Plan Options & Coverage Types

HMO, PPO, POS, EPO Differences

• Elevance Health: Offers extensive coverage options, including HMO, PPO, POS, and EPO plans. Notably strong in PPO options providing broad flexibility in choosing healthcare providers nationwide.
• CVS Health (Aetna): Also provides a comprehensive selection of plan types including HMO, PPO, POS, and EPO. Aetna is particularly recognized for extensive PPO offerings and streamlined HMO plans with manageable networks.

Individual Plans vs. Employer-Sponsored Plans

• Elevance Health: Robust presence in both individual ACA marketplace and employer-sponsored group plans. Individual plans available under Anthem brand widely in numerous states.
• CVS Health (Aetna): Strong market leader in employer-sponsored group coverage, with solid offerings in individual ACA marketplace plans in selected regions.

Medicare Advantage vs. Medicare Supplement

• Elevance Health: Offers diverse Medicare Advantage plans with comprehensive additional benefits (vision, dental, hearing). Extensive availability of Medicare Supplement (Medigap) plans nationwide.
• CVS Health (Aetna): Highly rated and popular Medicare Advantage plans, known for substantial supplemental benefits and personalized care programs. Aetna also offers competitive Medicare Supplement plans broadly available nationwide.

Medicaid and ACA Marketplace Options

• Elevance Health: Significant presence in Medicaid programs across multiple states, with comprehensive ACA marketplace offerings tailored to affordability and coverage flexibility.
• CVS Health (Aetna): Active participation in Medicaid managed care and selective ACA marketplace states, focusing on accessible and affordable coverage for low-to-moderate-income populations.

Cost & Affordability

Monthly Premiums Comparison

• Elevance Health: Competitive monthly premiums, with PPO plans typically priced slightly higher reflecting provider flexibility, while HMO and EPO plans offer more affordable premiums.
• CVS Health (Aetna): Offers competitive pricing; monthly premiums are comparable or slightly lower for certain PPO and employer-sponsored plans, reflecting broad national provider access.

Deductibles and Copayments

• Elevance Health: Provides varied deductible and copayment structures, typically lower for HMO plans but higher in flexible PPO and POS offerings.
• CVS Health (Aetna): Usually features moderate deductibles and predictable copayments across most plans, especially favored in employer-sponsored coverage.

Out-of-pocket Maximums

• Elevance Health: Moderate-to-low out-of-pocket maximums for HMO/EPO plans; slightly higher limits for PPO and POS plans reflecting broader flexibility.
• CVS Health (Aetna): Offers moderate out-of-pocket maximums, clearly structured, particularly beneficial in its employer-based group plans.

Pricing Transparency

• Elevance Health: Excellent transparency through intuitive online tools clearly outlining plan details, deductibles, premiums, and copayments.
• CVS Health (Aetna): Strong commitment to pricing transparency, clearly presenting costs and coverage details via user-friendly digital tools and detailed online portals.

Network Size & Provider Accessibility

Size and Geographic Reach of Provider Networks

• Elevance Health: Broad nationwide network under Anthem branding, extensive presence in urban and rural areas alike.
• CVS Health (Aetna): One of the largest national provider networks, offering extensive healthcare provider availability nationwide, ideal for frequent travelers or geographically dispersed employer groups.

Specialist Access and Referrals

• Elevance Health: PPO plans allow direct specialist access without referrals; HMO plans require primary care referrals.
• CVS Health (Aetna): Similar flexible specialist access in PPO and POS plans without referrals, whereas HMO plans usually require PCP referrals to specialists.

Availability of In-network Hospitals and Doctors

• Elevance Health: Extensive relationships with high-quality hospitals and specialists nationwide, particularly strong in larger metropolitan regions.
• CVS Health (Aetna): Equally extensive nationwide hospital and physician access, including prominent hospital systems and reputable specialists.

Out-of-network Coverage and Reimbursement Rates

• Elevance Health: Provides favorable out-of-network coverage primarily through PPO plans, typically reimbursing at competitive rates.
• CVS Health (Aetna): Strong out-of-network coverage through PPO/POS offerings, generally offering industry-standard reimbursement rates, enhancing flexibility.

Member Benefits & Perks

Wellness Incentives (Fitness Memberships, Preventive Screenings)

• Elevance Health: Offers comprehensive wellness programs, fitness center discounts, preventive screenings, health coaching, and incentives for healthy behaviors.
• CVS Health (Aetna): Provides extensive wellness initiatives, including fitness discounts, preventive care incentives, access to CVS retail clinics, and health coaching integrated with CVS Pharmacy services.

Chronic Disease Management Programs

• Elevance Health: Robust chronic disease management with personalized care programs for diabetes, cardiovascular conditions, and respiratory diseases, supported by digital tools.
• CVS Health (Aetna): Strong chronic disease management utilizing CVS Pharmacy resources, personalized medication management, and coordinated care, particularly for chronic conditions like diabetes and hypertension.

Telehealth and Virtual Care Offerings

• Elevance Health: Excellent virtual care solutions through platforms like LiveHealth Online, facilitating easy virtual medical and behavioral health consultations.
• CVS Health (Aetna): Robust virtual care capabilities through partnerships (such as Teladoc), integrated seamlessly with CVS Health retail clinics, providing comprehensive telehealth services.

Mental Health Coverage and Services

• Elevance Health: Comprehensive mental health coverage, with wide access to mental health providers, online therapy, psychiatry services, and integrated behavioral health care.
• CVS Health (Aetna): Exceptional mental health support through extensive provider networks, virtual mental healthcare, and strong pharmacy integration for medication management and therapy.

Customer Service & Member Experience

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

• Elevance Health: Generally favorable ratings, performing particularly well in member experience, claims handling, and digital service offerings, though scores vary slightly by region.
• CVS Health (Aetna): Consistently high customer satisfaction ratings, praised for responsiveness, ease of plan management, and user-friendly digital platforms.

Ease of Claims Processing and Disputes

• Elevance Health: Known for efficient claims handling, straightforward dispute resolution, and streamlined administrative processes.
• CVS Health (Aetna): Equally strong in efficient claims processing, easy claims resolution, and proactive customer support.

Quality and Usability of Online Portals/Apps

• Elevance Health: Highly intuitive digital tools, offering seamless claims tracking, provider searches, telehealth integration, and wellness program management.
• CVS Health (Aetna): Exceptional user-friendly mobile app and online portal, featuring pharmacy integration, telehealth access, claims management, and comprehensive wellness resources.

Reputation & Financial Stability

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

• Elevance Health: Strong financial ratings typically “A” or higher, reflecting robust financial stability and extensive market presence.
• CVS Health (Aetna): Equally strong financial ratings (“A” or higher) from leading rating agencies, highlighting consistent financial strength and reliable market leadership.

Company Reputation and Market History

• Elevance Health: Long-established market leader (formerly Anthem) with solid nationwide brand recognition and extensive experience across multiple health insurance sectors.
• CVS Health (Aetna): Established, trusted brand (Aetna, part of CVS Health), recognized for innovation, pharmacy integration, and market leadership, especially in employer-sponsored and Medicare segments.

Consumer Complaints and Regulatory Issues

• Elevance Health: Generally maintains lower-than-average complaint rates, with some occasional regional regulatory issues or network concerns.
• CVS Health (Aetna): Low complaint ratio, minimal regulatory issues, reflecting strong operational management and member satisfaction.

Medicare-specific Criteria

Both insurers offer highly-rated Medicare Advantage plans, extensive supplemental benefits (vision, dental, hearing), strong Medigap availability, and favorable Medicare star ratings (typically 4+ stars).

Employer & Small-Business Focus

Both companies offer customizable employer-sponsored group plans, including fully insured, self-funded, and level-funded options. CVS Health (Aetna) stands out with pharmacy integration and Elevance Health with regional flexibility and extensive wellness initiatives.