CVS Health has announced that it will exit the Affordable Care Act (ACA) individual marketplaces in 2026, marking the second time in the past decade that Aetna, its health insurance subsidiary, has discontinued ACA coverage. The decision is expected to impact 1 million Aetna enrollees across 17 states, who will need to secure new health coverage for the following year.
The conglomerate anticipates losing up to $400 million this year due to its ACA plans. In the first quarter, CVS set aside $448 million to cover medical claims from ACA members that were not covered by insurance premiums. This financial strain is likely a significant factor in the decision to exit the ACA marketplaces.
Financial Implications
CVS Health’s decision comes as the company faces significant financial challenges related to its ACA plans. The $448 million set aside in the first quarter highlights the scale of the financial burden. By exiting the individual marketplaces, CVS aims to mitigate future losses.
Impact on Aetna Enrollees
The exit will affect 1 million Aetna enrollees in 17 states, who will need to find alternative health coverage for 2026. This change could lead to uncertainty and potential coverage gaps for these individuals. Aetna will need to communicate effectively with its members to guide them through this transition.
Context and Background
This is not Aetna’s first withdrawal from the ACA marketplaces. The company has previously scaled back its ACA participation in the past decade. The ACA, enacted in 2010, has faced numerous challenges and controversies since its implementation, with insurer participation varying over the years.
Conclusion
CVS Health’s decision to exit the ACA individual marketplaces in 2026 reflects the ongoing challenges faced by insurers in this segment. As the healthcare landscape continues to evolve, the impact of this decision on Aetna enrollees and the broader insurance market remains to be seen.
