Insurer profile · CVS Health · NAIC + CMS
Aetna Health Inc. (a PA corp.)
Aetna Health Inc. (a PA corp.)'s complaint record, claim-denial rate and reputation grade, drawn from published NAIC complaint data and CMS Transparency in Coverage.
- D
- Reputation grade
- 18.6%
- Claims denied
- 3
- States (CMS data)
The verdict
Aetna Health Inc. (a PA corp.) earns a D reputation grade - a worse-than-average record versus peers, according to CMS Transparency in Coverage filings, 18.6% of its marketplace claims were denied across 3 states.
- D
- reputation grade
- 18.6%
- claims denied (CMS)
Graded on 1 of 3 measures: claim denials. The score is rescaled across the measures available, so it is not directly comparable with a carrier graded on more of them.
How we calculated this grade →NAIC CIS filing desk
NAIC NAIC D · 35.1
GRADE-D · INDEX-UNK · DENIAL-ELEV · RANK-UNK · PHOTO-SOLO · LINES-0 · BOOK-MID
- GRADE-D D · 35.1
- INDEX-UNK Index blank
- DENIAL-ELEV 18.6% denied
- RANK-UNK Rank pending
- PHOTO-SOLO No peer gap
- LINES-0 No lines
- BOOK-MID 3/7 fields
Instrument codes from this carrier’s NAIC Consumer Information Source filing: grade band, complaint index, CMS denial band, corpus rank, photo-finish peer, line book, and field completeness. Not an official NAIC rating.
These claim figures are from plan year 2025, not 2026. Aetna Health Inc. (a PA corp.) does not appear in the CMS Transparency in Coverage file for plan year 2026, so the most recent figures CMS has published for this insurer are the ones shown here. Illinois carriers left that file when the state moved to its own health-insurance marketplace for 2026; other insurers stop appearing when they exit the individual marketplace. The numbers below are unchanged and still describe the period they cover. They are simply not current-year, and are excluded from every national and state average on this site. See our methodology.
Aetna Health Inc. (a PA corp.) - claim denial rate by state
- DE
DE: 31.3% denied (22,590 of 72,242 claims)
31 % of claims denied
- IL
IL: 24.4% denied (45,153 of 185,335 claims)
24 % of claims denied
- NC
NC: 18.3% denied (1,693,812 of 9,237,233 claims)
18 % of claims denied
What this shows Denial rates vary by state plan and network. Across 3 reporting states, Aetna Health Inc. (a PA corp.) denied 18.6% of marketplace claims on average.
Among states with enough reported claims to compare, Aetna Health Inc. (a PA corp.)'s highest marketplace denial rates in this dataset are in Delaware (31.3%), Illinois (24.4%), and North Carolina (18.3%). State-level rates reflect the specific plans Aetna Health Inc. (a PA corp.) offers there and how each state's regulators and utilization-review rules apply, not necessarily the carrier's national practice.
CMS marketplace filing
Reported appeal outcomes for Aetna Health Inc. (a PA corp.)
The largest state samples are North Carolina (658 filed, 295 overturned) and Illinois (53 filed, 26 overturned); 2 states contribute to the profile total.
CMS reports an overturn outcome for 711 of these 711 filed appeals; missing outcomes are excluded from the percentage. These filing totals are not a prediction for an individual appeal. View the CMS source ↗
What the NAIC filing desk shows for Aetna Health Inc. (a PA corp.)
Aetna Health Inc. (a PA corp.)'s filing desk summarizes the NAIC complaint record and any CMS marketplace denial data on file.
See where Aetna Health Inc. (a PA corp.) sits against every reporting carrier in the claim-denial rate ranking. Appeal notes for Aetna Health Inc. (a PA corp.).
Nationwide insurers with similar scores or complaint volume
Two corpus-wide peer sets for Aetna Health Inc. (a PA corp.): nearest national-scale carriers by composite score and by NAIC complaint volume. These are cross-market neighborhoods, not the corporate-family list or same-grade chips above.
Similar composite score
Nearest carriers by composite score (35.1 here). Floored at 50+ complaints and 5+ states.
Aetna Health Inc. (a PA corp.) is part of the CVS Health family, alongside Aetna (CVS Health), Aetna Health Inc. (a FL corp.), Banner Health and Aetna Health Plan Inc., Aetna Life Insurance Company, and 1 more in PlainInsurer's dataset -- a shared parent doesn't mean shared performance, so check each subsidiary's own record before assuming they behave alike.
Questions about Aetna Health Inc. (a PA corp.)
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Source: NAIC published complaint index + CMS Transparency in Coverage PY2025 Complaint index, reputation grade and per-state claim denial rates for Aetna Health Inc. (a PA corp.) · 2024
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The full PlainInsurer extract, covering every insurer including Aetna Health Inc. (a PA corp.), is available as CSV and JSON. Underlying federal data is public domain; see our methodology for the compilation and grading method.
Data: NAIC published complaint index (2024) · CMS Transparency in Coverage PUF PY2025. Not affiliated with NAIC or CMS.
Every figure on PlainInsurer comes directly from NAIC MCAS and CMS Transparency in Coverage data; no editor types in numbers. See our editorial standards or methodology, or report an error. Data current as of 2026-08-11. Grades measure only the published complaint/denial data; we don't recommend any insurer or policy.