Health insurance can be confusing, with so many providers promising low costs and great coverage. Two big names in the game are Aetna and CareFirst. But how do these insurance giants compare when it comes to reputation, costs, and coverage?
This comprehensive guide examines the pros, cons, features, and key differences between Aetna and CareFirst to help you make an informed choice.
A Brief Comparison Table
| Feature | Aetna | CareFirst |
| Coverage Area | National | Mid-Atlantic states |
| Plan Options | HMO, PPO, POS, HDHP, Student | HMO, PPO, POS, HDHP, Medicare Advantage, Medicaid |
| Provider Network | 1.2 million doctors, 6,000 hospitals nationwide | 50,000+ doctors, hospitals in MD, DC, VA region |
| Average Monthly Premiums | Higher nationally | Lower for comparable plans in service regions |
| Prescription Coverage | Generic preferred, mail order discounts | Generic preferred |
| Telehealth Benefits | Copays for Teladoc consultations | Covered in full with office visit copay |
| Customer Service | Mixed reviews, complaints of long waits | Mixed reviews, complaints of unhelpful service |
| Member Resources | Sydney app and member site | Member site and app |
| Financial Strength | A (Excellent) rating from A.M. Best | A (Excellent) rating from A.M. Best |
Aetna Health Insurance Overview
Founded in 1853, Aetna is one of the largest health insurers in the United States, providing medical, dental, vision and other insurance products. Some key facts about Aetna:
- Serves over 39 million members nationwide across employer-sponsored, individual, and government-sponsored plans.
- Offers comprehensive HMO, PPO, POS, and HDHP plans with access to extensive provider networks.
- Operates in all 50 states plus Washington D.C.
- Received an “A” (Excellent) financial strength rating from A.M. Best.
Aetna Pros
- Large national provider network with over 1.2 million doctors and 6,000 hospitals. Getting in-network care is easy with Aetna.
- Digital tools like the Sydney Health mobile app with AI features to find care and manage benefits.
- Preventive care like routine physicals and cancer screenings covered at no charge on most plans.
- Discount programs provide savings on vision, fitness, alternative medicine, and more.
- Strong financial footing and long history as an established insurance provider.
Aetna Cons
- Received more consumer complaints than some competitors according to the National Association of Insurance Commissioners (NAIC).
- Doesn’t offer plans on the Affordable Care Act federal exchange.
- Mixed reviews for customer service, with some complaints of long waits and unhelpful reps.
Carefirst Health Insurance Overview
CareFirst is a not-for-profit health insurer focused in the mid-Atlantic region, Washington D.C., and Northern Virginia. Highlights include:
- Provides health insurance products to over 3.4 million members in Maryland, D.C., Virginia, and Delaware.
- Offers HMO, PPO, POS, HDHP, Medicare Advantage, and Medicaid plans.
- CareFirst Direct extends coverage nationwide for those needing broader provider access.
- Rated “A” (Excellent) by A.M. Best for financial strength.
CareFirst Pros
- Provider networks include over 50,000 doctors, specialists, and hospitals regionally. Convenient for mid-Atlantic residents.
- BlueRewards program offers discounts on fitness gear, gym memberships, vision care, alternative medicine, and more.
- Telehealth services fully covered with no out-of-pocket costs on most plans.
- Strong regional brand reputation and customer loyalty.
CareFirst Cons
- Primarily operates in mid-Atlantic region, with narrower nationwide coverage through affiliate Blue Cross Blue Shield providers.
- Mixed customer reviews regarding claims processing and reimbursement delays.
- Higher pricing for plans compared to some competitors.
Aetna And Carefirst: Key Feature Comparison
How do Aetna and CareFirst stack up when you look at coverage, costs, provider access, and other key factors? Here’s an overview:
- Health plan options – Both offer comprehensive selection of HMO, PPO, POS, HDHP and more. Aetna also provides student health insurance. CareFirst offers some Medicaid plans.
- Provider network – Aetna has the broader national network while CareFirst is stronger regionally in mid-Atlantic states. Those needing nationwide access may prefer Aetna.
- Prescription coverage – Prescriptions covered on all non-catastrophic plans. Generics preferred on formulary lists. Aetna offers mail order discounts.
- Costs and discounts – Average monthly premiums can be lower for CareFirst for comparable plans. Both offer programs for discounts on vision, dental, fitness, and alternative medicine services.
- Telehealth – Aetna covers Teladoc while CareFirst includes telehealth with office visit copays. Convenient either way.
- Customer service – Mixed reviews for both. Consumers have reported long hold times, billing issues, and unhelpful reps at times.
- Online resources – Both offer member websites and apps to find providers, manage claims and benefits. Aetna app considered more robust.
- Financial strength – Both rated “A” (Excellent) by A.M. Best signifying strong financial footing.
When choosing between the two, look at monthly premiums but also consider your need for local or nationwide coverage. Weigh the plan offerings and look for discounts that provide value.
Check reviews for quality of service. Both are strong choices overall for comprehensive major medical insurance.
Also Read: Differences Between Cigna And CareFirst.
Aetna And Carefirst: What Customers Are Saying
Digging further into customer feedback for both providers gives more insight. Here’s an overview of consumer impressions from review sites like ConsumerAffairs and online forums:
Common Praises for Aetna
- Large provider network provides good access to care
- Member site and app make it easy to find doctors and manage benefits
- Coverage for basic preventive services and telehealth
Common Complaints about Aetna
- Denials of prior authorizations and claims
- Long hold times trying to reach customer service
- Difficulty navigating automated phone menus
- Rate hikes at renewal time
Common Praises for CareFirst
- Strong regional presence with many plan options
- Member site and app are useful tools
- Telehealth covered on par with office visits
Common Complaints about CareFirst
- Delayed reimbursements and claims processing
- Customer service unhelpful at times in resolving issues
- Lack of nationwide coverage outside mid-Atlantic region
- High deductible costs on plans
While both insurers receive mixed reviews at times, they offer quality plans overall that satisfy most members. Checking third-party sites can provide balanced insight from real customers.
Choosing Between Aetna And Carefirst: Which Is Better?
So, when considering these two insurance giants, how do you decide what’s best for your situation?
If you live in the mid-Atlantic and want strong regional options, CareFirst could be the better choice with more affordable pricing on comparable plans to Aetna.
Those who travel or need broader coverage networks will benefit more from Aetna’s national presence and reciprocating coverage with other Blue Cross Blue Shield affiliates.
Ultimately, look at the nitty gritty of out-of-pocket costs, provider access, prescription needs, and your budget. Also consider each company’s customer service reputation. This will give you the full picture to make a sound insurance decision.
While not perfect, both Aetna and CareFirst present quality options for medical coverage. Weigh the pros and cons to find the right fit.
Also Read: Comparison Between EmblemHealth And Healthfirst.
Frequently Asked Questions (FAQ)
Aetna generally has a positive brand reputation as one of the largest and most established insurance companies in the U.S. They provide comprehensive plan options and access to a broad provider network. While not perfect, they meet coverage needs for most members.
Major competitors for CareFirst include other Blue Cross Blue Shield providers like Anthem and large insurers like UnitedHealthcare and Cigna. Competition is primarily regional against other Blues plans in mid-Atlantic and southern states.
It depends – Kaiser Permanente combines insurance and healthcare services for more coordinated care under one system. This appeals to some. But you may prefer Aetna if you want freedom of choice to keep your own doctors covered under a traditional insurance plan.
According to the 2020 NAIC U.S. Health Insurance Complaint Index Report, UnitedHealthcare currently has the lowest complaint index of 0.13. Other top performers with low complaint ratios include Kaiser Foundation Health Plan, Humana, Aetna, and Cigna.
Also Read: Is CareFirst Better Than UnitedHealthcare?
The Bottom Line
The right health insurance provides peace of mind. While no company is perfect, both Aetna and CareFirst present solid options for medical coverage. Look closely at costs, provider access, and customer service when evaluating these two insurance giants. Consider your location, budget, and specific needs. And check independent reviews to make an informed choice you can feel confident about.
With this comprehensive comparison as your guide, you can better navigate the complex health insurance landscape. Weigh the pros and cons between Aetna and CareFirst to find the right plan that fits your life and gives you security through quality healthcare coverage.
