Plan Options & Coverage Types

HMO, PPO, POS, EPO Differences

• Aetna: Offers extensive plan variety, including HMO, PPO, POS, and EPO options nationwide. PPO plans provide broad network access and flexibility in provider choice, while HMO plans emphasize coordinated care with required referrals.
• Cigna: Primarily offers PPO and HMO plans with wide network access, catering to employer groups and individuals seeking flexibility. PPO options are popular for their expansive networks without referral requirements.

Individual Plans vs. Employer-Sponsored Plans

• Aetna: Strong in employer-sponsored coverage, providing comprehensive solutions tailored for large and small businesses. Offers individual plans through ACA marketplace exchanges selectively by region.
• Cigna: Also highly competitive in employer-sponsored plans, known for strong group insurance and international coverage. Offers individual ACA marketplace plans primarily in selected states and regions.

Medicare Advantage vs. Medicare Supplement

• Aetna: A top provider of Medicare Advantage plans known for excellent member satisfaction, high star ratings, and extensive supplemental benefits (vision, dental, hearing). Offers widespread Medicare Supplement (Medigap) coverage options nationally.
• Cigna: Offers competitive Medicare Advantage plans featuring good supplemental benefits, personalized care coordination, and moderate-to-good star ratings. Provides extensive Medicare Supplement (Medigap) coverage nationwide, highly competitive in terms of cost and benefit structures.

Medicaid and ACA Marketplace Options

• Aetna: Participates selectively in Medicaid programs and ACA marketplace options, focusing on affordable, accessible coverage for lower- and moderate-income populations.
• Cigna: Limited Medicaid presence; offers ACA marketplace coverage selectively, catering primarily to individual consumers in certain states.

Cost & Affordability

Monthly Premiums Comparison

• Aetna: Offers competitively priced premiums, typically moderate to slightly higher due to broader PPO coverage flexibility, though highly competitive in employer-sponsored markets.
• Cigna: Premiums generally moderate-to-high, reflecting expansive networks and flexibility, especially popular among employer-sponsored groups.

Deductibles and Copayments

• Aetna: Provides flexible and clearly structured deductibles and copayments, particularly favorable for employer-sponsored plans.
• Cigna: Offers moderate-to-high deductibles and copayments, reflecting wide network flexibility and extensive provider access.

Out-of-pocket Maximums

• Aetna: Generally moderate out-of-pocket maximums, structured clearly and competitively across its PPO and HMO plans.
• Cigna: Out-of-pocket maximums tend to be moderate, clearly outlined, though potentially higher in PPO plans with broader provider choice.

Pricing Transparency

• Aetna: Known for strong pricing transparency, clearly outlining plan benefits, copays, deductibles, and premiums through intuitive online tools.
• Cigna: Offers excellent transparency in pricing, especially through their robust online comparison tools and digital platforms, providing clarity for members.

Network Size & Provider Accessibility

Size and Geographic Reach of Provider Networks

• Aetna: Extensive national network, one of the largest in the industry, ensuring broad availability of hospitals and doctors nationwide. Particularly beneficial for large employer groups and individuals who travel frequently.
• Cigna: Large nationwide provider network with significant international access, particularly suitable for businesses requiring global coverage and for frequent travelers.

Specialist Access and Referrals

• Aetna: PPO plans typically allow direct access to specialists without referrals, while HMO plans require primary care referrals.
• Cigna: Similarly flexible, with PPO plans allowing direct specialist visits without referrals; HMO plans require referrals from primary care physicians.

Availability of In-network Hospitals and Doctors

• Aetna: Extensive national network including top-rated hospitals, renowned specialists, and widespread provider options across both urban and rural settings.
• Cigna: Robust national network including strong relationships with leading hospitals and physicians, providing exceptional choice and coverage particularly beneficial to employer-sponsored members.

Out-of-network Coverage and Reimbursement Rates

• Aetna: Provides extensive out-of-network coverage in PPO/POS plans, typically offering competitive reimbursement rates nationwide.
• Cigna: Strong out-of-network coverage in PPO plans, particularly beneficial for members requiring frequent travel or specialist flexibility, offering competitive reimbursement rates.

Member Benefits & Perks

Wellness Incentives (Fitness Memberships, Preventive Screenings)

• Aetna: Comprehensive wellness incentives, including fitness memberships, preventive care screenings, and health coaching, integrated through CVS Health resources and services.
• Cigna: Extensive wellness programs, fitness incentives, preventive care, health coaching, and significant integration with employer wellness programs.

Chronic Disease Management Programs

• Aetna: Outstanding chronic care management leveraging CVS pharmacy integration, personalized medication adherence programs, remote monitoring, and care coordination.
• Cigna: Robust chronic condition management, providing comprehensive support, personalized care plans, and proactive interventions for conditions like diabetes, cardiovascular diseases, and asthma.

Telehealth and Virtual Care Offerings

• Aetna: Comprehensive telehealth offerings via partnerships with Teladoc, providing broad access to virtual consultations, including behavioral health services.
• Cigna: Strong telehealth offerings primarily through MDLIVE, providing nationwide virtual access to medical professionals, behavioral health, and wellness coaching.

Mental Health Coverage and Services

• Aetna: Extensive mental health services through broad provider networks, virtual therapy options, and CVS Health resources for medication management and comprehensive behavioral health solutions.
• Cigna: Highly rated mental health coverage, including extensive provider networks, proactive employer wellness integration, virtual behavioral health services, and mental wellness programs.

Customer Service & Member Experience

Customer Satisfaction Ratings (J.D. Power, NCQA)

• Aetna: Generally high customer satisfaction ratings, praised for digital engagement, claim processing efficiency, and member-centric support.
• Cigna: Solid customer satisfaction ratings overall, frequently noted for international coverage and employer-sponsored group service excellence.

Ease of Claims Processing and Disputes

• Aetna: Highly efficient claims processing, user-friendly digital experience, minimal disputes, and easy resolution procedures.
• Cigna: Similarly efficient claims management, though occasional complexities can occur with certain international or self-funded employer plans.

Quality and Usability of Online Portals/Apps

• Aetna: Excellent digital platforms; highly intuitive mobile app and online portal with robust health management tools, pharmacy integration, and telehealth accessibility.
• Cigna: User-friendly digital portals and apps, comprehensive wellness resources, claims tracking, and telehealth integration, particularly strong for employer-sponsored members.

Reputation & Financial Stability

Financial Strength Ratings (A.M. Best, Moody’s, S&P)

• Aetna (CVS Health): Strong financial ratings (“A” category), reflecting consistent financial stability and nationwide market leadership.
• Cigna: Equally robust ratings (A to A+ range), reflecting strong financial stability, particularly within global operations and employer-sponsored markets.

Company Reputation and Market History

• Aetna: Well-established, trusted brand with long history, now backed by CVS Health’s resources, recognized for innovation and integration of pharmacy and medical services.
• Cigna: Established global insurer with strong reputation for comprehensive employer-sponsored and international coverage solutions, dating back to the late 18th century.

Consumer Complaints and Regulatory Issues

• Aetna: Generally lower-than-average complaint ratio, with minimal regulatory issues due to proactive customer care and claims efficiency.
• Cigna: Also maintains lower complaint rates with few regulatory concerns, though some complexity occasionally arises within self-funded employer-sponsored plans.

Medicare-specific Criteria

• Aetna: Top-tier Medicare Advantage plans with consistently high Medicare Star Ratings (4+ stars), extensive supplemental benefits (vision, dental, hearing), and widespread Medigap availability nationwide.
• Cigna: Quality Medicare Advantage options with moderate-to-high star ratings, comprehensive supplemental benefits, and broad Medigap availability, though slightly narrower benefits than Aetna.

Employer & Small-Business Focus

Both companies excel in employer-sponsored health plans, offering fully insured, self-funded, and customizable plans. Aetna excels with integrated pharmacy services, while Cigna emphasizes international and employer wellness integration.