Kaiser Permanente vs. Aetna Insurance

While Kaiser Permanente and Aetna are similar on many fronts such as their plan structures, policy management options and customer satisfaction ratings on online review platforms, Aetna is ultimately preferable to Kaiser Permanente because it has a significantly larger network that extends 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 company 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 and also has a larger market share. Despite its limited availability, Kaiser Permanente has favorable customer satisfaction ratings in multiple of its service areas. Aetna’s core app has better ratings than Kaiser Permanente’s, although Aetna’s Medicaid app has worse reviews. Kaiser Permanente successfully adhered to federal medical loss ratio standards in 2022 and Aetna did not, meaning Kaiser Permanente used a greater proportion of its revenue to improve the experience of its customers.

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 moved to Northern California to treat shipyard workers 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 in Northern California 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]

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]

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

Kaiser Permanente vs. Aetna: A Quick Glance

Comparison	Kaiser Permanente	Aetna
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	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	39 hospitals, 622 medical offices and other outpatient facilities, 23,982 doctors and 68,218 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
Parent company has a higher market share than Kaiser Permanente for both Medicare Advantage and health insurance in general[5][6]	Medicaid member app has poor reviews
Larger network that spans the entire country	Failed to meet federal MLR requirements in 2022
More options for submitting claims

Kaiser Permanente vs. Aetna: Plan Structures

Kaiser Permanente and Aetna are tied when it comes to the plan structures they offer. Both companies can generally provide the same kinds of policies when it comes to who the policies are available to and how coverage works for each policy.

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 D-SNPs (dual-eligible special needs plans) in 30 states.^[7][8]

Conversely, Kaiser Permanente operates in only eight states. Medicare Part C 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 Colorado, the District of Columbia, Georgia, Maryland, Oregon, Virginia and Southwest Washington.^[9]

Kaiser Permanente vs. Aetna: In-Network Providers

Once again, Aetna comes out ahead of Kaiser Permanente regarding the size of its network. In 2021, Aetna’s network encompassed 1.2 million healthcare providers including over 5,700 hospitals and over 700,000 primary care physicians and specialists.^[10]

Unlike most other health insurance companies, Kaiser Permanente operates its own network, which includes 39 hospitals, 622 medical offices and other outpatient facilities, 23,982 doctors and 68,218 nurses.^[11] Kaiser Permanente also fully covers urgent and emergency care anywhere in the world but only covers routine care at in-network medical facilities.^[12]

Kaiser Permanente vs. Aetna: Cost

The cost of health insurance from Kaiser Permanente was between $340 and $525 per month on average from 2018 to 2021.^[13] Aetna has not publicly shared its average monthly premiums. Ultimately, health insurance plans are highly personalized and prices can vary significantly from person to person depending on factors like the following:

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

Your health insurance costs can also differ depending on the category or tier that your policy falls into. The different tiers do not indicate the quality of care provided but rather whether the policy comes with higher premiums or higher out-of-pocket costs through 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

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:^[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

Kaiser Permanente vs. Aetna: Policy Management

Kaiser Permanente and Aetna both allow you to manage your healthcare 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.

Aetna’s primary app has slightly better reviews than Kaiser Permanente’s, suggesting members have encountered a more accessible user experience on Aetna’s app. 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	3.7/5 stars[16]	4.3/5 stars[17]
Aetna Health	4.6/5 stars[18]	4.7/5 stars[19]
Aetna Better Health - Medicaid	3.2/5 stars[20]	1.8/5 stars[21]

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, 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.^[22]

Kaiser Permanente has not announced any MLR rebates for 2023 as it maintained an MLR above 90% across the individual, small group and large group markets in 2022.^[23] Conversely, Aetna will issue rebates to small group markets in Delaware and Florida and large group markets in the District of Columbia and the below states by September 30, 2023.^[24]

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

Kaiser Permanente vs. Aetna: Enrollment Process

To receive coverage through either Kaiser Permanente or Aetna beginning in 2024, you will need to sign up during the Health Insurance Marketplace 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.^[25]

Meanwhile, if you are interested in a Medicare Advantage plan, you should keep the following Medicare open enrollment deadlines in mind.^[26]

Enrollment Period	What You Can Do
Three months before your Medicare plan starts to three months after your Medicare plan 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

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:

• 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

Kaiser Permanente vs. Aetna: Policyholder Experience

Kaiser Permanente and Aetna have similar customer satisfaction ratings on online review platforms, although both of them have slightly 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	3/5 stars[27]	2.5/5 stars[28]
Better Business Bureau	1.06/5 stars[29]	1.11/5 stars[30]
Best Company	2.6/5 stars[31]	2.9/5 stars[32]

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 to submit claims digitally via Electronic Data Interchange (EDI) but does allow paper claims if necessary.^[33] Meanwhile, Aetna recommends that plan members submit claims through an online portal but also accepts claims submitted by mail, email and fax.^[34]