Aetna vs Cigna: how do they differ for employers?

Aetna and Cigna are often compared because they are similar in some ways: both are national, both have most of their commercial members in self-funded plans, and both are tied to a big pharmacy business. Where they part company is the size of employer each sells to.

The two companies in brief

Aetna is part of CVS Health. Its commercial business covered about 18.3 million people at June 30, 2026, of whom about 2.5 million were in fully insured plans and 15.8 million in self-funded ones. The American Medical Association puts CVS (Aetna) third in the national commercial market, with about 12%.

Cigna Healthcare is part of The Cigna Group. Its US employer business covered about 16.3 million medical customers at June 30, 2026 (our sum of Cigna’s reported lines), and roughly four in five of its medical customers are in self-funded plans. The AMA puts Cigna fourth nationally, with about 9%.

Which employers each one sells to

Aetna left Connecticut’s fully insured small group market in 2024. Its product line for small employers includes a level-funded plan called Aetna Funding Advantage.

Cigna’s small group page lists plans only for Arizona for 2026 and 2027, and Cigna says it stopped offering new traditional small group plans in Georgia and Tennessee from November 1, 2025. Cigna describes its employer business as mainly mid-size and large groups, and its level-funded product line is called Cigna Level Funding.

Our level-funded plans guide explains how level-funded arrangements work in general.

Networks

Aetna’s 2025 annual report cites about 2.0 million participating providers. Cigna’s 2025 annual report cites about 1.7 million physicians and more than 6,000 hospitals. The two companies count differently, so the totals are not a like-for-like comparison.

National totals say little about your town. Hospital contracts change from year to year for every carrier.

Pharmacy ownership

• Aetna shares a parent with CVS Caremark and the CVS stores and MinuteClinics, more than 800 of them at the end of 2025.
• Cigna sits in The Cigna Group alongside its Evernorth business, which includes Express Scripts and Accredo. Evernorth announced changes to its pharmacy benefit model in October 2025.

Member and financial ratings

In J.D. Power’s 2026 commercial member study, Aetna ranked highest in the East South Central region and Cigna tied for highest in Florida. Neither topped any other region. J.D. Power’s separate 2026 digital experience study ranked Cigna first among commercial plans.

AM Best rates the main insurers of both companies A (Excellent), affirmed in June 2026 for Aetna and March 2026 for Cigna.

Recent changes

Both carriers have left the individual (ACA) market or are leaving it: Aetna from January 2026, Cigna from January 2027. Aetna’s exchange exit largely explains the recent fall in its fully insured membership, and most of Cigna’s employer customers are already in self-funded plans.

Questions to ask a broker about these two carriers

1. Will both carriers quote a group of our size in our state?
2. Which funding types will each carrier offer a group our size here?
3. Which of my employees’ doctors and nearest hospitals are in each carrier’s network?
4. How have each carrier’s renewals run for similar employers here this year?

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.