events typically include:

• Getting married or divorce
• Having or adopting a child
• Moving homes
• Losing health coverage (e.g., your spouse or domestic partner lost their job or died)
• Becoming a U.S. citizen
• Household income falling below the federal poverty level

Aetna vs. Blue Cross: Policyholder Experience

Aetna ranked above the region average in nine of 21 regions analyzed by J.D. Power in a 2022 U.S. Commercial Member Health Plan study. However, Aetna was placed below average or did not rank at all in over half the regions analyzed, including:

• California
• Colorado
• East South Central
• Heartland
• Mountain

In the same study, Blue Cross fared better than Aetna and ranked highest in 12 of the 21 regions analyzed and above the region average in 20 locations, including:

• Delaware/West Virginia/Washington D.C.: CareFirst BlueCross BlueShield
• Heartland: Blue Cross and Blue Shield of Oklahoma
• Mountain: Regence BlueCross BlueShield of Utah
• Northeast:  Blue Cross & Blue Shield of Rhode Island
• Southwest: Anthem Blue Cross and Blue Shield Nevada
• Virginia: CareFirst BlueCross BlueShield

How To File Claims With Aetna and Blue Cross

When using an in-network doctor or hospital, your claims will be submitted to the insurance company by that provider. If you see an out-of-network provider, then you will need to submit a claim form yourself. Aetna, for example, has a list of forms that must be mailed to the mailing address provided on the form. Also, be sure to review your policy details for state-specific steps required when filing a claim.

Both Aetna and Blue Cross allow you to review the current status of your claim through the mobile app.

Aetna History

In 1850, Aetna Insurance Company created a fund to sell life insurance. In 1853 the life and health divisions of Aetna separated. The company’s first president was Eliphalet A. Bulkeley. The name “Aetna” was taken from an 11,000-foot volcano in Sicily, Italy, which was also the most active volcano in Europe.

Blue Cross History

Blue Cross was formed in 1929 as a partnership between Baylor University Hospital and its patients who were struggling financially. The administrators of the hospital wanted to make healthcare more affordable for some patients, many of whom were Dallas public school educators on restricted budgets. The initial payment plan set up by Baylor University Hospital consisted of a 50-cent prepay each month for up to 21 days of hospitalization per year. The success of the program leads to enrollment by employees in other professions across Dallas.

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Choose the Right Health Insurance for You

While both offer solid health plans, we rank BlueCross slightly higher than Aetna for its superior network size and higher than average customer satisfaction in several regions.

Aetna and Blue Cross are only two options among many. You may find an even better health plan at a lower price from a different provider in your area. To help you buy the best health insurance plan for your budget, use SmartFinancial to ensure that you’re getting the best price and plan. Just enter your zip code below or call 855.214.2291 to receive your free health insurance quotes.