Aetna vs. Blue Cross Blue Shield (2026 Comparison)

Blue Cross Blue Shield sells ACA marketplace health insurance plans in 36 states. Aetna doesn't offer ACA plans in the U.S. anymore.

BCBS States

Alabama, Alaska, Arizona, Arkansas, California, Delaware, Florida, Idaho, Illinois, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wyoming.

BCBS Plan Types

• HMO: You'll need a primary care physician to get referrals for specialists, and coverage stays within the network except in emergencies.
• POS: A primary care physician coordinates care and writes referrals. Out-of-network care is available at higher cost.
• EPO: No referrals needed to see a specialist. Coverage is limited to in-network providers. An EPO allows more flexibility than an HMO but without out-of-network access.
• PPO: No primary care physician or referrals required. You can see in-network and out-of-network providers, where in-network visits cost less.

Aetna sells Medicare Supplement plans in 44 states, generally offering Plans A, B, F, G and N, with Plans C and D available in some states like Vermont and New Jersey. BCBS covers 37 states and adds Plans K, L and M to its lineup. Availability varies by state. Aetna's plan lineup is consistent across state lines. BCBS adds Plans K, L and M where it operates, three options Aetna doesn't sell in any state.

Premium figures are drawn from MoneyGeek's 2026 analysis of Medicare Supplement plan data across both carriers, based on rates for a 65-year-old and 75-year-old nonsmoker.

Aetna doesn't sell Plans K, L or M in any state. Those three plans trade lower premiums for higher out-of-pocket exposure. Plan K requires you to cover 50% of most Medicare-covered costs until you reach the annual out-of-pocket limit.

Shoppers who want a cost-sharing plan or who live in a state where Aetna has no Medicare Supplement presence, should go to BCBS.

Price-focused Medicare Supplement shoppers in states where Aetna operates should look at Aetna first. Plan G costs $312 less per year with Aetna at 65, by 75 that gap grows to $672 annually. BCBS is the right call when you want Plans K, L or M, cost-sharing plans Aetna doesn't sell in any state.

Aetna has Medicare Advantage plans in 44 states across HMO, HMO-POS and PPO plan types. BCBS operates in 31 states and adds PFFS to its lineup. Aetna covers Colorado, Connecticut, Iowa and Kentucky where BCBS has no Medicare Advantage presence. BCBS reaches Idaho, Montana and New Mexico where Aetna doesn't operate.    

BCBS is a network of independent regional companies, not a single national insurer. The CMS star ratings and QRS scores are national averages. Check CMS Plan Finder to see ratings for the specific BCBS plan in your ZIP code.  

• 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
• BCBS Availability: Alabama, Arizona, Arkansas, California, Delaware, Florida, Georgia, Idaho, Illinois, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Washington, West Virginia

Aetna's HMO-POS star rating of 3.41 is its lowest across all three plan types and falls 0.68 points below BCBS's 4.09 on the same plan type. Shoppers who want an HMO-POS plan and need a quality rating above 4.0 stars should choose BCBS. Aetna also doesn't offer PFFS plans. If the ability to see any Medicare-accepting provider without a network requirement matters to your situation, Aetna can't deliver it.

Most Medicare Advantage shoppers who can access Aetna in their county will get better value there. Aetna's $0-premium share is 62% versus BCBS's 41%. Its out-of-pocket maximums are lower on HMO plans ($5,020 vs. $5,292) and PPO plans ($5,168 vs. $6,289).

Aetna also leads BCBS on HMO and PPO star ratings: 4.14 versus 3.73 and 4.05 versus 3.76. Choose BCBS for Medicare Advantage if you want an HMO-POS plan (4.09 stars versus Aetna's 3.41) or if Aetna doesn't operate in your county.