Kaiser Permanente vs. Aetna Insurance

While Kaiser Permanente and Aetna are similar on many fronts such as their health insurance plan structures, policy management options and customer satisfaction ratings on online review platforms, Aetna is ultimately preferable to Kaiser Permanente because it offers policies throughout all of the United States.

Nevertheless, Kaiser Permanente still has multiple perks despite its limited availability. The company is unique in that it offers a membership-based prepayment system and handles both medical care and insurance coverage.

Keep reading for more Kaiser Permanente vs. Aetna comparisons and see which of these health insurance companies is best suited to meet your coverage needs.

Key Takeaways Aetna operates through the entire country, while Kaiser Permanente only offers coverage in eight states and Washington, D.C. Aetna has a much larger network than Kaiser Permanente, though certain Kaiser Permanente plans take advantage of larger external provider networks. Despite its limited availability, Kaiser Permanente has favorable customer satisfaction ratings in multiple of its service areas. Aetna and Kaiser Permanente’s core apps are both rated well but Aetna’s Medicaid app has worse reviews.

Kaiser Permanente History

Kaiser Permanente traces its roots to the Great Depression in the 1930s when Dr. Sidney Garfield established a prepayment system for his hospital. His system required insurance companies to pay five cents per day so that the construction workers they covered could receive treatment at Garfield’s hospital in Southern California.^[1]

Garfield later partnered with Henry Kaiser to provide this same coverage to builders working on the Grand Coulee Dam in Washington. He then treated shipyard workers in the Pacific Northwest during World War II. Once the war ended and the shipyard workforce dwindled, Garfield and Kaiser teamed up to open their prepaid health insurance plan to the general population.^[1]

As a result, Permanente Health Plan began to insure members of the public in July of 1945 and enrolled more than 300,000 members within 10 years. Today, Kaiser Permanente consists of three collaborative organizations: Kaiser Foundation Hospitals and the Permanente Medical Groups, which provide medical treatments, and Kaiser Foundation Health Plan, which provides insurance coverage.^[1]

Click here to read our full Kaiser Permanente review.

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.^[2]

In addition, Aetna boasts several firsts for the United States health insurance industry such as paying out the first Medicare claim in 1966.^[2] Aetna became a part of CVS Health in 2018 following an acquisition worth nearly $80 billion.^[3]

Click here to read our full Aetna review.

Kaiser Permanente vs. Aetna: A Quick Glance

Comparison	Kaiser Permanente	Aetna
Plan Structures	HMO, PPO, EPO, POS, HMO-POS, CDHP, FSA, HDHP, HSA, Medicaid, Medicare, SNP	HMO, PPO, EPO, POS, HMO-POS, CDHP, FSA, HDHP, HSA, Indemnity, Medicaid, Medicare, SNP
Availability	Eight states plus D.C.	50 states plus D.C.
Coverage Limit	Varies	Varies
Deductible	Varies	Varies
Maximum Annual Benefit	Varies	Varies
Waiting Period	Varies	Varies
Providers In-Network	40 hospitals, 618 medical offices, 24,605 doctors and 73,618 nurses	1.2 million total providers including over 5,700 hospitals and over 700,000 primary care doctors and specialists
Covers Telehealth	Yes	Yes
Policy Management	Phone, mobile app or online account	Phone, mobile app or online account

Kaiser Permanente Pros and Cons

Pros	Cons
Highest customer satisfaction rating in nearly half of its services areas[4]	Only available in eight states plus the District of Columbia
Insurance and medical care conveniently handled by the same company

Aetna Pros and Cons

Pros	Cons
Highest customer satisfaction rating in three regions according to J.D. Power[4]	Medicaid member app has poor reviews
Large network that spans the entire country	Has failed to meet federal MLR standards in multiple regions over the past two years
Parent company has a higher market share than Kaiser Permanente for both Medicare Advantage and health insurance in general[5][6]

Kaiser Permanente vs. Aetna: Plan Structures

Kaiser Permanente and Aetna are basically tied when it comes to the plan structures they offer. Both companies can generally provide the same kinds of major medical insurance policies ranging from private individual and family plans to government-sponsored health care programs.

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

Kaiser Permanente vs. Aetna: Plan Availability

Aetna clearly beats Kaiser Permanente when it comes to availability as Aetna operates throughout the entire country. That said, the availability of certain plans may vary depending on your location. For example, Aetna sells prescription drug coverage to Medicare members in every state and the District of Columbia but only offers Medicaid plans in 17 states.^[7][8]

Conversely, Kaiser Permanente only operates in eight states plus Washington, D.C.^[9] Medicare Advantage members in California, Hawaii and most of Washington can only buy HMO plans from Kaiser Permanente. Meanwhile, the company offers both HMO and HMO-POS plans to Medicare Advantage members in the District of Columbia, Georgia, Maryland, Oregon, Virginia and Southwest Washington, while members in Colorado can enroll in an HMO, HMO-POS or PPO plan.^[10]

Kaiser Permanente vs. Aetna: In-Network Providers

For the most part, Aetna comes out ahead of Kaiser Permanente regarding the size of its network. In 2021, Aetna’s network encompassed 1.2 million health care providers including over 5,700 hospitals and over 700,000 primary care physicians (PCPs) and specialists.^[11]

Unlike most other health insurance companies, Kaiser Permanente operates its own network, which includes approximately 40 hospitals, 618 medical offices, 24,605 doctors and 73,618 nurses as of 2023.^[12] That said, certain Kaiser Permanente plans tap into outside regional and national networks, meaning you could be eligible for in-network care from up to 1.5 million providers depending on the type of plan you have.^[13]

Kaiser Permanente vs. Aetna: Cost

The cost of health insurance is highly dependent on the details of your plan and certain personal characteristics, making it difficult to make a precise comparison between Kaiser Permanente and Aetna on this metric. For general guidance, consider that Marketplace benchmark health plans average $477 per month and Medicare Advantage plans average $18.50 per month in 2024.^[14][15]

If you shop for a Marketplace health plan through either Kaiser Permanente or Aetna, then the price of your plan can only be set based on these factors:^[16]

• Age
• Location
• Tobacco use
• Whether you purchase an individual plan or a family plan
• Plan tier

The tier that your policy falls into indicates whether it comes with high premiums or high out-of-pocket costs. Bronze and silver plans are cheaper up front but require you to pay more in deductibles, copays and coinsurance when you receive medical care. Conversely, gold and platinum plans are more expensive up front in exchange for demanding less in out-of-pocket costs.^[17]

Kaiser Permanente vs. Aetna: Coverage Limits

Like the cost of health plans, coverage limits are hard to compare between companies since they are often dependent on each policyholder’s budget and needs. You should keep in mind that insurance companies are not allowed to place limits on the following essential health benefits:^[18][19]

• 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)

Kaiser Permanente vs. Aetna: Policy Management

Kaiser Permanente and Aetna both allow you to manage your health care plan over the phone, online or through a mobile app. Using each insurer’s respective app, you can contact doctors, access your identification card, refill prescriptions and more.

Both insurers have garned impressive reviews for their core policy management apps, suggesting members have encountered an accessible user experience on both apps. However, the same is not true of Aetna’s Better Health app for Medicaid members, which has significantly worse reviews.

App	Google Play Store Rating	Apple App Store Rating
Kaiser Permanente	4.7/5 stars[20]	4.8/5 stars[21]
Aetna Health	4.7/5 stars[22]	4.7/5 stars[23]
Aetna Better Health - Medicaid	3.3/5 stars[24]	1.8/5 stars[25]

Kaiser Permanente vs. Aetna: Medical Loss Ratio

Medical loss ratio (MLR) refers to the percentage of an insurance company’s income that is used to improve the experience of its customers. For example, an insurance carrier with a 90% MLR would spend 90% of policyholders’ premiums on paying out claims or otherwise improving the quality of their care, while the remaining 10% would go to profits, employee salaries and other overhead expenses.

Under the Affordable Care Act (ACA), insurers in the individual and small group health insurance markets are required to maintain an MLR of 80% or higher, while insurers in the large group market must maintain an MLR of 85% or higher. If an insurance provider fails to meet these MLR requirements on average across a three-year period, it must pay out proportional rebates to its customers.^[26]

Kaiser Permanente has not publicly disclosed its three-year rolling average MLR as of the end of 2023, although it did maintain an MLR above 90% across the individual, small group and large group markets in California in 2022 and has not announced any rebates for 2024.^[27] Meanwhile, Aetna paid out rebates in 14 states and the District of Columbia in 2023.^[28] In addition, Aetna expects to issue rebates to plan members in Maine in 2024, according to a document published by the Maine Bureau of Insurance.^[29]

Kaiser Permanente vs. Aetna: Enrollment Process

To receive coverage from either Kaiser Permanente or Aetna through the Health Insurance Marketplace, you will need to sign up during the open enrollment period. From November 1 through December 15, you can purchase coverage that will begin on January 1. Alternatively, you could sign up between December 16 and January 15 for coverage beginning on February 1.^[30]

Meanwhile, if you are interested in a Medicare Advantage plan, you should keep the following Medicare open enrollment deadlines in mind:^[31]

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 have already signed up for Medicare Parts A and B
October 15 to December 7	Switch from Original Medicare to Medicare Advantage, switch from one Medicare Advantage plan to another or drop Medicare Advantage and go back to Original Medicare
January 1 to March 31 (or any time during your first three months on Medicare)	Switch from one Medicare Advantage plan to another or drop Medicare Advantage and go back to Original Medicare

Outside of these dates, you can only sign up for health insurance if an event like one of the following occurs and triggers a special enrollment period:^[32]

• 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 

Kaiser Permanente vs. Aetna: Policyholder Experience

Kaiser Permanente and Aetna have similar customer satisfaction ratings on online review platforms, with both of them receiving below-average ratings across multiple websites. See below for an overview of their average ratings from ConsumerAffairs, the Better Business Bureau and Best Company.

Review Platform	Kaiser Permanente Rating	Aetna Rating
ConsumerAffairs	1.8/5 stars[33]	1.5/5 stars[34]
Better Business Bureau	1.06/5 stars[35]	1.09/5 stars[36]
Best Company	2.2/5 stars[37]	2.3/5 stars[38]

How To File Claims With Kaiser Permanente and Aetna

A health insurance claim will usually be filed on your behalf when you visit an in-network provider but you may need to file a claim yourself if you go to an out-of-network provider. Kaiser Permanente advises policyholders who receive care out of network to request an itemized bill and then submit all of the necessary information to file a claim online.^[39] Meanwhile, Aetna presents its members with numerous options for filing claims digitally on its website.^[40]