Health insurance is health insurance, right?

Not quite.

Every health coverage provider is different. So are the plans they offer and, to a certain extent, so is the quality of providers. This is why comparisons are often difficult. And what makes comparisons even more problematic is that every customer is also different and has different needs or requirements when it comes to healthcare and health insurance coverage.

So, when we approach a topic such as Aetna vs Blue Cross, it is important to keep in mind that it is not so much a matter of “Which is better?” as “Which is better for me?”


Health Insurance as a Battle of the Titans

On one hand, the variety of choices available to employers and individuals looking to acquire healthcare insurance is a plus. Being able to match a provider and a plan that best suits one’s needs is certainly far more desirable than a “one size fits all” health plan.

However, on the other hand, the large number of choices can also be a bit overwhelming and confusing. And how does one go about determining which providers are best overall? 

Currently in California, there are several large health insurers operating in the state and, among them, Aetna and Blue Cross, or Anthem Blue Cross as it is known in California, are among the top five. 


Who Is Aetna?

While Aetna is a national health insurance company and offers policies in every state, it does not rank in the top ten providers in terms of financial size or membership.

In California, Aetna offers coverage to employers in the small and large group markets but is not part of the state’s health marketplace exchange, Covered California, however. Nationally, Aetna has an excellent reputation and has an AM Best “A” financial strength rating.

In 2018, Aetna was acquired by CVS Health, but still provides employer health plans in all 50 U.S. states. The Balance voted Aetna as “Best for Employer-Based Plans” and noted that Aetna also offers affordable private health insurance options and that members also have access to HSA plans.

Additionally, The Balance review goes on to state that,

“There is a large provider network, so members will be able to find an Aetna-approved provider no matter the part of the country they reside in. Network plan options allow members to see an in-network doctor or any licensed doctor, although seeing ​a network doctor will provide the greatest savings. Aetna offers several types of provider plans including HMO, POS, PPO, EPO, and HDHP with HSA.”

Aetna also makes numerous wellness programs available to members that include gym memberships, health coaching, weight-loss programs, and more.

For employers, Aetna group plans allow them to offer full, medium, and narrow-network HMO networks to their employees at the same time. This is a degree of plan flexibility that is unusual in the California market.


A Look at Anthem Blue Cross 

In California, Blue Cross does business as Anthem Blue Cross, which serves as the trade name of Blue Cross of California. As the second-largest medical insurance provider in the United States by total members, Blue Cross serves over 40 million members nationwide.

In California, Anthem Blue Cross provides coverage for more residents than any other health insurance provider in the state at over 8 million members. In addition, Blue Cross has been a part of Covered California from the beginning of the state’s health exchange in 2014.

There are many policy options and Anthem Blue Cross offers HMO, PPO, EPO, and HSA plans for small groups, large groups, and seniors.  Anthem insures more PPO members in California than any other insurance company and their extensive PPO networks include most doctors and hospitals.


Aetna vs Blue Cross – How Do They Rate?

According to the State of California, Office of the Patient Advocate (OPA), for 2020-21, Aetna’s PPO plan ranked as “Fair” overall for the quality of medical care. 

In the area of “Appropriate Use of Tests, Treatments and Procedures” and “Behavioral and Mental Health Care” they were ranked as “Very Good”, and as “Good” for the “Preventive Screenings” category.

All other categories ranked by the OPA including Asthma and Lung Disease Care, Diabetes Care, Heart Care, and Maternity Care all received a “Fair” ranking.

A patient’s rating of their overall experience came out as “Fair” based on the following indicators:

  • Getting Care Easily: Poor
  • Satisfaction with Plan Services: Fair
  • Satisfaction with Plan Doctors: Good

Aetna’s HMO plan for the same period fared better, with an overall ranking of “Good” with the same categories of “Appropriate Use of Tests, Treatments and Procedures” and “Behavioral and Mental Health Care” both scoring “Very Good”, along with “Preventive Screenings.”

In addition, the category of Diabetes Care was considered “Good” as opposed to just “Fair.”

Interestingly, patients rated their overall experience with Aetna’s HMO as “Good” yet scored the “Getting Care Easily” category as “Poor” and “Satisfaction with Plan Doctors” as just “Fair.” The category of “Satisfaction with Plan Services” could not be scored as there were too few patients in the sample to report.

  • [Note: For a more in-depth look at how Anthem Blue Cross and Blue Shield of California fared in the OPA’s report card system, see this article.]

One more source for judging the overall quality of both these health insurance providers is provided by the National Committee for Quality Assurance (NCQA).

Their website, Health Insurance Ratings, ranks health insurance plans based on three broad categories of Customer Satisfaction, Prevention, and Treatment. Here is how they ranked Aetna vs Blue Cross:

Aetna HMO: 3.5 Overall

  • Customer Satisfaction: N/A
  • Prevention: 3.0
  • Satisfaction: 3.0

Aetna PPO: 3.5 Overall

  • Customer Satisfaction: 2.0
  • Prevention: 2.5
  • Satisfaction: 3.0

Blue Cross HMO: 3.5 Overall

  • Customer Satisfaction: 2.0
  • Prevention: 3.5
  • Satisfaction: 3.0

Blue Cross PPO: 3.5 Overall

  • Customer Satisfaction: 2.0
  • Prevention: 3.0
  • Satisfaction: 3.0

As we noted here earlier, while the overall quality and reputation of any health plan provider is critical, the final decision of which company – and plan – to choose rests on far more than this. This is why we strongly recommend making use of a knowledgeable and local resource like J.C. Lewis Insurance to help guide you through the decision-making process.


For Health Insurance in California, We Invite You to Visit J.C. Lewis Insurance

We provide California health insurance plans only from the leading health insurance carriers licensed to do business in California. If you are shopping for coverage for yourself or your employees, you need to look no further than J.C. Lewis Insurance.

As a family-owned and operated California health insurance agent located in beautiful Sonoma County, we specialize in medical insurance plans for small businesses, individuals and families, and for people with Medicare.

We are expert brokers, and we are also licensed and certified by each insurance carrier. This allows us to offer coverage to individuals, families, and small group employers, along with Medicare supplemental and prescription drug plans for seniors.

If you are self-employed, or your employer doesn’t provide health benefits, an individual or family plan may be the best option for you or you and your family.

And, if you are looking to purchase medical insurance coverage for you or your family, you will likely have many questions and concerns. We invite you to contact us with those questions about health coverage insurance and you can be confident that JC Lewis Insurance Services will help you find the right solution.

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