Aetna employer health plans in California
Who Aetna insures among California employers and what those plans pay in premium and broker compensation, and what the Aetna network pays physicians and hospitals.
Aetna employer health plans in California at a glance
What the data shows
Aetna insures 800 employer health plans in California (12% of 6,525 insured large plans), 7th of 8 carrier groups; Kaiser Permanente (3,845), Anthem (Elevance Health) (1,448) hold more.
Aetna has grown 5% in California since 2020, from 762 plans.
Most of these plans cover 100–499 people (487 plans); 114 cover 1,000 or more.
Median premium per person covered was $7,192, 6% below the California all-carrier median of $7,612. Benefit design and group mix differ, so this is not a price comparison.
92% of these plans reported broker or agent pay on their Aetna contracts; where paid, the median was 5.0% of premium (middle half 4.0%–5.7%).
In Aetna commercial, 28 of the 50 Employer 50 services have a California benchmark, at a median of 111% of Medicare across those services.
At California hospitals, Aetna's commercial rates run higher than other carriers' at the same hospital for 9 of 17 services; a hip or knee replacement stay has a median rate of $20,995 across 23 hospitals.
Aetna plans in California, 2020–2024
| Form year | Plans | Persons covered | Share of state | Median premium / person |
|---|---|---|---|---|
| 2020 | 762 | 570,488 | 11% | $6,371 |
| 2021 | 735 | 670,914 | 11% | $6,295 |
| 2022 | 740 | 5,856,344 | 11% | $6,620 |
| 2023 | 827 | 740,913 | 12% | $6,756 |
| 2024 | 800 | 1,208,434 | 12% | $7,192 |
| 2025 (partial) | 450 | 330,463 | 10% | $7,729 |
Plan size
| Persons covered | Plans | Share |
|---|---|---|
| Under 100 | 101 | 13% |
| 100–499 | 487 | 61% |
| 500–999 | 98 | 12% |
| 1,000–4,999 | 106 | 13% |
| 5,000 or more | 8 | 1% |
Premiums and broker pay
| Measure | Aetna | All carriers, California |
|---|---|---|
| Median premium per person covered | $7,192 | $7,612 |
| Premium per person, middle half | $5,520–$9,311 | $5,825–$9,721 |
| Plans reporting broker or agent pay | 92% | 84% |
| Median broker pay, % of premium | 5.0% | 5.0% |
| Broker pay, middle half | 4.0%–5.7% | 4.0%–5.8% |
| Median broker pay per person covered | $332 | $354 |
Industries
Aetna's California employer clients are concentrated in manufacturing (155 plans) and professional and technical services (130), followed by health care and social assistance (65).
| Industry | Plans | Share |
|---|---|---|
| Manufacturing | 155 | 19% |
| Professional and technical services | 130 | 16% |
| Health care and social assistance | 65 | 8% |
| Retail trade | 62 | 8% |
| Construction | 47 | 6% |
| Educational services | 45 | 6% |
Aetna employer clients in California
779 employers in California have a Aetna major-medical contract, 114 of them covering 1,000 or more people. For each one Medlyze has the plan year, the broker on each contract and what that broker was paid, and compiles the list for a state, an industry or a single employer on request.
| Employer | Persons covered | Plan year ends | Broker | Broker pay, % of premium |
|---|---|---|---|---|
| Employer name | Locked | Locked | Locked | Locked |
| Employer name | Locked | Locked | Locked | Locked |
| Employer name | Locked | Locked | Locked | Locked |
What the Aetna network pays physicians in California
| Service | Code | Median | Middle half | % of Medicare | Other networks, median | Provider groups |
|---|---|---|---|---|---|---|
| Diagnostic heart catheterization with coronary angiography | 93458 | $319 | $293–$412 | 111% | $385 | 122 |
| Echocardiogram, transthoracic complete with Doppler | 93306 | $72 | $68–$96 | 106% | $86 | 123 |
| Electrocardiogram (EKG), complete | 93000 | $22 | $20–$28 | 140% | $26 | 125 |
| Nuclear stress test (SPECT myocardial perfusion) | 78452 | $534 | $486–$623 | 125% | $579 | 124 |
| Treadmill stress test, complete | 93015 | $102 | $95–$133 | 138% | $108 | 122 |
| Cataract removal with lens implant | 66984 | $687 | $659–$791 | 148% | $672 | 118 |
| Abdominal ultrasound, complete | 76700 | $41 | $37–$51 | 111% | $48 | 191 |
| Bone density scan (DXA), axial | 77080 | $11 | $10–$13 | 114% | $12 | 185 |
| CT abdomen and pelvis with contrast | 74177 | $376 | $342–$443 | 125% | $432 | 190 |
| CT chest without contrast | 71250 | $248 | $199–$286 | 187% | $256 | 192 |
| Chest X-ray, 2 views | 71046 | $11 | $10–$14 | 111% | $13 | 193 |
| MRI brain without and with contrast | 70553 | $475 | $475–$617 | 150% | $670 | 190 |
| MRI cervical spine without contrast | 72141 | $475 | $359–$522 | 249% | $402 | 187 |
| MRI knee (lower-extremity joint) without contrast | 73721 | $475 | $375–$522 | 232% | $420 | 190 |
| MRI lumbar spine without contrast | 72148 | $475 | $366–$538 | 248% | $402 | 194 |
Professional fee only: facility, implant and anesthesia charges are not included. Limited: rates come from a sample of providers, and groups are counted only in specialties that perform the service.
What the Aetna network pays hospitals in California
Aetna commercial rates are on record at 56 California hospitals (the hospitals covered so far, not every hospital). Compared at the same hospitals, Aetna's rate is higher than the other carriers' median for 9 of 17 services and lower for 6. For Emergency visit, level 4, the rate runs from $228 to $9,305 across 14 hospitals.
This page shows 3 of the 17 services in full. The other rates, the size of each gap and every hospital's prices are in the Plan Cost Benchmark.
| Service | Hospitals | Median rate | Range (P10–P90) | vs other carriers, same hospitals | Cash price, median |
|---|---|---|---|---|---|
| Hip or knee replacement (hospital stay) | 23 | $20,995 | $8,062–$51,027 | About the same | $32,848 |
| C-section delivery (hospital stay) | 20 | Locked | Locked | About the same | Locked |
| Vaginal delivery (hospital stay) | 20 | Locked | Locked | Lower | Locked |
| MRI, lower back | 13 | $1,463 | $475–$2,181 | Higher | $6,210 |
| MRI, knee | 11 | Locked | Locked | Higher | Locked |
| CT, head | 13 | Locked | Locked | Higher | Locked |
| CT, abdomen and pelvis | 13 | Locked | Locked | Lower | Locked |
| Screening mammogram | 11 | Locked | Locked | Higher | Locked |
| Colonoscopy, diagnostic | 13 | Locked | Locked | Higher | Locked |
| Upper GI endoscopy with biopsy | 12 | Locked | Locked | Lower | Locked |
| Knee arthroscopy | 12 | Locked | Locked | Lower | Locked |
| Cataract surgery | 12 | Locked | Locked | Higher | Locked |
| Gallbladder removal, laparoscopic | 14 | Locked | Locked | Lower | Locked |
| Knee replacement, outpatient | 12 | Locked | Locked | Lower | Locked |
| Emergency visit, level 4 | 14 | $2,970 | $228–$9,305 | Higher | $5,064 |
| Comprehensive metabolic panel | 14 | Locked | Locked | Higher | Locked |
| Complete blood count | 15 | Locked | Locked | Higher | Locked |
Hospitals with the most published Aetna rates
| Hospital | Joint replacement | MRI lower back | CT abdomen | Colonoscopy | ER level 4 | Vaginal delivery |
|---|---|---|---|---|---|---|
| Clovis Community Medical Center | $8,062 | Locked | Locked | Locked | Locked | Locked |
| Foothill Regional Medical Center | $15,418 | Locked | Locked | Locked | Locked | Locked |
| Fresno Surgical Hospital | – | Locked | Locked | Locked | Locked | Locked |
| Los Angeles Community Hospital | $15,418 | Locked | Locked | Locked | Locked | Locked |
| Los Robles Hospital And Medical Center | $30,068 | Locked | Locked | Locked | Locked | Locked |
| Riverside Community Hospital | $22,998 | Locked | Locked | Locked | Locked | Locked |
| Southern California Hospital At Culver City | $15,418 | Locked | Locked | Locked | Locked | Locked |
| Southern California Hospital At Hollywood | $15,418 | Locked | Locked | Locked | Locked | Locked |
| St. Francis Medical Center | $32,644 | Locked | Locked | Locked | Locked | Locked |
| Thousand Oaks Surgical Hospital | $30,068 | Locked | Locked | Locked | Locked | Locked |
How the contracts are written: case rates 50%, fee schedules 22%, per diem 5%, percent of billed charges 15%, other 9% of Aetna's published commercial rates for these services in California.
Employers: see all 17 services and every hospital near your people in a Plan Cost Benchmark →
Hospital facility rate only: physician, anesthesia and implant charges are separate. Rates are what hospitals publish, not claims paid, and are not weighted by use.
Carriers in California
| Carrier | Plans | Share | Median premium / person | Median broker % |
|---|---|---|---|---|
| Kaiser Permanente | 3,845 | 59% | $7,918 | 4.6% |
| Anthem (Elevance Health) | 1,448 | 22% | $7,794 | 5.2% |
| Blue Cross Blue Shield | 1,178 | 18% | $8,573 | 5.3% |
| Other insurers (regional and local plans) | 1,165 | 18% | $6,939 | 5.0% |
| Cigna | 945 | 14% | $4,568 | 6.4% |
| UnitedHealthcare | 849 | 13% | $6,155 | 5.2% |
| Aetna | 800 | 12% | $7,192 | 5.0% |
| Humana | 19 | 0% | $749 | 11.6% |
Aetna in other states
FAQ
How many California employers have Aetna health insurance?
800 employer health plans in California reported a Aetna major-medical contract in their 2024 filings, covering 1,208,434 persons. Self-funded plans that Aetna only administers are not counted.
What is Aetna's share of the California insured employer market?
12% of insured large employer health plans, 7th of 8 carrier groups by plan count.
How much do brokers earn on Aetna plans in California?
Where broker or agent pay was reported, the median was 5.0% of premium (5.0% across all carriers in California).
Can I see the figures for a specific employer?
Yes. Brokers can request an Employer Account Brief on one employer, or a Prospect List for this market. Employers can request a Plan Cost Benchmark for their own plan. Use the request form on this page.
About these numbers
- Plans counted: the 800 California employer health plans with a Aetna major-medical contract in their 2024 filings. Self-funded plans that Aetna only administers are not counted here.
- Premium and broker figures: 760 contracts with 20+ persons covered and a reported premium; broker percentages use the 737 contracts that reported broker or agent pay.
- Network rates: Aetna commercial, professional fees only, from a sample of providers.
- Hospital prices: Aetna commercial rates at California hospitals; stay and facility prices only.
- Full method and limits: how the employer health plan data is built.