Carriers & the market
Aetna Reports Lower Medical Costs in Third Quarter as Medicare Advantage Margins Continue to Recover
CVS Health's quarterly report shows Aetna spent a smaller share of premium on member claims in the period ended September 30, with its Medicare business leading the improvement just weeks into open enrollment for 2027.
By the Goodsurance editorial teamNovember 11, 2026
CVS Health reported third-quarter 2026 results on November 4, showing its Aetna health insurance unit posted a medical benefit ratio of 91.3 percent for the three months ended September 30, compared with 92.8 percent in the same period of 2025. The 1.5 percentage point improvement came primarily from the Government segment, where Medicare Advantage cost management and disciplined pricing produced better-than-expected results.
The medical benefit ratio measures what share of premium revenue an insurer spends on member claims. A lower figure generally reflects a healthier financial picture for the plan.
Aetna's medical cost ratio fell year-over-year in Q3 2026, and more than 69 percent of its Medicare Advantage members are in 4-plus-star plans for 2027.
The result continues a stabilization trend after a period of elevated Medicare Advantage costs that pressured many large insurers starting in late 2024. CVS attributed the improvement to medical cost management and pricing discipline in its Medicare book.
For the annual enrollment period now running through December 7, Aetna's star ratings may be one factor consumers weigh when comparing plans. CVS reported that more than 69 percent of its Medicare Advantage members are enrolled in plans rated 4 stars or higher for 2027, the threshold at which CMS pays quality bonuses. Those bonuses can be used to fund supplemental benefits offered within some plans.
Earlier this month, CVS announced it will separate into two independent companies, keeping Aetna together with its pharmacy benefits management business. That transaction is expected to close in mid-2027, well after 2027 coverage begins in January.
In plain words
CVS Health owns Aetna insurance. It just released its July through September 2026 numbers.
The report shows Aetna is spending less of what it collects in premiums on medical bills than it did one year ago. That share fell from about 93 percent down to about 91 percent. The Medicare part of its business drove most of that drop.
More than two thirds of Aetna's Medicare Advantage members are in plans the government rated 4 stars or higher for 2027. That rating can matter because higher-rated plans sometimes offer more extra benefits.
Medicare open enrollment runs until December 7. After that date, most plan changes wait until next fall.
Understand the basics first
Source: CVS Health
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