Aetna vs. Anthem (2026 Comparison)

See how Aetna and Anthem stack up across ACA marketplace plans, Medicare Advantage and Medicare Supplement options to decide which company is best for you.

Compare health insurance quotes from top companies.

Written by Mark Fitzpatrick

Updated: June 30, 2026

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Aetna vs. Anthem: ACA Health Insurance

As of January 1, 2026, Aetna no longer offers ACA marketplace plans. Anthem is now the only option between the two for ACA health insurance coverage. Anthem operates in 13 states and offers HMO, EPO, POS and PPO plans, with an average Quality Rating System score of 83.3.

When we reviewed Aetna and Anthem across all three health insurance product lines in our analysis, the clearest pattern was coverage breadth. Aetna operates in more states, carries more plan types and earns higher CMS Star Ratings across every Medicare Advantage plan category. Anthem's two edges are PPO monthly premiums and HMO-POS out-of-pocket limits. For ACA coverage, Anthem is now the sole option.

Anthem's average ACA denial rate of 22.7% is nearly five percentage points above the national average of 18%. On a plan you're choosing partly because the premiums are manageable, a denial rate 4.7 percentage points above average means more claims rejected at the point of care. In my view, for anyone with a chronic condition or regular prescriptions, it's the number that should be driving the ACA decision, not premium alone.


Availability	N/A	13 States
Plan Types	N/A	HMO, EPO, POS, PPO
Avg. QRS Score	N/A	83.3
Avg. Denial Rate	N/A	22.7%

Anthem is the only option here, so the question isn't which carrier wins, it's whether Anthem's pricing is worth accepting. In our analysis, Anthem's HMO rate of $683 per month is only $5 above the national average. That's a manageable gap. The PPO at $874 is $71 above the national average, which adds up to $852 per year in premium above what the average PPO buyer pays elsewhere. If you need PPO flexibility and live in one of Anthem's 13 states, compare Anthem's PPO against Bronze or Silver HMO options, for some buyers, the trade-off doesn't pencil out.

ACA State Availability
N/A
California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Wisconsin
Plan Types
N/A
HMO, EPO, POS, PPO
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 Aetna has withdrawn from the individual market and no longer provides ACA plans.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.
HMO
N/A
$683
$678
EPO
N/A
$777
$731
POS
N/A
$806
$752
PPO
N/A
$874
$803
Anthem's premiums run above the national average across all four plan types. The gap is narrowest for HMOs at $5 per month over the national average, but widens to $71 per month for PPOs. In our analysis, Anthem's PPO pricing is the furthest from the national benchmark of any plan type it offers — worth weighing if you need that network flexibility.
Overall QRS Score
N/A
83.3
Medical Care QRS Score
N/A
82.23
Member Experience QRS Score
N/A
88.99
Plan Administration QRS Score
N/A
81.9
Avg. Denial Rate
N/A
22.7%
Anthem's strongest QRS score is member experience at 88.99, while plan administration is its weakest at 81.9. Its 22.7% average denial rate sits above the national average of 18%.

Anthem's 4.7-percentage-point denial rate gap above the national average hits hardest for policyholders with chronic conditions or frequent care needs, who are more likely to file the kinds of claims Anthem rejects at above-average rates.


ACA State Availability	N/A	California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Wisconsin
Plan Types	N/A	HMO, EPO, POS, PPO


HMO	N/A	$683	$678
EPO	N/A	$777	$731
POS	N/A	$806	$752
PPO	N/A	$874	$803


Overall QRS Score	N/A	83.3
Medical Care QRS Score	N/A	82.23
Member Experience QRS Score	N/A	88.99
Plan Administration QRS Score	N/A	81.9
Avg. Denial Rate	N/A	22.7%

Aetna vs. Anthem Medicare Supplement

Aetna is the stronger choice for Medicare Supplement plans, offering seven plan types across 44 states compared to Anthem's four plans in 12 states. Both use Attained Age pricing, meaning premiums increase as you age. Aetna also has high-deductible versions of Plans F and G, while Anthem doesn’t.


Availability	44 States	12 States
Plan Types	A, B, C, D, F, G, N	A, F, G, N
High-Deductible F and G	Yes	No
Dominant Pricing Style	Attained Age	Attained Age

Aetna sells Medicare Supplement plans in 44 states, covering far more ground than Anthem's 12 states. Aetna also has a broader plan lineup, including Plans B, C and D that Anthem doesn't carry. Plan N is available from Aetna in most states but absent from both providers’ Ohio catalogs.


Alabama	A, B, F, G, N	N/A
Alaska	A, F, G, N	N/A
Arizona	A, B, F, G, N	N/A
Arkansas	A, F, G, N	N/A
California	A, B, F, G, N	A, F, G, N
Colorado	A, B, F, G, N	A, F, G, N
Connecticut	N/A	A, F, G, N
Delaware	A, B, F, G, N	N/A
Florida	A, B, F, G, N	N/A
Georgia	A, F, G, N	A, F, G, N
Idaho	A, B, F, G, N	N/A
Indiana	A, B, F, G, N	A, F, G, N
Iowa	A, B, F, G, N	N/A
Kansas	A, B, F, G, N	N/A
Kentucky	A, B, F, G, N	A, F, G, N
Louisiana	A, B, F, G, N	N/A
Maine	N/A	A, F, G, N
Maryland	A, B, F, G, N	N/A
Michigan	A, B, F, G, N	N/A
Minnesota	Meets state standards	N/A
Mississippi	A, B, F, G, N	N/A
Missouri	A, B, F, G, N	A, F, G, N
Montana	A, B, F, G, N	N/A
Nebraska	A, B, F, G, N	N/A
Nevada	A, B, F, G, N	A, F, G, N
New Hampshire	A, B, F, G, N	A, F, G, N
New Jersey	A, B, C, D, F, G, N	N/A
New Mexico	A, F, G, N	N/A
North Carolina	A, B, F, G, N	N/A
North Dakota	A, B, F, G, N	N/A
Ohio	A, B, F, G	A, F, G
Oklahoma	A, B, F, G, N	N/A
Oregon	A, B, F, G, N	N/A
Pennsylvania	A, B, F, G, N	N/A
Rhode Island	A, F, G, N	N/A
South Carolina	A, B, F, G, N	N/A
South Dakota	A, B, F, G, N	N/A
Tennessee	A, B, F, G, N	N/A
Texas	A, B, F, G, N	N/A
Utah	A, B, F, G, N	N/A
Vermont	A, B, C, D, F, N	N/A
Virginia	A, B, F, G, N	N/A
West Virginia	A, B, F, G, N	N/A
Wisconsin	Medigap Basic Plan	Medigap Basic Plan
Wyoming	A, B, F, G, N	N/A


A	$206	$360	$242	$406
B	$244	N/A	$286	N/A
C	$276	N/A	$325	N/A
D	$217	N/A	$250	N/A
F	$185	$294	$215	$379
G	$144	$218	$169	$273
N	$172	$198	$206	$254

Aetna's Medicare Supplement rates are lower than Anthem's at every shared plan level. The gap is widest for Plan A: at age 65, Aetna's $206 per month is $154 less than Anthem's $360. Plan G, the most popular Medigap option, runs $74 cheaper per month with Aetna at 65 and $104 cheaper by age 75.

Plan N is the closest matchup, with only a $26 monthly gap at age 65. If Plan N fits your coverage needs and you live in one of the 12 states where Anthem operates, it's worth getting quotes from both insurers. Elsewhere, Aetna's pricing advantage is clear.

Aetna's state availability is broad, 44 states, but not universal. Connecticut, Maine and a handful of other states are Aetna gaps where Anthem actually fills the void. Check availability in your state before ruling either insurer out.

The lower monthly premium looks attractive, but if you use care frequently, you may spend more out-of-pocket before your Medigap coverage takes effect than you'd save on premiums. Run the numbers against your actual care use before choosing the high-deductible version.
Anthem's Medicare Supplement footprint covers only 12 states, so most beneficiaries won't have access to it at all. For those who do, the more meaningful issue is cost. Anthem's Plan G premium at age 65 is $74 per month above Aetna's rate for the same plan, $888 more per year on a plan that covers identical standardized benefits.

Anthem also doesn't offer Plans B, C or D, which limits your options if those plan types align better with your coverage needs. If you want the high-deductible version of Plan F or G, Anthem won't have it. Aetna carries both. The only realistic reason to choose Anthem for Medigap is if Plan N is your target and you want to compare a second quote, the $26 monthly gap at 65 is the narrowest in our data.

Aetna vs. Anthem Medicare Advantage

Aetna is also the better Medicare Advantage option, with broader availability across 43 states compared to Anthem's 12 and a higher average CMS Star Rating of 3.88 versus 3.56. Its $0 premium share is also wider: 62% of Aetna plans carry no monthly cost, versus 44% for Anthem. Both insurers offer HMO, HMO-POS and PPO plan types with enhanced drug benefits.


Availability	43 States	12 States
Plan Types	HMO, HMO-POS, PPO	HMO, HMO-POS, PPO
Avg. CMS Star Rating	3.88	3.56
Drug Benefits	Enhanced	Enhanced
% $0 Premium Plans	62%	44%

Aetna's Medicare Advantage plans are available in 43 states, covering most of the country. Anthem operates in just 12 states, all of which overlap with Aetna's footprint. Aetna is an option anywhere Anthem is. Both companies sell HMO, HMO-POS and PPO plans, though your options vary by state.
- Aetna Availability: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin
- Anthem Availability: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, Nevada, New York, Ohio, Virginia, Wisconsin


HMO	76%	40%	$7	$29	$5,020	$7,890
HMO-POS	66%	68%	$6	$13	$5,643	$5,205
PPO	56%	0%	$88	$37	$5,168	$7,183

For HMO plans, Aetna is the better value. Its $7 average monthly premium and $5,020 maximum out-of-pocket limit both beat Anthem's $29 premium and $7,890 MOOP by a wide margin. The math is straightforward: Aetna costs $264 less per year in premiums and exposes you to up to $2,870 less in worst-case costs.

HMO-POS plans are the one category where Anthem competes on out-of-pocket exposure. Anthem's $5,205 average MOOP is $438 lower than Aetna's $5,643, though Aetna still wins on monthly premium ($6 vs. $13).

Anthem's $37 average monthly premium is $51 less than Aetna's $88, a real savings of $612 per year if you don't hit your limit. But Anthem's average MOOP for PPO plans is $7,183, almost $2,015 above Aetna's $5,168. If you use your PPO coverage heavily in a given year, Aetna's lower ceiling provides better protection.

HMO
4.14
3.89
HMO-POS
3.41
3.3
PPO
4.05
3.8
Aetna earns higher CMS Star Ratings than Anthem across all three Medicare Advantage plan types. The gap is widest for HMOs, where Aetna averages 4.14 stars versus Anthem's 3.89, a 0.25-point spread that represents a meaningful quality difference in CMS's scoring system.

HMO-POS is the weakest category for both insurers, with Aetna at 3.41 and Anthem at 3.30. If you're comparing HMO-POS plans specifically, neither carrier is at its strongest, worth knowing before you commit.
Aetna's PPO plans carry an average monthly premium of $88, compared to Anthem's $37. For a beneficiary confident they won't hit their maximum out-of-pocket limit in a given year, Aetna's higher PPO premium represents real money: $612 per year more than Anthem's average.

For HMO-POS plans, Anthem's average MOOP of $5,205 is $438 lower than Aetna's $5,643. In a year where you use care heavily, Anthem's lower ceiling offers better cost protection in this specific plan category. Neither insurer is the clear choice for every HMO-POS enrollee, run the numbers against your care use before choosing.
Anthem doesn't offer any PPO plans with a $0 premium, every Anthem PPO charges a monthly cost, and at an average of $37 per month. For beneficiaries who want PPO flexibility without a premium, Aetna is the better fit: 56% of its PPO plans carry no monthly cost.

Anthem's state footprint for Medicare Advantage is also limited to 12 states. If you don't live in one of those states, Anthem isn't an option regardless of its pricing. And for anyone prioritizing quality ratings, Aetna's higher CMS Star scores across all three plan types, by margins of 0.11 to 0.25 stars, reflect a consistent quality gap that shows up in every plan category Anthem offers.


HMO	4.14	3.89
HMO-POS	3.41	3.3
PPO	4.05	3.8

Bottom Line

Aetna is the stronger choice for most people comparing these two insurers. In our analysis, it offers broader state availability, lower premiums and higher CMS Star Ratings across Medicare Advantage, and its Medicare Supplement rates are cheaper than Anthem's at every shared plan level.

For ACA coverage, Anthem is your only option between the two. Aetna exited the marketplace on January 1, 2026. Anthem's 22.7% denial rate is above the national average, worth factoring in if you have frequent care needs.

For Medicare Advantage PPOs, Anthem's lower monthly premium ($37 vs. $88) is worth considering if you're healthy and unlikely to hit your annual limit. But Aetna's $2,015 lower average MOOP for PPO plans provides better protection in a high-use year. Get quotes from both if you're in one of Anthem's 12 states, the right answer depends on how much care you actually use.

FAQ: Anthem vs. Aetna

Aetna is the stronger choice for both Medicare Supplement and Medicare Advantage. It sells seven Medigap plan types across 44 states versus Anthem's four plans in 12 states, and its premiums are lower at every shared plan level. For Medicare Advantage, Aetna earns higher CMS Star Ratings across all three plan types and covers 62% of its plans with a $0 premium versus Anthem's 44%. Anthem's two Medicare edges are a lower average MOOP for HMO-POS plans ($5,205 vs. $5,643) and lower PPO monthly premiums ($37 vs. $88).

No. Aetna exited the ACA individual marketplace on January 1, 2026. Anthem is the only option between these two insurers for ACA coverage. Anthem sells marketplace plans in 13 states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio and Wisconsin.

Anthem's average ACA denial rate is 22.7%, which is 4.7 percentage points above the national average of 18%. Aetna no longer participates in the ACA marketplace in 2026, so a direct side-by-side comparison isn't possible this year. Anthem's denial rate is the figure worth checking first if you have frequent care needs or a chronic condition.

Aetna's Plan G costs $144 per month on average for a 65-year-old, compared to Anthem's $218, a $74 monthly difference, or $888 per year. The benefits are identical under both plans because federal law standardizes Medicare Supplement coverage by plan letter. By age 75, Aetna's Plan G is $169 per month versus Anthem's $273, a $104 monthly gap.

No. Anthem's Medicare Supplement plans are sold in only 12 states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio and Wisconsin. Aetna covers 44 states. In Wisconsin, both carriers operate under the state's Medigap Basic Plan structure rather than the standard federal plan letter system. Check availability in your state before comparing quotes from either insurer.

About Mark Fitzpatrick

Mark Fitzpatrick, a licensed Property and Casualty (P&C) Insurance Producer in Connecticut, is MoneyGeek's resident insurance expert. He has spent nearly a decade analyzing the market, first at LendingTree and now at MoneyGeek, where he produces original research on hundreds of carriers and millions of rates across auto, home, renters, health and life insurance.

He covers economics and insurance at MoneyGeek, and his work has been featured in The Washington Post, The New York Times and NPR, among other outlets.

Like all MoneyGeek analysts, he draws on independent cost and consumer experience data. No insurance company partnership influences his recommendations.

Mark holds a B.A. from Boston College and an M.A. in Economics and International Relations from Johns Hopkins University. He started his career in financial risk management at State Street and is also a five-time “Jeopardy!” champion.

Read Full Bio »

Sources

CMS.gov. "What are you looking for today?." Accessed July 10, 2026.
HealthCare.gov. "Welcome to the Health Insurance Marketplace." Accessed July 10, 2026.
Medicare.gov. "Welcome to Medicare." Accessed July 10, 2026.

Aetna vs. Anthem (2026 Comparison)

Aetna vs. Anthem: ACA Health Insurance

Plan & State Availability

Pricing

Customer Experience

Aetna vs. Anthem Medicare Supplement

Plan & State Availability

Pricing

When to Avoid Aetna Medicare Supplement

When to Avoid Anthem Medicare Supplement

Aetna vs. Anthem Medicare Advantage

Plan & State Availability

Pricing

CMS Star Ratings

When to Avoid Aetna Medicare Advantage

When to Avoid Anthem Medicare Advantage

Bottom Line

FAQ: Anthem vs. Aetna

Is Aetna or Anthem better for Medicare?

Does Aetna offer ACA marketplace plans in 2026?

What is Anthem's denial rate compared to Aetna's?

Which insurer has cheaper Medicare Supplement Plan G?

Is Anthem's Medicare Supplement available outside its 12 states?

Related Pages

Sources