Aetna says its fourth-quarter earnings sank 49 percent as the health insurer paid more in medical claims and saw several other expenses rise.

The insurer earned $190.1 million, or 56 cents per share, in the three months that ended Dec. 31. That's down from the $372.6 million, or $1.02 per share, a year earlier. Total revenue climbed 16 percent to $9.93 billion.

Adjusted earnings totaled 94 cents per share. Analysts forecast 97 cents per share on about $8.89 billion in revenue.

The company's health care costs climbed 9 percent to $6.12 billion in the quarter, while its total benefits and expenses jumped 21 percent.

Aetna Inc. is the third-largest commercial health insurer based on enrollment, trailing WellPoint Inc. and UnitedHealth Group Inc.

Aetna is based in Hartford, Conn.