Aetna vs. Blue Cross

With its larger network and policy options, Blue Cross is the better choice

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Aetna and Blue Cross are two large, well-respected health insurance companies in the United States that offer millions of employees and individuals comprehensive medical coverage and other supplemental insurance products like dental, vision, and prescription drugs. The role of a policy with an insurance carrier is to help offset the financial cost of your medical expenses. To get major medical health insurance, you can obtain it from an employer or enroll in coverage from the Health Insurance Marketplace at HealthCare.gov, your state marketplace exchange, or from an insurance company directly.

When analyzing different health insurance plans, consider how much you are responsible for out-of-pocket based on the deductible and any money you will have to pay in the form of coinsurance and copays. Also, look at the insurance carrier’s reputation and level of customer satisfaction. 

Based on our research, Blue Cross is the better option as it has the highest quality standard ratings, offers multiple policy types, and has the largest coverage footprint nationwide, making it the best for the market it serves.

Aetna vs. Blue Cross: Which Should You Choose?

Aetna


Aetna

Aetna

Pros
  • Includes CVS pharmacy network

  • Rated “A” by AM Best

  • Large state-by-state network

Cons
  • Doesn’t offer individual health plans

  • Employer plans only available in 16 states

  • Customer satisfaction is lower than competitors

Blue Cross


Blue Cross Blue Shield

Blue Cross Blue Shield

Pros
  • Some walk-in retail stores available with staffed advisors

  • Rated “A” by AM Best

  • Offers employer-group and individual insurance

  • Large nationwide network

Cons
  • Individual policies not available in all states

  • Website usability is inconsistent

  • Mobile app features based on state carrier

At a Glance

  Aetna Blue Cross 
Plan Structures HMO, POS, PPO, EPO, Stop-Loss HMO, POS, PPO, EPO, Stop-Loss
Available Nationwide  No  Yes 
AM Best Rating
Providers In-Network  1.2 million  1.7 million 
Offers Telehealth  Yes  Yes 
Policy Management  Mobile app, website, phone Mobile app, website, phone 
Medical Loss Ratio (MLR)  N/A  N/A 
NCQA Rating  4.0 for customer satisfaction  4.0 for customer satisfaction 

Aetna vs. Blue Cross: Available Plan Structures

Both Aetna and Blue Cross offer HMO, PPO, POS, EPO, and Stop-Loss health insurance plans. 

These plans offer different types of provider networks and pricing structures. You’ll need to contact your human resources or plan administrator to find out which ones are available. 

Aetna vs. Blue Cross: Availability

Aetna provides employer-sponsored insurance in 16 states across the U.S. including California, Florida, Illinois, New York, and Texas. It does not offer individual plans through HealthCare.gov or state exchanges. In 2022, the company will begin offering ACA Marketplace plans in Florida, Missouri, Nevada, North Carolina, and Texas.

Blue Cross offers employer-based and individual health insurance plans in 50 states, the District of Columbia, and Puerto Rico. Individual plans can be purchased on HealthCare.gov, state exchanges, or directly through the insurance company. 

Aetna vs. Blue Cross: Providers In-Network

Staying “in-network” is the easiest step to help keep your medical costs lower. When you see an in-network provider, you get the pre-negotiated rate between the provider and the insurance company. Aetna has a slightly smaller network overall at 1.2 million, but considering it’s just in 16 states, it averages to 750,000 in-network providers by each state, ultimately making it the larger network based on region. 

Aetna is also owned by CVS Health, which has one of the largest pharmacy benefits managers through CVS. CVS is a leading pharmacy chain in 40 states with nearly 10,000 locations across the U.S. 

Blue Cross has the largest provider network with 1.7 million doctors, hospitals, and facilities in-network across 50 states, D.C., and Puerto Rico, averaging more than 333,000 providers by state in the U.S. The number of pharmacies for Blue Cross varies by state and specific network associated with your plan.

Aetna vs. Blue Cross: Policy Management

Both Aetna and Blue Cross offer policy management through their member mobile apps in addition to websites and customer service. 

The Aetna Health app allows you to view your policy coverage and track spending up to your medical deductible, view your ID card, find an in-network doctor, track, filter, and pay claims, find in-network doctors, get medical care cost estimates, and receive personalized recommendations to improve your overall health. Another app called Attain by Aetna combines your health history with your Apple Watch activity to set goals, achieve milestones, and earn rewards like a new Apple Watch or gift cards from retailers. 

Depending on the subsidiary carrier, Blue Cross mobile apps allow you to find an in-network doctor, view your policy coverage and ID card, estimate your health care costs, and access your medical records. Other subsidiaries may offer additional benefits. 

Aetna vs. Blue Cross: Medical Loss Ratio (MLR)

As a result of the Affordable Care Act (ACA), carriers must spend at least 80% of their premium dollar revenue on paying medical claims. This rule is referred to as the Medical Loss Ratio. The more money a company spends on its customers, ideally, the fewer profits benefit the insurance carrier. If a company fails to spend at least 80% of revenue on claims, it is required to rebate back its customers up to the 80% threshold.

Since Aetna and Blue Cross file their medical loss ratio totals by state, there is no company percentage total overall. In our research, we found both Aetna and Blue Cross pay between 82% and nearly 90% in medical claims from profits depending on the state.

Aetna vs. Blue Cross: Policyholder Experience 

Both companies are rated A by AM Best for financial stability. When it comes to customer satisfaction, Blue Cross companies outrank Aetna on the health insurance rating website National Committee for Quality Assurance (NCQA). NCQA rates more than 1,000 health insurance plans each year on a scale of 1.0-5.0 based on clinical quality, customer satisfaction, and its own NCQA National Survey. The latest 2019 plan ratings are for private, commercial plans based on this combination of standards scores.

In three states, Aetna plans have 4.0 ratings for customer satisfaction. Only one Aetna Health company has less than a 2.0 rating for customer satisfaction and preventive care (California). However, Aetna has a lower rating overall for customer satisfaction, treatment, and prevention state-by-state compared to Blue Cross.

Nine Blue Cross states rank 4.0 or higher overall compared to Aetna’s three states that scored that high. Blue Cross Blue Shield in Georgia has the lowest overall rating of 3.0. The company also has higher rankings for prevention and treatment. 

Aetna vs. Blue Cross: Cost 

Aetna only offers group plans for employees, and every company pays a different percentage toward its employees' premium. Cost can range from $0 to several hundred dollars depending on the number of insureds, their age, state, and tobacco usage. 

Blue Cross also offers employer-sponsored plans that will vary in cost. However, Blue Cross also offers individual plans in multiple states, and prices can vary by ZIP code as well as other factors including plan choice and deductible. For example, a 35-year-old non-smoking woman in Minneapolis would pay $276 in premium each month for the lowest price Bronze plan with a $7,000 deductible that is unsubsidized. A 35-year-old woman in Dallas would pay $379 for a higher $8,550 deductible plan. 

Aetna vs. Blue Cross: Enrollment Process

Employer-sponsored open enrollment typically runs between October and November, depending on the company calendar. Open enrollment for individual health insurance is November 1–January 15 each year. If you have a qualifying life event (e.g., lost job, married/divorced, a move to another state, in an employer waiting period, etc.), you might be able to enroll in a health insurance policy outside of these dates. 

Aetna plans are purchased through an employer, so there isn’t an online marketplace to purchase from. (In 2022, the company will begin offering individual ACA plans in select states.) Its website is consistent and very user-friendly for membership needs outside of enrollment. 

Blue Cross enrollment varies by company and state. Individual enrollment can be processed online through the federal Marketplace, a state exchange, or through the company’s state website. 

When applying for an individual insurance policy, remember to have your total household income from the previous year available when you begin the application process, in addition to your Social Security number.

Frequently Asked Questions

Do Aetna and Blue Cross Offer Affordable Health Insurance Plans? 

The affordability of Aetna and Blue Cross companies varied in the last enrollment period, from slight decreases to increases of less than 10% in the states we investigated. Overall, both companies offer value for coverage, especially on bronze Marketplace plans or well-funded employer-sponsored coverage. 

When deciding between health insurance programs that fit your budget, consider the deductible, copays, and coinsurance. The higher the deductible, the lower the monthly premium because you’re taking on more financial responsibility. If your health needs more attention and you see multiple specialists each year, a higher-priced premium with a low deductible might save you money in the long run. 

Is It Worth Getting a Health Insurance Plan Through Aetna or Blue Cross? 

Both Aetna and Blue Cross are seasoned, well-respected companies. Blue Cross offers more when it comes to plan availability, a larger network, and overall higher ratings based on a mixture of customer satisfaction, prevention tactics, and treatment. But if your company only offers an Aetna plan, you can have confidence that the company will take care of your coverage. Employer-sponsored health insurance greatly reduces your out-of-pocket expenses.

Health insurance is always a good financial investment to help protect your assets should a major medical occurrence sideline your income and health. 

How Can I Enroll in an Aetna or Blue Cross Health Insurance Plan? 

Talk to your Human Resources Department if you are offered Aetna or Blue Cross coverage as an employee benefit. Ask if there is a waiting period or if you can enroll a spouse or dependents with your group coverage. 

If you are self-employed and purchase your own health insurance, Blue Cross can be accessed through HealthCare.gov, your state exchange, website entities that market health insurance, or directly through the state Blue Cross company. Run a free quote to get an idea of pricing, deductible ranges, coinsurance, and copay options. 

Methodology

We analyzed two popular health insurance companies to identify which provides the best coverage based on plan structure, estimated costs, provider network size, state availability, plan options, and financial ratings. Mobile app ratings, overall customer satisfaction, and ratings on prevention and treatment also weighed in.

Based on these criteria, we determined that Blue Cross is a better overall choice than Aetna, although if Aetna is offered by your employer, it does provide comprehensive and affordable insurance.

Article Sources

  1. Statista. "CVS Health's number of stores 2005-2020. " Accessed July 23, 2021. 

  2. CMS.gov. "Medical Loss Ration Search Tool." Accessed July 23, 2021. 

  3. NCQA. "NCQA Health Insurance Plan Ratings." Accessed July 23, 2021.