October 19, 2021

Wv Health

Health Simplified

Aetna vs. Blue Cross: Which Should You Choose?

  Monthly Premium Deductible  Maximum Out-of-Pocket Cost 
Blue Cross of Rhode Island $447.63 $3,250 $6,825
Blue Cross of Michigan  $653.29  $3,000  $8,500 
Blue Cross of Arizona  $644.92  $4,000  $8,550

Both companies make it easy to get a personalized quote online. Just keep in mind that for Blue Cross, you have to visit your state’s website in order to get an accurate quote. As an alternative, you can apply through your state’s insurance marketplace to see what Blue Cross and Aetna plans are available with premium subsidies. 


Also, neither company advertises a discounted rate if you purchase a family or couples plan, but choosing a high-deductible policy can help you get a lower monthly premium.  


Aetna vs. Blue Cross: Coverage Limits

Whether you have health insurance through Aetna or Blue Cross, the out-of-pocket coverage limits will depend on the specific policy you buy.

For instance, Aetna’s Level 1 PPO plan has an annual maximum benefit of $15,000 for in-network care, and the Level 2 PPO plan has an annual maximum benefit of $25,000 for in-network care. There are also individual limits for various services and treatments.

With Blue Cross, the coverage limits depend on your state’s plans. In most states, Blue Cross offers Bronze, Silver, and Gold plans with varying out-of-pocket maximums and deductibles. We recommend visiting your state’s Blue Cross website to see the available plans and the amount of coverage they offer.


Aetna vs. Blue Cross: Availability

Aetna and Blue Cross both sell health insurance in all 50 states and Washington, D.C. However, specific plan types and coverage limits will vary depending on location. 


Aetna vs. Blue Cross: Policy Management

Aetna and Blue Cross have standard options for policy management. Both companies have an online member portal that allows you to see your policy information, view the status of claims, and make updates to your plan.

You can get in touch with customer service agents for Aetna and Blue Cross by calling their main phone numbers during business hours. Neither company offers 24/7 support or an online chat feature.

With Aetna and Blue Cross, one of the best ways to manage your policy is through the company’s mobile apps, which are free to download on iOS and Android devices.

Aetna’s app allows you to search for doctors, view your claims, see your plan details, get your ID cards, track your spending, pay approved claims, and even compare costs for medical visits and procedures.

Blue Cross has a different app for each state, and the app features vary. At a minimum, you can find an in-network doctor or urgent care facility, access your claims, download your ID cards, view your policy information, and check your deductible and HSA balance. In some states, the app also allows you to pay your bills, research drug prices, submit out-of-network claims, and get connected with the 24-hour nurse hotline. 


Aetna vs. Blue Cross: Policyholder Experience

Overall, Aetna and Blue Cross have some concerning reviews from current and past policyholders. For both companies, many customers have complained about billing issues, slow claim payouts, and denied claims. Aetna specifically has a number of negative reviews related to its customer support agents. 

We also came across ratings for Blue Cross and Aetna in J.D. Power’s 2020 U.S. Medicare Advantage Study, which ranks insurance companies that offer Medicare Advantage plans based on coverage and benefits, cost, customer service, and more. 

Aetna was rated below average for overall customer satisfaction in J.D. Power’s study, as was Blue Cross of Michigan, the only local Blue Cross company rated. J.D. Power does not publish a study for private individual health insurance companies. 


Aetna vs. Blue Cross: Enrollment Process

To enroll in an individual health insurance plan from Blue Cross, you’ll have to do so during the annual open enrollment period. However, you can also purchase coverage outside of open enrollment if you have experienced a qualifying life event. Examples include giving birth, getting married, losing employer-sponsored coverage, getting divorced, and moving to a new state.

If you apply for coverage because you have experienced a qualifying life event, Blue Cross will ask to see documentation verifying the event. So, for instance, if you had a baby, your child’s birth certificate would be sufficient. If you lost your job, you could provide a letter of termination from your previous insurance company. 

If you qualify for Medicare, you can purchase an Aetna plan during the specific Medicare open enrollment period, which is separate from the individual open enrollment period. If you already receive Social Security benefits, you won’t need to verify your eligibility. However, if you are not receiving retirement benefits, or if you qualify for Medicare due to a disability, you will likely need to provide some documentation that proves you qualify for coverage.

Aetna and Blue Cross both offer online quotes and, in some cases, you can purchase a policy through the website. We found the online experience for both companies to be pretty good, but some Blue Cross states have a more outdated website than others. 


Frequently Asked Questions

How Do I Enroll for an Aetna or Blue Cross Health Insurance Policy? 

Aetna and Blue Cross both allow prospective customers to get a policy and purchase coverage online, depending on the state and the policy you want. 

To get an individual or family plan through Blue Cross, you’ll need to sign up during the annual open enrollment period, unless you have recently experienced a qualifying life event, such as giving birth or getting divorced.

To get a Medicare plan through Aetna, you’ll also have to sign up during the special open enrollment period, unless you meet certain circumstances, like moving to another state or losing your existing coverage.

Once you choose a plan and buy a policy, your coverage will begin after a short waiting period. 

Is It Worth Buying Private Health Insurance Through Aetna or Blue Cross? 

Getting private health insurance can be a good option, but it’s not the right choice for everyone. Part of it depends on the type of coverage you can qualify for.

For instance, the cost of private individual coverage through Blue Cross is likely more expensive than the cost of employer-sponsored coverage. If you are shopping for coverage on a budget, opting into your employer’s group health insurance plan is probably a cheaper option.

However, the downside is that employer-sponsored insurance limits the plans you can get. If you need specific coverage or a high amount of coverage, a private individual plan will give you more freedom and flexibility to choose a policy that meets your unique needs. And if you’re self-employed, your only option is private coverage, unless you can get insurance through your spouse.

If you qualify for Medicare, it’s a different story. Medicare is typically less expensive than private individual health insurance, and many people can qualify for a $0 premium for Medicare Part A. Because of that, purchasing a Medicare plan through Aetna is a good option for some people.

A lower-cost alternative to private health insurance is a Health Savings Account (HSA) or Flexible Spending Account (FSA), which act like a savings account that you can use to pay for certain medical costs. Both Aetna and Blue Cross offer these plans.

Keep in mind that although health insurance is no longer mandatory at the federal level, some states still impose a tax penalty on uninsured residents. Additionally, not having health insurance means you are responsible for paying 100% of your medical fees out-of-pocket, whether it’s an annual checkup or a major surgery.

What Type of Health Insurance Plan Should I Get? 

There are many different types of health insurance plans, and Blue Cross and Aetna offer most of them. Some of the most common types of health insurance are PPO, HMO, and POS plans.

With an HMO plan, your coverage is only valid in-network, which limits the providers you can visit. With a PPO plan, you can choose any provider you want, whether they are in-network or out-of-network. POS plans are a hybrid between a PPO and an HMO. It allows you to get out-of-network care, but you are usually responsible for some of the costs.

The best health insurance plan for you depends on the type of coverage you want and your budget. For instance, if you want peace of mind knowing that you can see almost any provider, anywhere, go for a PPO plan. If you rarely see the doctor and care more about paying a low premium, an HMO might be a better choice. And if you want the best of both worlds, a POS plan could work for you, just know that you will have to pay a portion of the out-of-network care costs.


Methodology

To review Aetna and Blue Cross, we focused on some of the most important factors to consider when comparing health insurance companies. For each provider, we looked at the policies available, the cost of coverage, the coverage limits for various plans, the policy management tools, the overall customer experience, and the enrollment process. We also paid attention to the network size and area of availability for both companies.