Aetna vs. Anthem (2026 Comparison)

Anthem offers ACA marketplace coverage in 13 states, with plan choices including HMO, EPO, POS and PPO network options. Aetna has withdrawn from the individual market and no longer provides ACA plans.

• HMO plans: You’ll need to stay in-network for care and get referrals to see a specialist.
• EPO plans: Referrals aren’t required to visit specialists, but services must still stay in- network to be covered.
• POS plans: These plans combine features of HMOs and PPOs, requiring a primary care physician while still allowing some out-of-network care at a higher cost.
• PPO plans: You can see specialists without referrals and have the option to go out of network, though you’ll pay less when you stay in-network.

Anthem's health insurance premiums are above the national average across all four plan types. HMOs are the most affordable at $683 per month, at $5 over the national average. Costs climb from there, with PPOs reaching $874 per month, $71 above the national average and the most expensive option.

Anthem earns its highest Quality Rating System (QRS) scores in member experience, scoring 88.99, while plan administration is its weakest area at 81.9. Anthem's 22.7% average denial rate is also above the national average 18%

Both insurers use Attained Age pricing, so premiums increase as you get older, but Aetna's Medicare Supplement rates are lower than Anthem's across every shared plan type. At age 65, Aetna's Plan G costs $144 per month on average versus Anthem's $218, a $74 difference. By age 75, Aetna's Plan G is $169 compared to Anthem's $273. Plan F shows a similar pattern, with Aetna running $109 cheaper at 65. Plan N is the closest matchup, with just a $26 difference for 65-year-olds. Aetna also covers Plans B, C and D, which Anthem doesn't offer at all.

Aetna is more affordable for HMO plans, with a much stronger share of $0 premium options and lower overall out-of-pocket exposure. For HMO-POS plans, the two insurers are more closely matched, offering comparable $0 premium availability, though Anthem out-of-pocket limits are lower on average. PPO plans present a clearer tradeoff. Anthem charges lower monthly premiums, but Aetna gives much greater protection against high medical costs. If you want the lowest monthly cost, Anthem's PPO premium of $37 beats Aetna's $88. But if cost protection is more important to you, Aetna's MOOP of $5,168 is nearly $2,000 lower than Anthem for PPO plans.

Aetna outscores Anthem on CMS Star Ratings across all three Medicare Advantage plan types. The gap is widest for HMOs, where Aetna averages 4.14 stars versus Anthem's 3.89. PPOs follow a similar pattern at 4.05 versus 3.80. HMO-POS plans are the weakest category for both insurers, with Aetna at 3.41 and Anthem at 3.30.