Aetna employer health plans in Pennsylvania
Who Aetna insures among Pennsylvania 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 Pennsylvania at a glance
What the data shows
Aetna insures 158 employer health plans in Pennsylvania (11% of 1,491 insured large plans), 4th of 8 carrier groups; Blue Cross Blue Shield (800), Cigna (207) hold more.
Aetna has shrunk 31% in Pennsylvania since 2020, from 228 plans, as insured plans moved carrier or to self-funding.
Most of these plans cover 100–499 people (63 plans); 22 cover 1,000 or more.
Median premium per person covered was $5,612, 21% below the Pennsylvania all-carrier median of $7,075. Benefit design and group mix differ, so this is not a price comparison.
58% of these plans reported broker or agent pay on their Aetna contracts; where paid, the median was 3.1% of premium (middle half 0.8%–7.0%).
In Aetna commercial, 28 of the 50 Employer 50 services have a Pennsylvania benchmark, at a median of 109% of Medicare across those services.
At Pennsylvania hospitals, Aetna's commercial rates run higher than other carriers' at the same hospital for 16 of 17 services; a hip or knee replacement stay has a median rate of $32,221 across 48 hospitals.
Aetna plans in Pennsylvania, 2020–2024
| Form year | Plans | Persons covered | Share of state | Median premium / person |
|---|---|---|---|---|
| 2020 | 228 | 123,612 | 13% | $5,210 |
| 2021 | 191 | 130,688 | 11% | $4,656 |
| 2022 | 171 | 112,259 | 10% | $5,420 |
| 2023 | 179 | 131,609 | 11% | $5,689 |
| 2024 | 158 | 130,491 | 11% | $5,612 |
| 2025 (partial) | 93 | 97,516 | 10% | $5,766 |
Plan size
| Persons covered | Plans | Share |
|---|---|---|
| Under 100 | 47 | 30% |
| 100–499 | 63 | 40% |
| 500–999 | 25 | 16% |
| 1,000–4,999 | 18 | 11% |
| 5,000 or more | 4 | 3% |
Premiums and broker pay
| Measure | Aetna | All carriers, Pennsylvania |
|---|---|---|
| Median premium per person covered | $5,612 | $7,075 |
| Premium per person, middle half | $2,150–$7,626 | $4,536–$9,457 |
| Plans reporting broker or agent pay | 58% | 69% |
| Median broker pay, % of premium | 3.1% | 3.7% |
| Broker pay, middle half | 0.8%–7.0% | 2.5%–5.3% |
| Median broker pay per person covered | $78 | $256 |
Industries
Aetna's Pennsylvania employer clients are concentrated in manufacturing (40 plans) and professional and technical services (26), followed by educational services (12).
| Industry | Plans | Share |
|---|---|---|
| Manufacturing | 40 | 25% |
| Professional and technical services | 26 | 16% |
| Educational services | 12 | 8% |
| Wholesale trade | 11 | 7% |
| Other services | 11 | 7% |
| Finance and insurance | 10 | 6% |
Aetna employer clients in Pennsylvania
151 employers in Pennsylvania have a Aetna major-medical contract, 22 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 Pennsylvania
| Service | Code | Median | Middle half | % of Medicare | Other networks, median | Provider groups |
|---|---|---|---|---|---|---|
| Diagnostic heart catheterization with coronary angiography | 93458 | $341 | $314–$504 | 119% | $426 | 62 |
| Echocardiogram, transthoracic complete with Doppler | 93306 | $260 | $217–$341 | 132% | $307 | 66 |
| Electrocardiogram (EKG), complete | 93000 | $20 | $16–$25 | 133% | $26 | 67 |
| Nuclear stress test (SPECT myocardial perfusion) | 78452 | $82 | $74–$120 | 110% | $119 | 64 |
| Treadmill stress test, complete | 93015 | $87 | $78–$122 | 119% | $128 | 58 |
| Cataract removal with lens implant | 66984 | $582 | $521–$617 | 126% | $623 | 124 |
| Abdominal ultrasound, complete | 76700 | $41 | $37–$55 | 108% | $57 | 138 |
| Bone density scan (DXA), axial | 77080 | $10 | $9–$14 | 108% | $12 | 133 |
| CT abdomen and pelvis with contrast | 74177 | $368 | $335–$458 | 123% | $457 | 132 |
| CT chest without contrast | 71250 | $183 | $157–$287 | 138% | $267 | 133 |
| Chest X-ray, 2 views | 71046 | $11 | $10–$14 | 107% | $15 | 135 |
| MRI brain without and with contrast | 70553 | $454 | $425–$630 | 143% | $642 | 136 |
| MRI cervical spine without contrast | 72141 | $425 | $314–$600 | 223% | $341 | 132 |
| MRI knee (lower-extremity joint) without contrast | 73721 | $425 | $334–$603 | 208% | $399 | 137 |
| MRI lumbar spine without contrast | 72148 | $425 | $320–$603 | 222% | $381 | 135 |
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 Pennsylvania
Aetna commercial rates are on record at 66 Pennsylvania 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 16 of 17 services and lower for 1. For Emergency visit, level 4, the rate runs from $418 to $1,497 across 21 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) | 48 | $32,221 | $20,005–$46,495 | Higher | – |
| C-section delivery (hospital stay) | 47 | Locked | Locked | Higher | Locked |
| Vaginal delivery (hospital stay) | 47 | Locked | Locked | Higher | Locked |
| MRI, lower back | 35 | $871 | $535–$1,421 | Higher | $513 |
| MRI, knee | 34 | Locked | Locked | Higher | Locked |
| CT, head | 33 | Locked | Locked | Higher | Locked |
| CT, abdomen and pelvis | 35 | Locked | Locked | Higher | Locked |
| Screening mammogram | 34 | Locked | Locked | Higher | Locked |
| Colonoscopy, diagnostic | 18 | Locked | Locked | Higher | Locked |
| Upper GI endoscopy with biopsy | 18 | Locked | Locked | Higher | Locked |
| Knee arthroscopy | 18 | Locked | Locked | Higher | Locked |
| Cataract surgery | 18 | Locked | Locked | Higher | Locked |
| Gallbladder removal, laparoscopic | 26 | Locked | Locked | Higher | Locked |
| Knee replacement, outpatient | 26 | Locked | Locked | Higher | Locked |
| Emergency visit, level 4 | 21 | $943 | $418–$1,497 | Lower | $1,797 |
| Comprehensive metabolic panel | 25 | Locked | Locked | Higher | Locked |
| Complete blood count | 27 | 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 |
|---|---|---|---|---|---|---|
| Ahn Allegheny General Hospital | $37,461 | Locked | Locked | Locked | Locked | Locked |
| Ahn Allegheny Valley Hospital | $28,841 | Locked | Locked | Locked | Locked | Locked |
| Ahn Canonsburg General Hospital | $28,841 | Locked | Locked | Locked | Locked | Locked |
| Ahn Forbes Hospital | $31,899 | Locked | Locked | Locked | Locked | Locked |
| Ahn Grove City Medical Center | $26,188 | Locked | Locked | Locked | Locked | Locked |
| Ahn Saint Vincent Hospital | $27,881 | Locked | Locked | Locked | Locked | Locked |
| Ahn Wexford Hospital | $35,257 | Locked | Locked | Locked | Locked | Locked |
| Bryn Mawr Hospital | $46,495 | Locked | Locked | Locked | Locked | Locked |
| Jefferson Lansdale Hospital | $31,085 | Locked | Locked | Locked | Locked | Locked |
| Thomas Jefferson University Hospital | $46,651 | Locked | Locked | Locked | Locked | Locked |
How the contracts are written: case rates 19%, fee schedules 59%, per diem 1%, percent of billed charges 12%, other 10% of Aetna's published commercial rates for these services in Pennsylvania.
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 Pennsylvania
| Carrier | Plans | Share | Median premium / person | Median broker % |
|---|---|---|---|---|
| Blue Cross Blue Shield | 800 | 54% | $7,441 | 3.3% |
| Other insurers (regional and local plans) | 423 | 28% | $7,243 | 3.4% |
| Cigna | 207 | 14% | $3,936 | 6.1% |
| Aetna | 158 | 11% | $5,612 | 3.1% |
| UnitedHealthcare | 122 | 8% | $5,192 | 4.4% |
| Kaiser Permanente | 97 | 7% | $9,455 | 3.0% |
| Anthem (Elevance Health) | 7 | 0% | $8,992 | 2.0% |
| Humana | 5 | 0% | $2,657 | – |
Aetna in other states
FAQ
How many Pennsylvania employers have Aetna health insurance?
158 employer health plans in Pennsylvania reported a Aetna major-medical contract in their 2024 filings, covering 130,491 persons. Self-funded plans that Aetna only administers are not counted.
What is Aetna's share of the Pennsylvania insured employer market?
11% of insured large employer health plans, 4th of 8 carrier groups by plan count.
How much do brokers earn on Aetna plans in Pennsylvania?
Where broker or agent pay was reported, the median was 3.1% of premium (3.7% across all carriers in Pennsylvania).
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 158 Pennsylvania 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: 129 contracts with 20+ persons covered and a reported premium; broker percentages use the 91 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 Pennsylvania hospitals; stay and facility prices only.
- Full method and limits: how the employer health plan data is built.