Aetna vs. Humana Insurance

Aetna and Humana are similar in many regards such as the types of health plans they offer and how they allow customers to manage their policies but consumers may ultimately find it more convenient to buy Aetna insurance since the company has a larger network and provides multiple options for filing claims if you do go to an out-of-network doctor or hospital.

Even so, Humana has a larger market share than Aetna in the health insurance industry and has received slightly better ratings from customers on online review platforms. One of Humana’s additional benefits is that it sells coverage in Puerto Rico, while Aetna does not.

Keep reading for a closer look at Aetna vs. Humana insurance to help you decide which health insurance provider could provide the best plan for your needs and budget.

Key Takeaways Aetna and Humana both offer coverage in every U.S. state and the District of Columbia, although Humana is the only one of the two that offers coverage in Puerto Rico. While Humana has a higher market share in the Medicare Advantage and broader health insurance industries, Aetna has a higher number of in-network providers. Aetna has the best customer satisfaction ratings of any health insurance company in some regions, although Humana generally has somewhat higher customer satisfaction ratings across the board. The Aetna Health app has better reviews than the MyHumana app and similar reviews to Humana’s CenterWell Pharmacy app, while the Aetna Better Health - Medicaid app receives substantially worse reviews. Aetna failed to meet federal medical loss ratio standards in 2022, meaning it must pay rebates to customers because it did not use enough of its income to improve the quality of care for its customers.

Aetna History

Named after the tallest active volcano in Europe, Mount Etna, Aetna got its start in the early 1800s by selling fire and life insurance. Toward the end of the 1800s, the company began to shift toward its current focus of selling health insurance. Aetna has been involved in many notable moments throughout United States history such as underwriting life insurance policies for the first American astronauts in 1963 and paying out the first Medicare claim in 1966.^[1]

Aetna previously planned on merging with Humana but the deal was abandoned in 2017 after a district court allowed the Department of Justice to halt the merger by issuing an injunction.^[2] Instead, CVS Health acquired Aetna in 2018 in a deal worth nearly $80 billion.^[3]

Click here to read our full Aetna review.

Humana History

Humana was founded as a nursing home company called Extendicare in 1961. After adopting its current name in the 1970s, it transitioned to being a hospital company and eventually became a health insurance company in the 1980s. Today, Humana aims to have a social impact beyond providing health coverage through initiatives like reducing greenhouse gas emissions and giving food to needy families.^[4]

Click here to read our full Humana review.

Aetna vs. Humana Insurance: A Quick Glance

Comparison	Aetna	Humana
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 plus D.C.	50 states plus D.C. and Puerto Rico
Coverage Limit	Varies	Varies
Deductible	Varies	Varies
Maximum Annual Benefit	Varies	Varies
Waiting Period	Varies	Varies
Providers In-Network	1.2 million total providers including over 5,700 hospitals and over 700,000 primary care doctors and specialists	22,000 participating providers
Covers Telehealth	Yes	Yes
Policy Management	Phone, mobile app or online account	Phone, mobile app or online account

Aetna Pros and Cons

Pros	Cons
Highest customer satisfaction ratings in the East South Central, Northwest and Southwest regions[5]	Medicaid member app has poor reviews
Larger network than Humana	Failed to meet federal MLR requirements in 2022
Aetna Health app is better-rated than MyHumana app

Humana Pros and Cons

Pros	Cons
Higher market share than CVS Health for both Medicare Part C and health insurance in general[6][7]	Smaller network than Aetna despite widespread availability
Better customer satisfaction ratings than Aetna on multiple online review platforms

Aetna vs. Humana Insurance: Plan Structures

Neither Aetna nor Humana has an advantage over the other when you compare the kinds of plan structures they offer. As a result, both health insurance companies are fine to treat as a one-stop shop for any type of health coverage you may need.

Plan	Aetna	Humana
Individual & Family	✓	✓
Medicare Advantage	✓	✓
Medicaid	✓	✓
Dental	✓	✓
Vision	✓	✓
Employer Group	✓	✓

Aetna vs. Humana Insurance: Plan Availability

Humana has a very slight edge over Aetna when it comes to plan availability as Humana operates in some capacity in all 50 states, the District of Columbia and Puerto Rico.^[8] Of course, certain Humana plans are only available in certain regions. For example, the company only offers PPO (preferred provider organization) dental insurance in 41 states plus Washington, D.C.^[9]

Meanwhile, Aetna offers insurance in all 50 states and the District of Columbia but not Puerto Rico.^[10] Similarly, some of its coverage options are restricted to certain geographic areas. For example, eligible members can only buy D-SNPs (dual-eligible special needs plans) from Aetna in 30 states.^[11]

Aetna vs. Humana Insurance: In-Network Providers

Aetna boasts a much larger network than Humana, with Aetna’s line-up of in-network providers including over 5,700 hospitals, more than 700,000 primary care doctors or specialists and a total of around 1.2 million healthcare providers in general as of 2021.^[12] Meanwhile, Humana’s network consists of about 22,000 participating providers as of 2022.^[13]

Aetna vs. Humana Insurance: Cost

The cost of health insurance from Aetna and Humana can’t be easily compared because health plans tend to be specifically tailored to the needs and budget of each individual and prices can differ greatly from one person to another as a result. In general, the factors that will impact your monthly premium payments for health coverage include the following:

• Age
• Health habits such as dieting, exercising, smoking or drinking
• Medical history
• Location
• Deductible
• Health plan
• Health insurance company

Your coverage prices can also vary based on the tier that your plan falls into. The tier system is a way of differentiating policies that come with high premiums from those that come with high out-of-pocket costs in the form of deductibles, copays and coinsurance.

Tier	Description
Bronze	Lowest monthly premiums, highest out-of-pocket costs
Silver	Moderate monthly premiums, moderate out-of-pocket costs
Gold	High monthly premiums, low out-of-pocket costs
Platinum	Highest monthly premiums, lowest out-of-pocket costs

Aetna vs. Humana Insurance: Coverage Limits

Similarly, there is no set coverage limit you should expect from Aetna or Humana since your coverage limits will depend on the details of your personalized policy. However, you should note that your insurer is not allowed to place a limit on any of the following services since they are classified as essential health benefits:^[14][15]

• 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

Aetna vs. Humana Insurance: Policy Management

Both Aetna and Humana allow you to manage your policy by using a mobile app or online portal or simply by talking to a representative over the phone. You can use your respective insurance provider’s app to see details about your plan, manage your claims, find in-network doctors and enjoy many other benefits.

Aetna’s primary app seems to be more user-friendly as it has a better star rating than Humana’s primary app on both Google Play and the App Store. However, Aetna has a secondary app for Medicaid members that has received far worse reviews. Meanwhile, the app for CenterWell Pharmacy, which is operated by Humana and allows members to manage their prescription drug coverage plans, is generally more favorably reviewed than the main MyHumana app.

App	Google Play Store Rating	Apple App Store Rating
Aetna Health	4.6/5 stars[16]	4.7/5 stars[17]
Aetna Better Health - Medicaid	3.3/5 stars[18]	1.8/5 stars[19]
MyHumana	4.1/5 stars [20]	2.9/5 stars[21]
CenterWell Pharmacy	4.4/5 stars[22]	4.7/5 stars[23]

Aetna vs. Humana Insurance: Medical Loss Ratio

Medical loss ratio (MLR) is a measurement of the percentage of a health insurance company’s revenue that goes toward improving the quality of customer care. For example, if an insurance provider has an MLR of 75%, it means that 75% of the money the company receives from premium payments goes toward paying out claims and other actions intended to create a better experience for policyholders. Meanwhile, the remaining 25% goes toward administrative costs or profits.

The Affordable Care Act requires companies that sell individual and small group health insurance to maintain a three-year rolling average MLR of at least 80%. For companies that sell large group health insurance, the minimum required MLR is 85%. Every year, insurers are required by the federal government to pay proportional rebates to their members if they failed to meet these MLR requirements on average over the course of the previous three years.^[24]

Humana has not announced any rebates for 2023 and instead reported a year-to-date MLR above 85% as of August 2023.^[25] The same is not true for Aetna, which must issue rebates to members of small group markets in Delaware and Florida and members of large group markets in the regions listed below by September 30, 2023.^[26]

• Arizona
• District of Columbia
• Florida
• Kansas
• Kentucky
• Louisiana
• Maryland
• Minnesota
• Mississippi
• Nebraska
• New Jersey
• Texas
• Virginia
• Wyoming

Aetna vs. Humana Insurance: Enrollment Process

If you are interested in Aetna or Humana insurance for 2024, you generally have to sign up for coverage during the Health Insurance Marketplace open enrollment period. You can sign up between November 1 and December 15 if you would like your coverage to begin on January 1. Otherwise, you can enroll from December 16 through January 15 for coverage that will begin on February 1.^[27]

There are separate Medicare open enrollment deadlines that apply to those looking for Medicare Part C plans from Medicare Advantage providers. The below table goes over the dates during which eligible individuals can buy new Humana or Aetna Medicare Advantage plans or make changes to their health coverage.^[28]

Enrollment Period	What You Can Do
Three months before your Medicare coverage starts to three months after your Medicare coverage starts	Enroll in a Medicare Advantage plan as long as you already have Medicare Parts A and B
October 15 to December 7	Switch from Original Medicare to Medicare Advantage or switch from one Medicare Advantage plan to another
January 1 to March 31	Switch from one Medicare Advantage plan to another or drop Medicare Advantage and go back to Original Medicare

Even if you miss out on the deadlines listed above, it may still be possible for you to sign up for health insurance depending on your circumstances. Life events that significantly alter your health insurance needs such as the following can trigger a special enrollment period, making you eligible to sign up for a new health plan:

• Getting married or divorced
• Giving birth to or adopting a child
• Changing or losing your job
• Moving to a new residence
• Graduating from college
• Losing your existing health coverage due to the death of a family member
• Becoming a United States citizen
• Leaving prison

Aetna vs. Humana Insurance: Policyholder Experience

Humana has garnered slightly higher customer satisfaction ratings than Aetna on average across multiple online review platforms like ConsumerAffairs, the Better Business Bureau and Best Company. The below table provides an overview of each company’s average star rating from these websites.

Review Platform	Aetna Rating	Humana Rating
ConsumerAffairs	2.5/5 stars[29]	3/5 stars[30]
Better Business Bureau	1.11/5 stars[31]	1.26/5 stars[32]
Best Company	2.9/5 stars[33]	2.7/5 stars[34]

How To File Claims With Aetna and Humana

Aetna members can file claims via online portal, mail, email or fax, while Humana members may be able to submit forms via online portal, mail or fax depending on the type of claim.^[35][36] Keep in mind that you typically don’t need to file an insurance claim whenever you go to an in-network provider since the provider will usually file a claim for you. However, if you visit an out-of-network provider, you may have to file the claim yourself.