Aetna's third-quarter net income rose 4 percent, fueled in part by enrollment and revenue gains from a multi-billion-dollar acquisition the health insurer completed earlier this year.

But the Hartford, Conn., company's expenses also jumped, and it became the second big health insurer to miss Wall Street expectations for the quarter. Aetna shares slipped Tuesday in premarket trading.

Aetna's health care costs — its largest expense — climbed 57 percent in the quarter, which partially countered a 46 percent gain in total revenue. The company said a poor performance from two products and federal budget cuts hurt its Medicare business, which mostly involves privately run versions of the government's coverage program for the elderly and disabled people.

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