Agility partner, Aetna announced on May 1 that it will leave the ACA market in 2026. In its statement announcing this action, Aetna confirmed that its ACA cost trends were unsustainable and explained the reason it was leaving.
We previewed these challenges in February, and today’s announcement follows other troubling payor 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 payor, UnitedHealthcare, announced disappointing 2025 first-quarter earnings due to higher-than-expected Medicare Advantage costs. In its statement, UnitedHealthcare said it was adjusting its forward guidance downward for the rest of 2025 and making plans to fully address its Medicare Advantage (MA) cost issues in 2026.
This statement indicates that the benefits in 2026 will not be as robust in all their MA plans, and service area reductions MAY happen. All these events combine to paint a picture of payors under significant cost pressures in 2025 that they must address in 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, like Aetna’s, within 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 about 2026 ACA changes or other information they need to make the best decision for health insurance covering 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 on 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 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 about changes to their current insurance coverage, government subsidies they receive, or providers leaving their current policy’s network for them to access.
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. Sebastian Alcantara, 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, Carolina Alcorta, is also available for any questions or concerns about the Medicare market ahead. You can also contact Agility at (866) 590-9771 or email [email protected] to reach the agent support team about this Aetna issue or anything else we mention in this article.
Stay tuned to Agility for more updates about what payors are doing or what we see them announce in their financial statements about 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.
