Aetna vs Cigna vs UnitedHealthcare: What Actually Differs, and How to Choose

• Aetna, as an insurance company, sells no marketplace plans in any of my 8 states in 2026. In 2025 it sold them in Florida, North Carolina, Arizona, Texas and Indiana.
• Cigna, as an insurance company, sells marketplace plans in 2026 in some counties of Florida, North Carolina, Arizona, Texas and Indiana. Cigna has announced a planned exit from its individual and family medical plan business as of January 1, 2027. Details are under the table.
• UnitedHealthcare, as an insurance company, sells marketplace plans in 2026 in some counties of all seven states on HealthCare.gov.
• Georgia is unsettled. Georgia Access's list of insurance companies (last updated October 23, 2025) names Cigna and UnitedHealthcare. A Georgia Access plan list dated August 28, 2026 includes no medical plans from either, but it also leaves out most of another insurer's plans, so it may simply be incomplete. Check georgiaaccess.gov before you count on either.
• None of their 2026 marketplace plans in these states is a PPO. Each one is an HMO or an EPO.
• Choosing for 2027? This is the 2026 picture. Aetna isn't selling marketplace plans, Cigna has announced it's leaving, and CMS, the federal agency that runs HealthCare.gov, hasn't published anyone's 2027 plans yet, including UnitedHealthcare's.
• As networks, Aetna and Cigna also sit behind short-term plans sold under the Allstate Health Solutions name by other insurance companies. A short-term plan is a health plan sold outside the marketplace for a set period. These aren't Aetna or Cigna plans, and they aren't marketplace plans.

Side by side for 2026: of the three, only UnitedHealthcare sells marketplace plans in Michigan and South Carolina. Where Cigna and UnitedHealthcare both sell, UnitedHealthcare covers more counties in Florida, Arizona and Texas, and Cigna covers more in North Carolina and Indiana. Those are counts of counties, not of people, so check your own county. Where CMS rated a plan from each company (Florida, North Carolina, Arizona and Texas), Cigna's rated as well or better overall and on Medical Care, and UnitedHealthcare's rated as well or better on Plan Administration, which includes customer service. The tables below have the details.

After that, the plan matters more than the name on it: whether your doctors are in its network, how it covers your prescriptions, and what a bad year would cost you.

This counts the counties where each company sells at least one marketplace medical plan in 2026. HMO and EPO are plan types; I explain them further down. Plans are sold county by county, so check your own county before you count on any of them.

For the seven states on HealthCare.gov, the counts come from the plan data published by CMS, the federal agency that runs HealthCare.gov. Georgia runs its own marketplace, Georgia Access, and the Georgia row comes from Georgia Access's list of insurance companies and its plan list dated August 28, 2026. The exact names of the insurance companies that issue these plans are listed near the foot of this page.

What changes after 2026:

• 2027 plans aren't public yet. CMS hadn't published its 2027 plan data when I checked on September 23, 2026. The enrollment dates are in my open enrollment guide.
• Cigna's 2027 plans. The Cigna Group owns the Cigna insurance companies. In its quarterly report for the period ending June 30, 2026, it says that in April 2026 it "announced its planned exit from the Individual and Family Plans medical business as of January 1, 2027." It's an announcement; the 2027 plan lists aren't out yet. If it goes ahead, a Cigna marketplace plan you have now won't be there for 2027, and you'll need a plan from a different company. The Cigna Group is a separate company from the Cigna insurance companies that issue these plans, and it isn't responsible for their financial condition or for their obligations under their policies. If you're in Florida, my Florida guide for 2027 goes through what to do if your Cigna plan is ending.

To see the plans in your own county, use HealthCare.gov's plan and price search, or in Georgia, georgiaaccess.gov. In the seven states on HealthCare.gov, I help you enroll through healthcare.gov and HealthSherpa. In Georgia, you enroll yourself at Georgia Access. I'm not an agent on Georgia Access, but I can go through a plan's summary with you. If you'd rather I check your county, or you're on a Cigna marketplace plan now and want to plan for 2027, book 30 minutes with me and bring your ZIP code.

The insurance company issues your policy, pays your claims and decides what's covered, including your prescriptions. A network is what HealthCare.gov calls "the facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services." A network doesn't sell you insurance, and it doesn't pay your claims.

Here's how that plays out with these three names:

• A Cigna marketplace plan is issued by a Cigna insurance company and uses a Cigna network. Cigna is both the insurer and the network.
• An Allstate Health Solutions short-term plan is insured by a company that isn't Aetna or Cigna. For Georgia, Indiana and South Carolina, Allstate Health Solutions' short-term brochures and its website both name that company as National Health Insurance Company. For Florida, its documents differ on which of its insurers issues the policy, so check the name on the policy itself. For Arizona, Michigan, North Carolina and Texas, I haven't read a brochure, so if you're offered one of these plans there, check the name on the policy too. Allstate Health Solutions itself is a marketing name, and it says "Each underwriting company is responsible for its respective products." It describes itself as part of The Allstate Corporation, which is a separate company from the insurers that issue these plans and isn't responsible for their financial condition or for their obligations under their policies. These plans use a network from Aetna or from Cigna, depending on the plan and the state: the Aetna Open Choice PPO Network, for example, or the Cigna PPO Network for Shared Administration. On these plans, Aetna or Cigna supplies only the network. The insurance, the claims and any drug coverage come from the plan, not from Aetna or Cigna.

So if your plan only uses Aetna's or Cigna's network, questions like "how good is Aetna's customer service?" or "does Cigna cover my drug?" aren't really about your plan. Ask them about the company that issued it. Its name is on your policy.

Your plan's own list of network doctors has the answer. A company's name doesn't tell you which network a plan uses. In 2026, Cigna's marketplace plans in Florida use networks Cigna calls the Florida Connect Network and the Florida Partnered Care Network. UnitedHealthcare's marketplace plans in most of these states use one it calls the Individual Exchange Benefit Plan Network, but in Texas its plans use three different networks. An Allstate Health Solutions short-term plan on Cigna's network uses the Cigna PPO Network for Shared Administration. Those are different networks with different names, so check your doctor in the one your plan uses.

• For a marketplace plan, use the plan's Summary of Benefits and Coverage. That's a short, standard summary every marketplace plan has to give you, and it has to tell you where to find the plan's list of network doctors, by web address or other contact details. In that directory, pick your plan's exact name first, then look up each doctor.
• For a short-term plan, Allstate Health Solutions tells members to "check your plan ID card" and pick the matching network in its provider search. Use the search your plan points you to.
• Check before you enroll, and check again each year before you renew.

Your plan's own drug list has the answer. A formulary is, in HealthCare.gov's words, "a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list."

• For a marketplace plan, the Summary of Benefits and Coverage has to tell you where to find the plan's drug coverage, the same way. Look up each of your prescriptions there, by name and dose, before you enroll.
• A short-term plan may not cover prescriptions at all. Allstate Health Solutions says its short-term plans "tend to not cover pre-existing conditions, mental health care or prescription drugs (though some do)." What counts as pre-existing is explained below. Where one of its plans does cover drugs, the plan's own drug list applies. Aetna's or Cigna's drug lists don't come with their network.

HealthCare.gov defines the plan types you'll see:

• HMO: "usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency."
• EPO: "services are covered only if you use doctors, specialists, or hospitals in the plan's network (except in an emergency)."
• PPO: "You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost."

In 2026, every Cigna and UnitedHealthcare marketplace plan in the seven HealthCare.gov states is an HMO or an EPO. None is a PPO. So if a doctor you won't give up is outside a plan's network, that plan generally won't pay for that doctor except in an emergency.

An HMO doesn't always mean you need a referral to see a specialist. Here's what the companies reported to CMS for their 2026 plans in the seven states on HealthCare.gov:

• No referral needed: Cigna's HMO plans in North Carolina, Arizona and Texas, and its EPO plans in Florida and Indiana; UnitedHealthcare's HMO plans in Michigan, North Carolina and South Carolina, and its EPO plans in Indiana.
• Referral needed: Cigna's HMO plans in Florida, and UnitedHealthcare's HMO plans in Florida, Arizona and Texas.

Every marketplace plan's Summary of Benefits and Coverage prints the plan type at the top, and answers the referral question directly, in a row titled "Do you need a referral to see a specialist?"

A short-term plan doesn't have to give you a Summary of Benefits and Coverage. Read its brochure and its certificate, the document that sets out what the plan covers, for the same answers.

• Pre-existing conditions. As quoted above, Allstate Health Solutions says its short-term plans tend not to cover pre-existing conditions. Its brochures for Florida, Georgia, Indiana and South Carolina define a pre-existing condition by the year before your coverage starts. It's a sickness, injury or condition you got, or were told to get, medical advice, care or a prescription for in that year, or had signs or symptoms of that should have sent you to a doctor, whether or not it was diagnosed. A pregnancy that exists the day before your coverage starts counts too.
• When one ends. Those brochures say that when one of these plans ends, that "is not considered a qualifying life event for the purposes of enrolling in an ACA-compliant major medical plan," meaning a plan that meets the Affordable Care Act's rules, like a marketplace plan. A qualifying life event is what lets you sign up for health insurance outside the yearly open enrollment period, so the end of one of these plans doesn't, by itself, let you buy a marketplace plan outside that period. The brochures also say that a sickness or condition that starts while you're on one of these plans counts as pre-existing on a later short-term plan, which won't cover it.
• Underwriting. Allstate Health Solutions' brochure for Georgia and Indiana says these plans "are medically underwritten." That means the insurance company looks at your health history and decides whether to take you, and at what price.
• No help with the premium. The premium tax credit, the government's help with a marketplace plan's monthly premium, only applies to a plan you enroll in through the marketplace. It never applies to a short-term plan.

These plans have exclusions and limitations, and rules about when a policy can be kept or when it ends. For costs and complete details of the coverage, call me or the insurance company.

• Marketplace premiums. HealthCare.gov says insurance companies "can account for only 5 things when setting premiums": your age, where you live, tobacco use, whether the plan covers just you or your family, and the plan category. The categories are Bronze, Silver, Gold, Platinum and Catastrophic, and they're based on how you and the plan share costs. Your health history isn't one of the five. So the only premium that tells you anything is one quoted for where you live, your age and your household.
• The worst case. Add a year of premiums to the plan's out-of-pocket maximum. That's roughly the most a bad year costs you for covered, in-network care. Your deductible, the amount you pay for covered care before the plan starts to pay, counts toward the maximum; it isn't on top of it. What the maximum leaves out is care outside the network and anything the plan doesn't cover. For a marketplace plan, HealthCare.gov puts the out-of-pocket limit at no more than $10,600 for one person or $21,200 for a family in 2026, and $12,000 or $24,000 in 2027. A short-term plan sets its own limits. The deductibles guide walks through the arithmetic.

CMS calculates a quality rating from 1 to 5 stars for marketplace plans, and HealthCare.gov shows it next to each rated plan. HealthCare.gov says a plan's overall rating "is based on the quality of health care services and members' experiences with their health plan," with three parts:

• Member Experience, based on surveys of members.
• Medical Care, based on how well the plan's network providers manage members' care.
• Plan Administration, "based on how well the plan is run," including customer service.

Here are CMS's 2026 ratings for these companies' marketplace plans in the seven HealthCare.gov states. Aetna, as an insurance company, sells no marketplace plans in these states in 2026, so it has no row. On HealthCare.gov, the overall rating is labeled "Overall Rating."

None of these plans has a Member Experience rating for 2026. CMS lists that part as not rated for every one of them.

These are the ratings shown for 2026 plans. When you shop for a 2027 plan, use the 2027 ratings shown next to each plan on HealthCare.gov.

A few things to keep in mind when you read these:

• They're per plan, per state, not per company. The same company's plans rate differently from one state to the next.
• They look back a year. HealthCare.gov says "Ratings for this year are based on data from last year." The 2027 ratings will replace these.
• Not rated isn't a bad sign. HealthCare.gov says that when "plans are new or have low enrollment ... ratings aren't available. This doesn't mean the plans are low quality."
• Short-term plans aren't rated. This rating system covers marketplace plans only.
• CMS's own description: "CMS scores qualified health plans (QHPs) offered through the Exchanges using the Quality Rating System (QRS) based on third-party validated clinical measure data and QHP Enrollee Survey responses. CMS calculates ratings yearly on a 5-star scale. Ratings may change from year to year."

If you have a problem with any insurance company, your state's insurance department takes complaints. The National Association of Insurance Commissioners lists every state's department.

As CMS's 2026 data names them:

• Florida: Cigna Health and Life Insurance Company (EPO); Cigna HealthCare of Florida, Inc. (HMO); UnitedHealthcare of Florida, Inc.
• Michigan: UnitedHealthcare Community Plan, Inc.
• North Carolina: Cigna HealthCare of North Carolina, Inc.; UnitedHealthcare of North Carolina, Inc
• Arizona: Cigna HealthCare of Arizona, Inc; UnitedHealthcare of Arizona, Inc.
• Texas: Cigna HealthCare of Texas, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare Benefits of Texas, Inc. (Bexar County only)
• Indiana: Cigna Health and Life Insurance Company; UnitedHealthcare Insurance Company
• South Carolina: UnitedHealthcare of South Carolina, Inc.