# Aetna

**Canonical:** https://apis.io/providers/aetna/  
**Website:** https://www.aetna.com  
**APIs profiled:** 4

Aetna, a CVS Health company, offers health insurance, dental, vision, and other plans for individuals, families, employers, health care providers, and insurance agents and brokers. As a major U.S. health insurer, Aetna provides federally mandated FHIR R4 APIs for patient access, provider directory, and drug formulary data under CMS Interoperability and Patient Access Final Rule (CMS-9115-F). Provider connectivity is supported through the Availity portal for EDI transactions.

## Kin Score — 24.6 / 100 (emerging)

Scored 2026-08-20 under rubric 0.12.0. Trend: flat (+0.0 from 24.6).

| Facet | Score |
|---|---|
| Discoverability | 50.0 |
| Contract Quality | 38.9 |
| Governance | 0.0 |
| Contract Governance | 0.0 |
| Operational Transparency | 10.5 |
| Developer Ergonomics | 14.3 |
| Commercial Clarity | 32.9 |
| Access Clarity | 32.9 |

Regulatory layer — **Health**: 12.5 (matched via tags).

## Agent readiness — 18.4 (agent-aware)

| Dimension | Value |
|---|---|
| Spec Presence | yes |
| Agentic Access | no |
| Reversibility Documented | no |
| MCP Server | no |
| Auth Clarity | no |
| Idempotency | no |
| Error Semantics | no |
| OpenAPI Examples | no |
| Rate Limit Signal | documented |
| Event Surface Described | no |
| Agent Skills | no |
| Well Known Catalog | no |
| Consent Identity | no |
| Agent Card | no |
| Dry Run Mode | no |

## Access

Freemium — onboarding: unknown, pricing: freemium, trial: no (confidence: medium).

## APIs (4)

- **Aetna Patient Access FHIR API** — FHIR R4 compliant Patient Access API providing members secure access to their health data including claims, clinical data, and coverage information. Required under CMS Interoper...
- **Aetna Provider Directory FHIR API** — FHIR R4 compliant Provider Directory API providing standardized access to in-network provider and facility information. Enables third-party applications to search for providers,...
- **Aetna Drug Formulary FHIR API** — FHIR R4 compliant Drug Formulary API providing standardized access to plan formulary data including covered drugs, tiers, cost-sharing requirements, and prior authorization requ...
- **Aetna Provider EDI API** — Electronic Data Interchange connectivity for healthcare providers enabling electronic submission of claims, eligibility verification, claim status inquiries, and remittance advi...

## Security (1)

- **Aetna Domain Security** — TLSv1.3 · HSTS · DMARC

## Plans (1)

- **Aetna Plans Pricing**

## Use cases (6)

- **Member Health Record Access** — Members use SMART on FHIR apps to access their complete health records across providers.
- **Provider Network Verification** — Developers build directory search tools to help patients find in-network providers.
- **Drug Cost Comparison** — Applications use formulary API to compare medication costs across Aetna plans.
- **Electronic Claims Submission** — Healthcare providers submit claims electronically via EDI 837 transactions through Availity.
- **Eligibility Verification** — Providers verify member eligibility and benefits in real time using 270/271 EDI transactions.
- **Remittance Processing** — Providers receive and process electronic remittance advice via EDI 835 transactions.

## Tags

Health Insurance, Healthcare, FHIR, Patient Access, Provider Directory, Fortune 100

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Profiled by [API Evangelist](https://apievangelist.com) and published on [APIs.io](https://apis.io/providers/aetna/). Scores are computed from the provider's own public artifacts under a published rubric.