Aetna vs Anthem: how do they compare for employer health plans?

Aetna and Anthem are similar in size in the commercial market. The main difference is structural: Aetna is one national carrier, while Anthem is a Blue Cross Blue Shield company with a fixed home territory.

Two different kinds of carrier

Aetna is part of CVS Health and sells under the Aetna name nationwide. Its commercial business covered about 18.3 million people at June 30, 2026, about 15.8 million of them in self-funded plans.

Anthem plans belong to Elevance Health, which holds the Blue Cross Blue Shield license in 14 states: California (Blue Cross only), Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (outside the Kansas City area), Nevada, New Hampshire, New York (New York City area and upstate), Ohio, Virginia (outside Northern Virginia) and Wisconsin. Its employer business covered about 24.4 million people at September 30, 2026, about 21.0 million of them self-funded (our sum of Elevance’s figures).

The American Medical Association’s latest study puts Elevance second and CVS (Aetna) third in the national commercial market, each with about 12% (2024 data).

Where you can choose between them

Outside Anthem’s 14 states, Anthem does not sell Blue plans to ordinary employers, so the comparison there is Aetna against the local Blue company. Inside them, both carriers sell to employers.

Plans for small and mid-size groups

Both carriers sell fully insured, level-funded and self-funded plans, though not every type is offered in every state or to every group size. Aetna’s level-funded product line is called Aetna Funding Advantage, and Anthem’s is called Anthem Balanced Funding, sold in some of its states. Aetna left Connecticut’s fully insured small group market in 2024. Our level-funded plans guide explains how level-funded arrangements work in general.

Networks and staff in other states

Aetna uses one national network, citing about 2.0 million participating providers in its 2025 annual report.

Anthem builds its own network in its home states and, for employees living or traveling elsewhere, uses BlueCard, which gives access to the local Blue company’s network and prices. Anthem reported about 6.6 million BlueCard members, other Blues’ members using its networks, at September 30, 2026.

The two companies count their networks differently, so totals are not a like-for-like comparison. Hospital contracts also change: Anthem and Mount Sinai in New York, for example, were out of contract for several months before a new deal in April 2026.

Pharmacy ownership

Aetna and CVS Caremark share a parent company. Anthem’s pharmacy business, CarelonRx (renamed from IngenioRx in 2023), is Elevance’s own, but Elevance’s annual report says certain core pharmacy services are delegated to CaremarkPCS Health, part of CVS Health, under an agreement that runs to the end of 2027.

Member and financial ratings

In Ohio, Aetna ranked highest in J.D. Power’s 2025 study and Anthem in 2026, a reminder that these regional results move from year to year.

Recent changes worth knowing

• Aetna left the individual (ACA) exchanges from January 2026, which largely explains the fall in its fully insured membership.
• Anthem introduced a policy from January 2026 in 11 of its states under which network hospitals can be charged when out-of-network specialists such as anesthesiologists are involved in care; the American Hospital Association has asked Elevance to withdraw it. Elevance also reported fully insured employer membership down about 7% year on year at September 30, 2026, while self-funded membership grew.

Questions to ask a broker about these two carriers

1. Are we in one of Anthem’s states, and will both carriers quote a group our size?
2. Which funding types will each carrier offer a group our size in our state?
3. Which of my employees’ doctors and nearest hospitals are in each carrier’s network, and are any contract disputes due before our renewal?
4. How would staff in other states be covered under each carrier’s network arrangements?
5. How have each carrier’s renewals run for similar groups here?

Our state guides for Georgia, California and Colorado describe those markets. Our group health insurance quotes page explains what a broker will ask for, and the form below connects you with a licensed broker.

How we write these: every comparison uses the carriers' own published information, their parent companies' filings and independent surveys, each listed below with its date. We are not paid by, affiliated with or endorsed by any carrier, and we do not rank them, describe their plan benefits or recommend any plan. Carrier and product names are trademarks of their owners. Plans, networks and prices vary by state, county and group size: only a licensed broker or the insurer can say what is available to your business and explain its terms.