Aetna vs. Cigna

Cigna edges out Aetna as the most comprehensive health insurance company

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Health insurance is a type of insurance designed to help offset the cost of medical expenses. Health insurance companies take on the financial risk of your health which is subsidized by monthly premium, your out-of-pocket responsibility until a deductible is met, coinsurance, and copayments. Today health insurance choices come in a variety of plan structures to fit a multitude of different needs.

When deciding between health insurance companies, it’s important to look at benefits offered, the deductible amount, coinsurance, and maximum out-of-pocket costs (the total you have to pay before the insurance company picks up the tab 100%). You should also consider the carrier’s reputation in terms of industry ratings, customer satisfaction, and outcomes. This applies to both employees picking between plans at work and the self-employed or individuals buying insurance on their own to financially protect their families. 

Aetna and Cigna are two large, reputable health insurance carriers with extensive histories. After analyzing benefits and reputation, we picked Cigna as best for its global footprint and its high customer satisfaction ratings.

Aetna vs. Cigna: Which Should You Choose?

Aetna


Aetna

Aetna

Pros
  • Includes CVS pharmacy network

  • Rated “A” by AM Best

  • Large state-by-state network

Cons
  • Individual health plans only available in 5 states

  • Employer plans only available in 16 states

  • Customer satisfaction, prevention, and treatment ratings are lower

Cigna


Cigna

Cigna

Pros
  • Offers both employer-sponsored and individual health plans

  • Rated “A” by AM Best

  • Offers MDLive, a telehealth company

Cons
  • Individual plans only available in 10 states

  • Wellness mobile app poorly rated in app stores

At a Glance

  Aetna Cigna 
Plan Structures HMO, POS PPO, EPO, stop-loss HMO, POS, PPO, EPO, stop-loss
Available Nationwide  No No 
AM Best Rating  A
Providers In-Network  1.2 million 1.5 million (globally) 
Offers Telehealth  Yes Yes 
Policy Management (Mobile app, website, phone, etc.)  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. Cigna: Available Plan Structures

Aetna and Cigna offer the same type of plan structures that include HMO, POS, PPO, EPO, and employer stop-loss plans. However, some Aetna policyholders are limited to the plan structure offered by their company and are forced to select the plan structure available to them. We found HMO and EPO plans are the most popular of Cigna’s policies in the individual marketplace, based on affordability. In both cases, plan structure availability and size of network vary by state. 

Both Aetna and Cigna offer an HMO/PPO hybrid called point of service (POS) plans. This option allows seeing a doctor in or out of network. However, you will most likely still have to get a referral from your primary care physician to see a specialist outside your contracted network. When examining network plans from either of these companies, make sure you understand what kind of network you will be buying into and how it will affect who you can receive care from. 

If you decide to purchase a high-deductible health plan from either company, the plan may qualify for contributions into a Health Savings Account (HSA). HSA’s are a great option to save for health care expenses tax-free. Some employers will also contribute to an HSA up to a certain percentage, so check with your human resources department to find out what you qualify for.

Aetna vs. Cigna: Availability

Aetna employer plans are offered in 16 states nationwide. During the 2021 open enrollment period, they will also offer individual plans in five states for 2022 coverage which can be found on HealthCare.gov or state exchanges.

Cigna offers employer group health plans in 15 states across the U.S. under Cigna state entities. Individual plans can be purchased in 10 states within 19 markets on HealthCare.gov, state exchanges, website marketing entities, and directly from Cigna itself. In 2022, the company plans to expand coverage to three additional states: Georgia, Mississippi, and Pennsylvania.

Aetna vs. Cigna: Providers In-Network

To keep your medical bills lower, it’s important to stay in-network to get the best pricing from a provider or facility. Many insurance plans do not discount or cover out-of-network expenses, so a large network is key for getting the best cost for care. 

Aetna has 1.2 million in-network providers in total and is also owned by CVS Health, one of the largest pharmacy benefits managers in the U.S. with nearly 10,000 locations across the U.S. 

Cigna advertises its company information on a global level because it’s in more than 30 countries, totaling more than 1.5 million providers. This makes Cigna individual insurance a good option for someone living overseas for work or school. 

Aetna vs. Cigna: Policy Management

Both Aetna and Cigna encourage members to manage their insurance policy through a mobile app in addition to websites and customer service. 

The Aetna Health app allows you to view your plan coverage and track spending up to your deductible, display your ID card, find a doctor, review and pay claims, get cost estimates, and receive personalized recommendations to improve your overall health. Another app, 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. 

Cigna has three mobile apps. The myCigna Mobile App allows you to view or email your ID card, search claims, view all of your account balances, find a provider, and more. The app also allows you to track health initiatives, manage your prescriptions, and follow your health history. The Cigna Wellbeing Mobile App lets you track your sleep, stress levels, and physical activity. It also has recipes and wellness tips and connects you to telemedicine services for remote doctor office visits. 

If you are getting coverage overseas, the Cigna Envoy Mobile App can help manage your claims and find doctors in your local area in addition to having a digital record of your ID card. 

Aetna vs. Cigna: Medical Loss Ratio (MLR)

As a result of the Affordable Care Act (ACA), a health insurance company is required to spend 80% of its premium revenue on clinical services and quality improvements. This rule is known as the Medical Loss Ratio (MLR). If a carrier doesn’t spend at least 80% of revenue on claims, it is mandated to pay back its customers the difference up to the 80% threshold.

Aetna and Cigna are required to file their medical loss ratio totals by state. While there isn’t a national percentage total available to review, we found that in many states the companies were spending well more than 80% on patient claims as required. As an example, when spot-checking 2019 MLR for Aetna, we found the company pays more than 88% of its revenue towards claims for large groups in Pennsylvania. And Cigna pays over 94% of its revenue towards claims for large groups in Arizona. 

Aetna vs. Cigna: Policyholder Experience 

Aetna and Cigna are well-respected insurance companies with decades of proven financial security. The National Committee for Quality Assurance (NCQA) annually rates more than 1,000 health insurance plans based on clinical quality, customer satisfaction, and its NCQA National Survey results. The latest 2019 plan ratings are for private, commercial plans (employer-sponsored insurance) based on this combination of standards scores.

Based on NCQA ratings, each insurance carrier is rated by state; there isn’t a collective national total. However, from our research, Cigna scored better nationally overall compared to Aetna. It had the highest rankings in overall total score and higher ratings for preventive care and treatment. Aetna only outscored Cigna for customer satisfaction based on a top-five average. 

Aetna vs. Cigna: Cost 

Aetna and Cigna both offer employer-sponsored plans, but pricing will depend on the amount your employer is willing to cost-share with you. Some pay 100% and some pay 50% or less or won’t cover your spouse and dependents. Costs vary from company to company, so you’ll need to determine your cost at the time of hire or during your company open enrollment. 

Aetna individual health plan pricing is not yet available. 

In four states where Cigna offers individual health insurance plans, you can find pricing online to get an idea of your total monthly premiums costs. For example, you will see pricing and deductibles vary by state when quoting the lowest cost Silver plan for 30-year-old non-smoking men and women:

  • Orlando: $447 per month with a $6,000 deductible
  • Chicago: $408 per month with a $5,000 deductible
  • Durum, N.C.: $425 per month with a $5,500 deductible 
  • Richmond, VA.: $392 per month with a $6,500 deductible

Note: Although the pricing did not change based on sex, it is based on ZIP code and can vary within the same region.

When reviewing plan costs, look for other extras that a plan might offer to limit your out-of-pocket responsibilities. To help ease average doctor office visits, Aetna works with TeleDoc for a discounted telehealth rate of $45 per visit. In its individual states, Aetna features no-cost or low-cost visits to CVS's MinuteClinics, access to a Care Concierge at CVS HealthHUB locations, and 90-day refills delivered for free.

In the 10 states where Cigna markets to those who purchase their own health insurance, it offers $0 virtual telehealth visits on individual plans (except in Arizona). Cigna also offers a $25 cap for a 30-day supply of preferred brand insulin for diabetics. Another cost to look for is your total out-of-pocket maximum. That total is what you will have to pay before the health insurance carrier begins paying 100% of medical bills.

Aetna vs. Cigna: Enrollment Process

For Aetna and Cigna employer plans, check with your human resources department to find out when open enrollment occurs during the calendar year. Traditionally it’s held in October or November for the following plan year. During this time, you can change plans, increase benefits, or enroll in a new offering. You won’t be able to change your plan outside of this time unless you have a qualifying life event like a marriage or birth/adoption of a child. 

If you’re interested in buying an Aetna or Cigna plan on HealthCare.gov or your state exchange, the enrollment period is set every year from Nov. 1– Dec. 15 (in most states and subject to change) for the following calendar year. Like with employer open enrollment, if you experience a qualifying life event, you are able to change your health policy outside of the normal enrollment dates. 

You will need your Social Security number in order to enroll in a health insurance plan. You will also need to decide what account your payment should be deducted from each month (checking or credit card), and for qualifying high-deductible health plans, how much money you want to contribute to your Health Savings Account (HSA) or Flexible Spending Account (FSA) each month to capitalize on any employer matching funds. You can also make monthly or annual contributions to an HSA if you buy a qualifying individual high-deductible plan. 

Both types of accounts are a great way to set aside money tax-free for health care expenses. HSAs allow you to save $3,550 per year for an individual while FSA accounts are capped at $2,750 per year.

Frequently Asked Questions

Do Aetna and Cigna Offer Affordable Health Insurance Plans? 

Both Aetna and Cigna have affordable health insurance options. When looking at your coverage options, the most affordable plan will have more up-front out-of-pocket costs for you. However, if you’re healthy or don’t anticipate seeing a doctor more than once or twice a year, an affordable plan can still provide you some of the financial protections you desire.

The Affordable Care Act has helped lower individual health insurance premiums with its tax subsidy program. More than 90% of individuals and families who enroll in an ACA receive financial assistance. Since Cigna participates in the individual Marketplace, subsidies are available to those who qualify.

The employer-sponsored group market has seen a steady increase of insurance premiums over the years as employers work to keep rates low while cost-shifting more to employees to balance the increases. Subsidies in the individual market don’t apply to the employer market, so plans offered by Aetna would only be subsidized by the employer, not the government. 

How Much Health Insurance Can I Afford?

To figure out how much health insurance you can afford out-of-pocket, you’ll need to take into consideration not only your monthly premium amount, but the total medical deductible you are responsible for, any coinsurance you split with your insurance, and copayments for doctor visits. If you require a higher level of care, it’s smart to look at more expensive plans with lower deductibles or select a plan that starts paying 100% after you meet your deductible. You could ultimately pay less for medical treatment overall. 

If you’re healthy overall and typically don’t see a doctor more than once or twice a year, mostly for preventive care, a lower-cost plan with a high deductible could be the most affordable.

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

Having health insurance is always worth it because without it, you are responsible for the full cost of medical services, from routine care to emergency services. When you have health insurance, the company is obligated to fulfill its requirement to protect you, the policyholder, as outlined in the insurance certificate. 

As reputable companies, both Aetna and Cigna would fulfill those requirements and make it worth purchasing a policy from either company. 

Methodology

To compare Aetna and Cigna, we looked at plan structures, network availability, in-network providers, telehealth options, how policies are managed, medical loss ratios, and customer satisfaction ratings to determine which health insurance company was the better choice. 

While Aetna is a strong contender for coverage, Cigna edged out Aetna in nearly every category, with a larger provider base, $0 telehealth, more digital connectivity, and higher customer satisfaction.

Article Sources

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

  2. Kaiser Family Foundation. "Explaining Health Care Reform: Medical Loss Ratio (MLR)." Accessed July 30, 2021.

  3. CMS.gov. "Medical Loss Ratio Search Tool." Accessed July 30, 2021.

  4. National Committee of Quality Assurance. "NCQA Health Insurance Plan Ratings 2019-2020 – Summary Report (Private/Commercial)." Accessed July 23, 2021.

  5. Kaiser Family Foundation. "How the American Rescue Plan Act Affects Subsidies for Marketplace Shoppers and People Who Are Uninsured." Accessed July 30, 2021.