Every ACA agent knows that Aetna announced on May 1 that it will leave the ACA market in 2026. The statement announcing Aetna’s action confirmed that its ACA cost trends were unsustainable and explained this as the reason it was leaving.
So how do we help these million Aetna clients find new coverage in the ACA? Is Aetna’s action a precursor for more payor changes, and what about what comes out of Washington, D.C., and Congress on the future of the ACA? We look at all of this below, starting with helping the current Aetna clients.
This is For the Aetna ACA Agent Partners
It starts by helping one million current Aetna ACA clients who have seven months to find a new ACA coverage option. Let’s take a look at the following steps you need to do starting now:
Start building your Aetna ACA client transition now:
- Map your ACA Aetna markets to:
-
- Determine the counties with the most Aetna ACA clients,
-
- Find new ACA partners in these markets that match Aetna’s 2025 product portfolio or are even better in benefits.
- Identify top replacement carriers in your counties, especially for clients eligible to switch now via a Special Enrollment Period (SEP).
- Match available plans to your clients’ specific demographics and healthcare needs.
- Match Aetna’s networks (hospitals, major medical groups, etc.) to competitor payors.
- Export your Aetna book from HealthSherpa,
- Prioritize client outreach from the most impacted to the least impacted counties.
Agility provides access to our “Master 2025 ACA Pricing Cheat Sheet” and “Top 30 2024 Aetna Silver Markets—2025 Silver Leader” data, which facilitate mapping and identify the best ACA plans by geography across the nation. Contact Agility ACA product specialist Sebastian Alcantara to find out how you can gain access to this game-changing database.
Contract with Top Replacement Carriers
- If you don’t have a contract with the best performing carriers in your market from your above analysis, now is the time to secure your spot by contracting now:
-
- Agility agents can log in to your Agility Portal and check your contracting status
-
- Prioritize carriers with strong ACA presence in your area using the Cheat Sheet data.
Access the Agility ACA Contracting page now to access the best ACA plans you identify by geography across the nation. You can contact Agility ACA product specialist Sebastian Alcantara with any questions or to request help with this process.
Contact Your Aetna ACA Clients
With your transition plan now in place, it’s time to contact your clients, starting in your most impacted counties first. Your outreach should include something like this: “Let’s take 15 minutes to determine if you’re still on the best plan for your needs.”
- Tell them they have coverage through the end of 2025, so nothing’s changing for now.
- Ask them to share more information about their current circumstances so you can determine:
-
- What insurance options they need now and in the future?
-
- Is it possible they qualify for a Special Election Period (SEP), which they can use to move to a new ACA plan now
- If your client is unable to make an immediate move, tell the client you’ll find a new ACA solution that best meets his or her needs during the upcoming ACA Open Enrollment Period.
- You’ll send regular updates about 2026 ACA changes or other information they need to make the best decision for health insurance covering their family.
These steps should secure great healthcare for these million Aetna ACA clients in 2026.
Precursor for other ACA Payors
The second question is whether these changes are indication of what’s to come in the ACA payor market. We previewed these challenges in February, establishing that payors are dealing with similar pressures that moved Aetna to leave the market. Each payor, however, has unique business circumstances to address, either negative or positive, that impact their 2026 policy benefits outlook.
We should expect more negative announcements within the ACA marketplace, but these can vary from complete exits to service area reductions for 2026. The larger question is what Congress will do to directly impact the ACA in the present and future.
The Congressional budgeting process for 2026 is ongoing as this is being written, and there’s still A LOT that’s uncertain about how this process ends. What’s less debatable is how vital the ACA marketplace is in addressing other critical healthcare markets.
The individual plans ACA provides are increasingly better solutions for rising healthcare benefit costs employers face for employees through Individual Coverage Health Reimbursement Arrangements (ICHRAs). These arrangements show significant savings and cost certainty for employers desperate for both.
Recent rules from CMS show that the administration favors ICHRA as a healthcare solution. Will Congress eliminate or severely damage ICHRA’s foundation in the ACA marketplace?
Anything is possible, but with the administration’s backing, ICHRA, it’s unlikely Congress will do any significant damage to the ACA to protect the ICHRA. ACA waters, however, should still be choppy for 2026, so what should ACA agents do?
- Prepare for more payors to “adjust” their ACA markets with:
-
- Service area reductions
-
- Higher cost shares in specific markets that are struggling with higher costs
-
- Targeting better benefits to geographic markets or client demographics with lower medical costs or utilization.
- Prioritize quick, concise client communication to update ACA clients about changes to their current insurance coverage, government subsidies they receive, or providers leaving their current policy’s network for their access.
Agility is developing strategies, tactics, and media that agents can use to successfully navigate the choppy waters in the ACA over the coming weeks. Sebastian Alcantara, the Agility ACA product specialist, can now answer any ACA questions or concerns.
You can also contact Agility at (866) 590-9771 or email [email protected] to reach the agent support team about these ACA issues or anything else we mention in this article.
Stay tuned to Agility for more updates about what payors are doing or what we hear from Congress about the ACA for the rest of 2025 and into 2026. Agility will provide you with what you need to navigate these uncertain times for you and your ACA clients.
