Aetna The Ultimate Guide: Plans, Ratings & NAIC Code
Aetna: A Comprehensive Overview of a Health Insurance Giant
Aetna, a name synonymous with health insurance in the United States, has a long and storied history of providing coverage and care to millions of Americans. As a subsidiary of CVS Health, Aetna is a key player in the evolving landscape of healthcare, striving to make quality care more affordable, accessible, and convenient. This in-depth guide explores every facet of Aetna, from its humble beginnings to its current status as a healthcare industry leader. Whether you’re a potential member, an employer considering benefit plans, or simply curious about the forces shaping American healthcare, this comprehensive overview will provide you with the facts you need to know about Aetna.
Basic Company Overview: Who is Aetna?
Aetna is one of the nation’s leading diversified health care benefits companies, providing a broad range of traditional, voluntary, and consumer-directed health insurance products and related services. The company’s offerings include medical, pharmacy, dental, behavioral health, group life, and disability plans, as well as Medicare and Medicaid products. Aetna’s customer base is extensive, serving employer groups, individuals, college students, part-time and hourly workers, health plans, and government-sponsored plans.
At its core, Aetna’s mission is to build a healthier world by connecting people to the care they need. This mission is amplified through its integration with CVS Health, creating a unique and powerful combination of health insurance, pharmacy services, and retail health clinics. This synergy aims to create a more integrated and seamless healthcare experience for consumers.
Aetna’s headquarters is located in Hartford, Connecticut, a city where it has deep historical roots. The company’s iconic headquarters, a massive colonial-revival building, is a testament to its long-standing presence and influence in the insurance industry.
The Rich History of Aetna: From Fire Insurance to a Healthcare Leader
Aetna’s journey began not in health insurance, but in fire insurance. The company’s roots trace back to the Aetna (Fire) Insurance Company, founded in Hartford, Connecticut, in 1819. The name “Aetna” was inspired by Mount Etna, the most active volcano in Europe at the time, symbolizing the company’s resilience and strength.
The Leap into Life Insurance
In 1850, the company ventured into a new market by establishing an annuity fund to sell life insurance. This new division was so successful that in 1853, the Aetna Life Insurance Company was incorporated as a separate entity, with Eliphalet A. Bulkeley as its first president. This marked the true beginning of the Aetna we know today.
The company’s growth was fueled by innovative business practices and aggressive marketing, especially during the Civil War era when the demand for life insurance surged. By the late 19th century, Aetna had become a major player in the life insurance industry.
Diversification and Expansion: Aetna's Foray into New Insurance Lines
The late 19th and early 20th centuries were a period of significant diversification for Aetna. The company began offering accident insurance in 1891 and health insurance in 1899. In 1902, Aetna established a liability department to offer employers’ liability and workmen’s collective insurance, a precursor to modern workers’ compensation.
The early 20th century also saw Aetna become a pioneer in group insurance. The company sold its first group life insurance policy in 1913 and expanded to offer group accident policies in 1914, group disability in 1919, and group health care in 1936. This move into group benefits laid the foundation for Aetna’s future as a dominant force in employer-sponsored health insurance.
Post-War Growth and the Rise of Managed Care
The post-World War II era saw a dramatic increase in the demand for health insurance, and Aetna was well-positioned to meet this demand. The company’s growth was further accelerated by the rise of employer-sponsored health benefits. In the 1960s, Aetna underwent a major corporate restructuring, creating a holding company, Aetna Life and Casualty, to oversee its various insurance businesses.
The latter half of the 20th century was marked by the emergence of managed care, with the introduction of Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Aetna was at the forefront of this trend, developing and refining its managed care products to control costs and improve the quality of care.
Major Acquisitions and Expansions: Shaping the Modern Aetna
Aetna’s history is punctuated by a series of strategic acquisitions and expansions that have shaped its growth and market position. These moves have allowed the company to expand its membership, enter new markets, and enhance its capabilities.
Key Acquisitions in the 1990s
The 1990s were a transformative decade for Aetna. In 1996, Aetna merged with U.S. Healthcare, a leading HMO operator. This was a landmark deal that significantly expanded Aetna’s presence in the managed care market and added millions of new members. Following the U.S. Healthcare merger, Aetna made another significant acquisition in 1998, purchasing NYLCare Health Plans, further solidifying its position as a national healthcare leader.
The Prudential HealthCare Acquisition
In 1999, Aetna acquired Prudential HealthCare for $1 billion. This acquisition added another 6.7 million members to Aetna’s rolls, making it the largest provider of health benefits in the United States at the time, with a total of 21 million members.
The Attempted Humana Merger
In 2015, Aetna announced its intention to acquire Humana, another major health insurer, for $37 billion. The deal would have created a healthcare giant with a massive presence in the Medicare Advantage market. However, the proposed merger faced intense scrutiny from regulators and was ultimately blocked by a federal judge in 2017 due to concerns about its anti-competitive effects.
The Landmark CVS Health Acquisition
In a move that sent shockwaves through the healthcare industry, CVS Health, the nation’s largest pharmacy chain, announced in 2017 that it would acquire Aetna for $69 billion. The deal, which was completed in 2018, created a new kind of healthcare company, one that combines the services of a health insurer, a pharmacy benefits manager (PBM), and a retail pharmacy.
The rationale behind the merger was to create a more integrated and consumer-centric healthcare experience. By combining Aetna’s health insurance expertise with CVS’s vast retail footprint and pharmacy services, the new company aims to:
Improve care coordination: By sharing data and insights, CVS and Aetna can better coordinate care for members, especially those with chronic conditions.
Lower costs: The merger is expected to generate significant cost savings through improved efficiency, better drug price negotiation, and a focus on preventive care.
Enhance the consumer experience: The combined company aims to make healthcare more convenient and accessible through its network of CVS pharmacies and MinuteClinic locations.
The CVS Health-Aetna merger is a bold experiment in healthcare integration, and its long-term impact on the industry is still unfolding. However, it is clear that the deal has fundamentally changed the competitive landscape and has set a new standard for a vertically integrated healthcare model.
Aetna by the Numbers: Key Metrics and Statistics
To fully understand Aetna’s scale and influence, it’s essential to look at the key metrics that define its business.
Number of Members/Enrollees
Aetna provides health insurance and related services to millions of people across the United States. While the exact number of members fluctuates, Aetna consistently ranks among the top health insurers in the country in terms of membership. As of recent reports, Aetna serves:
Over 22 million medical members
Approximately 12.7 million dental members
Over 13 million pharmacy benefit management services members
Aetna also has a significant presence in the Medicare market, with nearly 11 million Medicare members, including 3.4 million enrolled in Aetna Medicare Advantage plans.
Annual Revenue
As a subsidiary of CVS Health, Aetna’s financial performance is reported as part of CVS Health’s overall earnings. The Health Care Benefits segment, which includes Aetna, is a major contributor to CVS Health’s revenue. In 2023, Aetna’s total revenues were a staggering $186.8 billion, demonstrating its immense financial scale.
Coverage States
Aetna offers health insurance plans in all 50 states and the District of Columbia. However, the specific types of plans and networks available vary by state. Aetna has a particularly strong presence in certain states and continuously works to expand its network and plan offerings to reach more Americans.
NCQA Rating
The National Committee for Quality Assurance (NCQA) is a private, non-profit organization that accredits and certifies a wide range of health care organizations. NCQA ratings are a key indicator of a health plan’s quality. Aetna is committed to NCQA accreditation and many of its health plans have received high ratings for their quality and performance. The ratings can be found on the NCQA’s Health Plan Report Card, which is updated annually.
Number of Employees
Aetna is a major employer in the United States. While the exact number of employees dedicated solely to Aetna is not always reported separately from CVS Health, prior to the acquisition, Aetna had approximately 50,000 employees. As part of CVS Health, which has over 300,000 employees, Aetna’s workforce is part of a much larger and more diverse team dedicated to improving healthcare.
Aetna's Products & Services: A Comprehensive Portfolio of Health and Wellness Solutions
Aetna offers a wide array of products and services designed to meet the diverse needs of its customers. From traditional health insurance plans to innovative digital tools, Aetna provides a comprehensive suite of solutions to help people manage their health and well-being.
Aetna Plan Types: Finding the Right Fit for Your Needs
Aetna offers a variety of health insurance plan types, each with its own structure and benefits. Understanding the differences between these plans is crucial for choosing the one that’s right for you.
Health Maintenance Organization (HMO): HMO plans typically require members to use a network of doctors, hospitals, and specialists. Members choose a primary care physician (PCP) who coordinates their care and provides referrals to specialists. HMOs often have lower premiums and out-of-pocket costs than other types of plans.
Preferred Provider Organization (PPO): PPO plans offer more flexibility than HMOs. Members can see any doctor or specialist they choose, both in and out of network, without a referral. However, out-of-pocket costs are typically lower when using in-network providers.
Exclusive Provider Organization (EPO): EPO plans are a hybrid of HMOs and PPOs. Like HMOs, they require members to use a network of providers. However, like PPOs, they do not require a PCP referral to see a specialist. EPOs generally do not cover out-of-network care, except in emergencies.
High-Deductible Health Plan (HDHP) with Health Savings Account (HSA): HDHPs have lower premiums and higher deductibles than traditional plans. They are often paired with a Health Savings Account (HSA), a tax-advantaged savings account that can be used to pay for qualified medical expenses.
Medicare Plans: Aetna is a major provider of Medicare plans, including:
Medicare Advantage (Part C) plans: These plans are offered by private insurers like Aetna and combine the benefits of Original Medicare (Part A and Part B) with additional benefits, such as prescription drug coverage, dental, and vision.
Medicare Supplement (Medigap) plans: These plans help pay for some of the out-of-pocket costs that Original Medicare doesn’t cover, such as deductibles, copayments, and coinsurance.
Prescription Drug Plans (Part D): These standalone plans provide coverage for prescription medications.
Medicaid Plans: Aetna also participates in state Medicaid programs, providing health insurance coverage to low-income individuals and families.
Dental Plans: Aetna offers a range of dental plans, including PPO, DMO (Dental Maintenance Organization), and indemnity plans.
Vision Plans: Aetna’s vision plans provide coverage for eye exams, glasses, and contact lenses.
Supplemental Plans: Aetna offers a variety of supplemental insurance plans, such as accident, critical illness, and hospital indemnity plans, which provide cash benefits to help cover unexpected medical costs.
Aetna's Provider Network: Access to a Vast Network of Care
Aetna has one of the largest provider networks in the United States, with over 1.2 million health care professionals, more than 690,000 primary care doctors and specialists, and over 5,700 hospitals. This extensive network gives members a wide choice of doctors, hospitals, and other healthcare providers.
Digital Tools: Empowering Members to Manage Their Health
Aetna is committed to using technology to empower its members and make healthcare simpler and more convenient. The company offers a range of digital tools and resources, including:
Aetna Health App: This mobile app allows members to find doctors, view claims, manage their benefits, and access a variety of health and wellness resources. The app also features “Aetna Care Paths,” a personalized digital experience for members with specific health conditions.
Secure Member Website: The Aetna member website provides a secure portal where members can access their plan information, find care, and manage their health.
Telehealth Services: Aetna offers telehealth services that allow members to consult with doctors and other healthcare professionals remotely, via phone or video.
Online Health and Wellness Programs: Aetna provides a variety of online programs and resources to help members manage their health, lose weight, quit smoking, and reduce stress.
Market Sectors and Project Expertise: Serving a Diverse Clientele
Aetna’s expertise spans a wide range of market sectors, allowing the company to tailor its products and services to the unique needs of different customer groups.
Small, Mid-size, and Large Businesses
Aetna is a leading provider of employer-sponsored health insurance plans, serving businesses of all sizes, from small startups to large multinational corporations. The company offers a variety of plan options and funding arrangements to meet the diverse needs and budgets of employers.
Public Sector Employers
Aetna has a dedicated public sector division that provides health insurance and related services to federal, state, and local government employees, as well as to educational institutions.
International Plans
Aetna International provides comprehensive health and wellness benefits to people living and working abroad. The company has a global network of providers and offers a range of plans to meet the needs of expatriates, international students, and frequent travelers.
Multi-employer Labor Funds
Aetna has extensive experience working with multi-employer labor funds to provide health and welfare benefits to union members.
Retiree Health Care
Aetna offers a range of solutions to help employers provide health care benefits to their retirees, including group Medicare Advantage plans and retiree-only plans.
Aetna's Partnerships: Collaborating for a Healthier Future
Aetna understands that it cannot transform healthcare on its own. The company has forged strategic partnerships with a variety of organizations to enhance its capabilities and expand its reach.
The CVS Health Partnership
The most significant partnership in Aetna’s recent history is its merger with CVS Health. This groundbreaking collaboration is creating a new model for healthcare delivery, one that is more integrated, convenient, and consumer-focused.
Other Key Partnerships and Subsidiaries
Aetna also works closely with a number of other companies and organizations to provide a comprehensive suite of health and wellness solutions. These include:
ActiveHealth Management: A subsidiary of Aetna that provides health management services, including care management, wellness programs, and data analytics.
First Health: A national PPO network that provides access to a broad network of providers.
Meritain Health: A third-party administrator (TPA) that provides a variety of services to self-funded employers.
Awards and Recognitions: Acknowledged for Excellence
Aetna has been recognized with numerous awards and accolades for its commitment to quality, innovation, and corporate social responsibility. These awards are a testament to the company’s dedication to its members, its employees, and the communities it serves.
While a comprehensive list would be extensive, Aetna and its parent company, CVS Health, have been recognized for their work in areas such as:
Customer satisfaction
Diversity and inclusion
Corporate citizenship
Health equity
Innovation in healthcare
Licensing & Regulatory Information: A Commitment to Compliance
As a major health insurer, Aetna is subject to a complex web of federal and state regulations. The company is committed to complying with all applicable laws and regulations and to maintaining the highest standards of ethical conduct.
State Licenses
Aetna is licensed to sell health insurance in all 50 states and the District of Columbia. The specific licenses and regulations vary by state, and Aetna works closely with state insurance departments to ensure compliance.
NAIC Code
The National Association of Insurance Commissioners (NAIC) is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia, and five U.S. territories. The NAIC assigns a unique code to each insurance company for identification purposes. Aetna Life Insurance Company’s NAIC code is 60054. This code is used by regulators to track the company’s financial performance and compliance with regulatory requirements.
CMS Star Ratings for Medicare Plans
The Centers for Medicare & Medicaid Services (CMS) uses a five-star rating system to measure the quality and performance of Medicare Advantage and Prescription Drug Plans. The ratings are based on a variety of factors, including member satisfaction, clinical outcomes, and customer service.
Aetna has consistently received high star ratings for its Medicare Advantage plans. For 2025, 88% of Aetna’s Medicare Advantage members are in plans rated 4 stars or higher. This is a significant achievement and a testament to the quality of Aetna’s Medicare plans.
The Future of Aetna: A Vision for a More Connected and Consumer-Centric Healthcare System
As part of CVS Health, Aetna is at the forefront of a major transformation in the healthcare industry. The company is moving away from the traditional fee-for-service model and toward a more integrated and value-based approach to care.
In the years to come, you can expect to see Aetna and CVS Health continue to:
Expand their network of HealthHUBs: These redesigned CVS stores offer a broader range of health services, including chronic disease management, wellness programs, and durable medical equipment.
Invest in digital health technology: Aetna will continue to develop and deploy digital tools to empower members and make healthcare more convenient and accessible.
Focus on preventive care: By identifying and addressing health risks early, Aetna and CVS Health aim to improve health outcomes and reduce long-term healthcare costs.
Promote health equity: Aetna is committed to addressing health disparities and ensuring that all individuals have access to quality, affordable healthcare.
Aetna’s journey from a small fire insurance company to a national healthcare leader is a testament to its ability to adapt and innovate in a constantly changing world. As the healthcare industry continues to evolve, Aetna, as part of CVS Health, is well-positioned to play a leading role in shaping a healthier future for all Americans.
Profile Structure
Name: Aetna (a CVS Health company)
Industry: Health Insurance, Healthcare Benefits
Founded: 1853
HQ: 151 Farmington Avenue, Hartford, Connecticut 06156, USA
CEO: Karen S. Lynch (CEO of parent company, CVS Health); Brian Kane (President of Aetna)
Employees: Approximately 50,000 (within the larger CVS Health organization)
Annual Revenue: $99.5 billion (for the Health Care Benefits segment in 2023)
Coverage: All 50 U.S. states and the District of Columbia
Plan Types: HMO, PPO, EPO, HDHP with HSA, Medicare (Advantage, Supplement, Part D), Medicaid, Dental, Vision, and Supplemental Plans.
Key Differentiator: Vertical integration with CVS Health, combining health insurance with a vast network of pharmacy services and retail health clinics (MinuteClinic, HealthHUBs) to create a more connected and accessible care experience.
Website: aetna.com
LinkedIn: linkedin.com/company/aetna
Aetna Leadership & Teams
Tom Weidenkopf – EVP, Chief Human Resources Officer
Terry Mills – Chief Medical Officer
Cathy Hughes – Chief Network and Operations Officer
Michelle Johnson – Chief of Staff, Aetna Medical Affairs
Marti Taylor – Chief Executive Officer
Jennifer Sweet – Chief Executive Officer Aetna Better Health of Florida
Joel Gray – Chief Executive Officer Aetna Better Health of Virginia
Stephane Rogers – Chief Executive officer Aetna Better Health Texas
Paige Franklin – Chief Executive Officer Aetna Better Health of Kentucky
Melanie Fernando – Chief Operating Officer Aetna Better Health of Illinois
Joseph Manger – Chief Executive Officer Aetna Better Health of New Jersey
Tricia Taylor-Lyphout Chief Operations Officer
Rushil Desai – President & Chief Executive Officer Aetna Better Health of Illinois
Jordan Erp – VP, Chief Medicare Actuary
Molly Votaw – Chief Financial Officer
Jayna Harley – Chief Network & Operations Officer
Kiran Jiwani – Chief Operating Officer
Christopher Huelsman – Vice President, Chief Growth Officer
Don Mazza – VP, Chief Medicare Officer
Ann Kay Logarbo – Chief Medical Officer
Brian Wheeler – Chief Operating Officer Aetna Better Health of Texas
Andre Greenwood – Chief Executive Officer Aetna Better Health of GA
Carrah Kalat – Chief Marketing Officer
Brian Knobloch – Chief Operating Officer
Kyle Lmpson – Chief Marketing and Outreach Officer
Melissa Hulke – Chief Strategy and Business Operations Officer, West Region
Kara Kirby – Chief Financial Officer Michigan Medicaid
Paula Starnes – President & Chief Executive Officer Aetna Better Health of Pennsylvania
Benjamin Kornitzer – Chief Medical Officer
Derek Darling – Chief Network & Operations Officer, North Atlantic
Gary Billy – Chief Operating Officer Aetna Better Health of Ohio
Julio Aviles – Chief Financial Officer Aetna Better Health of Pennsylvania
Michael Ciarrocchi – Chief Market Development Officer, Meritain Health
Olunwa Ikpeazu – Chief Medical Officer