What’s next for ACA exchanges after Aetna departure?

By Susan Rupe

Aetna recently announced it will withdraw from the Affordable Care Act marketplaces in 17 states at the end of 2025. Will any other carriers follow suit? What does this mean for the future of health insurance for the 24 million people who obtain coverage on the exchange?

Louise Norris, health policy analyst with healthinsurance.org, told InsuranceNewsNet that carriers have entered, exited and sometimes reentered the ACA marketplace since the exchanges opened for business at the end of 2013.

Aetna’s withdrawal from the marketplace this year will mark the second time the carrier stepped away from the ACA exchanges, Norris said. The company left the ACA marketplace in 2018 and came back in 2022. Aetna’s departure from the exchange will leave 1 million customers in search of new coverage.

“The fact that Aetna exited before and then came back makes their leaving the marketplace a little less significant. And they did make it clear that they weren't making money off their individual market business, so it's logical that they would leave,” Norris said.

Carriers left the individual health insurance marketplace in 2017 and 2018 amid uncertainty over whether the ACA would be repealed or replaced. But several of them returned in 2019 “and for about three years, we had more entries than exits” into the marketplace, Norris said, “and then for the past two years, it has been kind of half and half; we saw some entries every year and some exits every year.”

In 2025, 19 states saw either new carriers entering their exchanges, other carriers leaving, or both, Norris said. “But in the majority of states, the number of participating carriers stayed the same. I don’t know whether we might see more of this heading into 2026. The environment is more unstable than it has been the last few years.”

Rate filings coming in June

Carriers that plan to offer coverage on the exchanges will begin filing their rate requests with the individual states in June, with most states announcing those rates in August.

Norris said a few states are asking for carriers to file two sets of rate requests as the Trump administration proposes a rule that would lower marketplace enrollment and the future of enhanced subsidies for marketplace enrollees remains uncertain. Marketplace subsidy enhancements introduced by the American Rescue Plan and extended by the Inflation Reduction Act are due to sunset on Dec. 31 and are not expected to be renewed.

“Some states are telling the carriers to file their rates on the assumption that the ARP subsidy enhancements will not get extended, but also provide details about what the rates would be if those subsidies do get extended,” she said.

Millions could drop out as a result of ACA changes

If the enhanced subsidies expire, millions of people will drop out of ACA coverage. The Congressional Budget Office projected the loss of enhanced subsidies will lead to about 4 million fewer enrollees. In addition, the Trump administration has proposed shortening the open enrollment period, rolling back special enrollment periods and requiring greater documentation from consumers before enrolling. That proposed marketplace rule will cause between 750,000 and 2 million people to lose coverage in 2026 alone. The CBO also projected ACA benchmark premiums to average about 4% higher for 2026 if the enhanced subsides expire.

“Carriers are obviously aware that there could be up to 6 million fewer enrollees for 2026 and they are considering whether they want to stay in the market and also what rates they will charge, basing it on a fairly significant decrease in enrollment next year,” Norris said.

If ACA coverage becomes more expensive or more difficult for people to obtain, younger and healthier consumers are more likely to drop out of the marketplace, Norris said, leaving an older and sicker population for ACA insurers to cover. That also will impact carrier rates.

“I'm sure it's a busy time in the actuarial offices of all these insurance companies just trying to figure this out,” she said. “I would not be surprised to see significantly higher rate increases for 2026 than what we’ve seen over the past few years.”

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].