Agility partner Aetna announced on May 1 that it will exit the ACA market in 2026. In its statement announcing the action, Aetna confirmed that its ACA cost trends were unsustainable and explained its decision to leave.
We previewed these challenges in February, and today’s announcement follows other troubling payer activity in the last month. Elevance is now accepting paper applications only for its 2025 Medicare Advantage Plans, and no more enrollments are occurring through the online Medicare Advantage broker portal.
The nation’s largest payer, UnitedHealthcare, reported disappointing first-quarter 2025 earnings due to higher-than-expected Medicare Advantage costs. In its statement, UnitedHealthcare said it was lowering its forward guidance for the rest of 2025 and planning to fully address its Medicare Advantage (MA) cost issues in 2026.
This statement indicates that the 2026 benefits will not be as robust across all their MA plans, and service-area reductions may occur. All these events indicate that payers face significant cost pressures in 2025, which they must address in their 2026 operations.
Each payor has unique business circumstances to address, either negative or positive, that will impact their 2026 policy benefits outlook. We should expect more negative announcements, such as Aetna’s, in the ACA and Medicare insurance markets for 2026.
What does this mean for insurance agents serving the million Aetna ACA customers, and how do agents navigate these choppy 2026 insurance market waters? If you’re a current ACA partner with Aetna, you should do the following:
- Reach out to your Aetna ACA clients and tell them:
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- They have coverage through the end of 2025, so nothing’s changing for now.
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- You’ll find them a new ACA solution that best meets their needs during the upcoming ACA Annual Enrollment Period.
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- You’ll ask them to share more information about their current circumstances so you can determine exactly what insurance options they need.
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- You’ll send them regular updates on the 2026 ACA changes and any other information they need to make the best decision for health insurance coverage for their family.
- Start finding new ACA partners in your Aetna markets that match Aetna’s 2025 product portfolio in these markets or are even better.
- Information is power, so empower yourself by knowing what your payor partners say and do. This is a window into what they can do for 2026 policy benefits.
How Do Insurance Agents Successfully Navigate These 2026 Choppy Insurance Market Waters?
- Be prepared for more payors to “adjust” their ACA, Medicare, and commercial markets with:
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- Service area reductions
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- Higher cost shares in specific markets are struggling with higher costs
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- Targeting better benefits to geographic markets or client demographics with lower medical costs or utilization.
- Prioritize quick, concise client communication to update them on changes to their current insurance coverage, government subsidies they receive, or providers leaving their current policy’s network, so they can access care.
Agility is developing strategies, tactics, and media that agents can use to successfully navigate the Aetna action and any subsequent “adjustments” payors make in the coming weeks. Mike Berglund, the Agility ACA product specialist, is available now to answer any Aetna or ACA questions or concerns agents have about this action.
Our Medicare product specialist, Scott Meeks, is also available to answer any questions or address any concerns about the Medicare market ahead. You can contact Mike, Scott, and Agility through our Producer Support team at (866) 590-9771 or by email support@enrollinsurance.com to discuss this Aetna issue or any other insurance questions you need answers to.
Stay tuned to Agility for updates on what payers are doing and what we see in their financial statements regarding their plans for the rest of 2025 and into 2026. Agility will provide you with what you need to navigate these choppy waters and safely reach the other side for you and your clients.
