Aetna employer health plans in North Carolina
Who Aetna insures among North Carolina 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 North Carolina at a glance
What the data shows
Aetna insures 66 employer health plans in North Carolina (7% of 939 insured large plans), 5th of 8 carrier groups; Blue Cross Blue Shield (478), Cigna (186) hold more.
Aetna has grown 32% in North Carolina since 2020, from 50 plans.
Most of these plans cover 100–499 people (39 plans); 5 cover 1,000 or more.
Median premium per person covered was $5,745, 4% below the North Carolina all-carrier median of $6,006. Benefit design and group mix differ, so this is not a price comparison.
68% of these plans reported broker or agent pay on their Aetna contracts; where paid, the median was 1.5% of premium (middle half 0.6%–5.7%).
In Aetna commercial, 28 of the 50 Employer 50 services have a North Carolina benchmark, at a median of 126% of Medicare across those services.
At North Carolina hospitals, Aetna's commercial rates run higher than other carriers' at the same hospital for 10 of 14 services; a hip or knee replacement stay has a median rate of $26,924 across 18 hospitals.
Aetna plans in North Carolina, 2020–2024
| Form year | Plans | Persons covered | Share of state | Median premium / person |
|---|---|---|---|---|
| 2020 | 50 | 18,734 | 5% | $5,084 |
| 2021 | 63 | 30,519 | 7% | $5,028 |
| 2022 | 64 | 28,259 | 6% | $5,919 |
| 2023 | 66 | 57,572 | 7% | $5,689 |
| 2024 | 66 | 55,984 | 7% | $5,745 |
| 2025 (partial) | 36 | 27,034 | 7% | $6,385 |
Plan size
| Persons covered | Plans | Share |
|---|---|---|
| Under 100 | 18 | 27% |
| 100–499 | 39 | 59% |
| 500–999 | 4 | 6% |
| 1,000–4,999 | 4 | 6% |
| 5,000 or more | 1 | 2% |
Premiums and broker pay
| Measure | Aetna | All carriers, North Carolina |
|---|---|---|
| Median premium per person covered | $5,745 | $6,006 |
| Premium per person, middle half | $4,203–$8,000 | $3,259–$8,027 |
| Plans reporting broker or agent pay | 68% | 79% |
| Median broker pay, % of premium | 1.5% | 4.0% |
| Broker pay, middle half | 0.6%–5.7% | 2.6%–6.3% |
| Median broker pay per person covered | $64 | $216 |
Industries
Aetna's North Carolina employer clients are concentrated in manufacturing (19 plans) and health care and social assistance (15), followed by retail trade (9).
| Industry | Plans | Share |
|---|---|---|
| Manufacturing | 19 | 29% |
| Health care and social assistance | 15 | 23% |
| Retail trade | 9 | 14% |
| Construction | 4 | 6% |
| Wholesale trade | 3 | 5% |
| Real estate | 3 | 5% |
Aetna employer clients in North Carolina
61 employers in North Carolina have a Aetna major-medical contract, 5 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 |
Brokers: request the Aetna Prospect List for North Carolina →
What the Aetna network pays physicians in North Carolina
| Service | Code | Median | Middle half | % of Medicare | Other networks, median | Provider groups |
|---|---|---|---|---|---|---|
| Diagnostic heart catheterization with coronary angiography | 93458 | $347 | $293–$391 | 121% | $515 | 32 |
| Echocardiogram, transthoracic complete with Doppler | 93306 | $82 | $69–$94 | 121% | $124 | 43 |
| Electrocardiogram (EKG), complete | 93000 | $19 | $16–$26 | 126% | $30 | 45 |
| Nuclear stress test (SPECT myocardial perfusion) | 78452 | $465 | $391–$579 | 109% | $707 | 36 |
| Treadmill stress test, complete | 93015 | $94 | $82–$128 | 128% | $127 | 37 |
| Cataract removal with lens implant | 66984 | $622 | $522–$794 | 135% | $718 | 50 |
| Abdominal ultrasound, complete | 76700 | $50 | $39–$72 | 134% | $65 | 103 |
| Bone density scan (DXA), axial | 77080 | $61 | $41–$105 | 155% | $91 | 100 |
| CT abdomen and pelvis with contrast | 74177 | $413 | $330–$671 | 137% | $568 | 100 |
| CT chest without contrast | 71250 | $245 | $171–$381 | 184% | $322 | 103 |
| Chest X-ray, 2 views | 71046 | $13 | $10–$18 | 128% | $18 | 94 |
| MRI brain without and with contrast | 70553 | $553 | $402–$937 | 174% | $846 | 102 |
| MRI cervical spine without contrast | 72141 | $420 | $311–$600 | 220% | $481 | 102 |
| MRI knee (lower-extremity joint) without contrast | 73721 | $423 | $336–$600 | 207% | $495 | 100 |
| MRI lumbar spine without contrast | 72148 | $418 | $312–$600 | 218% | $499 | 102 |
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 North Carolina
Aetna commercial rates are on record at 39 North Carolina 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 10 of 14 services and lower for 4. For Hip or knee replacement (hospital stay), the rate runs from $1,860 to $44,775 across 18 hospitals.
This page shows 3 of the 14 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) | 18 | $26,924 | $1,860–$44,775 | Higher | – |
| C-section delivery (hospital stay) | 17 | Locked | Locked | Higher | Locked |
| Vaginal delivery (hospital stay) | 17 | Locked | Locked | Higher | Locked |
| MRI, lower back | 13 | $270 | $270–$2,942 | Lower | $2,013 |
| MRI, knee | 13 | Locked | Locked | Lower | Locked |
| CT, head | 18 | Locked | Locked | Higher | Locked |
| CT, abdomen and pelvis | 18 | Locked | Locked | Higher | Locked |
| Screening mammogram | 13 | Locked | Locked | Higher | Locked |
| Colonoscopy, diagnostic | 9 | Locked | Locked | Lower | Locked |
| Upper GI endoscopy with biopsy | 9 | Locked | Locked | Higher | Locked |
| Gallbladder removal, laparoscopic | 9 | Locked | Locked | Lower | Locked |
| Emergency visit, level 4 | 18 | $1,841 | $229–$2,171 | Higher | $1,591 |
| Comprehensive metabolic panel | 21 | Locked | Locked | Higher | Locked |
| Complete blood count | 21 | 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 |
|---|---|---|---|---|---|---|
| Atrium Health Cabarrus | $44,775 | Locked | Locked | Locked | Locked | Locked |
| Atrium Health Carolinas Medical Center | $44,775 | Locked | Locked | Locked | Locked | Locked |
| Atrium Health Kings Mountain | – | Locked | Locked | Locked | Locked | Locked |
| Atrium Health Lincoln | – | Locked | Locked | Locked | Locked | Locked |
| Atrium Health Mercy | $44,775 | Locked | Locked | Locked | Locked | Locked |
| Atrium Health Stanly | – | Locked | Locked | Locked | Locked | Locked |
| Atrium Health Union | $44,775 | Locked | Locked | Locked | Locked | Locked |
| Atrium Health University City | $44,775 | Locked | Locked | Locked | Locked | Locked |
| Novant Health Brunswick Medical Center | – | Locked | Locked | Locked | Locked | Locked |
| Novant Health New Hanover Regional Medical Center | $29,175 | Locked | Locked | Locked | Locked | Locked |
How the contracts are written: case rates 4%, fee schedules 48%, per diem 3%, percent of billed charges 41%, other 3% of Aetna's published commercial rates for these services in North Carolina.
Employers: see all 14 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 North Carolina
| Carrier | Plans | Share | Median premium / person | Median broker % |
|---|---|---|---|---|
| Blue Cross Blue Shield | 478 | 51% | $6,672 | 3.2% |
| Cigna | 186 | 20% | $2,375 | 8.1% |
| UnitedHealthcare | 153 | 16% | $6,004 | 4.8% |
| Other insurers (regional and local plans) | 89 | 9% | $1,360 | 9.6% |
| Aetna | 66 | 7% | $5,745 | 1.5% |
| Kaiser Permanente | 64 | 7% | $8,943 | 2.9% |
| Anthem (Elevance Health) | 8 | 1% | $6,519 | 5.0% |
| Humana | 3 | 0% | $3,482 | 2.7% |
Aetna in other states
FAQ
How many North Carolina employers have Aetna health insurance?
66 employer health plans in North Carolina reported a Aetna major-medical contract in their 2024 filings, covering 55,984 persons. Self-funded plans that Aetna only administers are not counted.
What is Aetna's share of the North Carolina insured employer market?
7% of insured large employer health plans, 5th of 8 carrier groups by plan count.
How much do brokers earn on Aetna plans in North Carolina?
Where broker or agent pay was reported, the median was 1.5% of premium (4.0% across all carriers in North Carolina).
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 66 North Carolina 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: 59 contracts with 20+ persons covered and a reported premium; broker percentages use the 45 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 North Carolina hospitals; stay and facility prices only.
- Full method and limits: how the employer health plan data is built.