CVS Health’s Aetna to withdraw from ACA insurance marketplaces next year
On Thursday morning, CVS Health released its first-quarter earnings report to investors and revealed that it will be withdrawing from Affordable Care Act exchanges, pulling all medical insurance options for cases where subsidiary Aetna “independently operates ACA plans for 2026.”
Aetna had rejoined the government exchanges in 2022, after exiting in 2018 along with a number of other health plans. At the time, the company cited financial losses associated with plans sold through the often government subsidized markets.
Its motivation for pulling out in 2026 is similar, with CVS Health writing in its statement to investors that the company will be exploring other ways to serve its 27.1 million patients. Despite posting $1.8 billion in profits in the first quarter of the year, CVS Health reported a decline in enrollments in Aetna plans on ACA marketplaces, including those offering Medicare plans.
“This decision is consistent with others taken this year to focus the Company's portfolio. [Aetna] is best able to serve members through its other health benefit solutions, which offer access to quality care, affordable health benefits and exceptional service,” the company said. “[Aetna] will continue delivering superior service and support to its individual exchange members through 2025 and residual activities in 2026.”
Aetna sees gains
The financial situation of Aetna seems to be on the upward trend. Where the managed care giant reported a medical loss ratio—a measurement of the percentage of member premiums spent on care—of 90.4% in the fourth quarter of 2024, that number has dropped to 87.3%.
In the earning report, CVS highlighted Aetna’s new tools to manage prior authorizations and provide more transparent coverage to patients and providers, something that may be contributing to its improved efficiency.
“Aetna has introduced an approach to bundling approvals for prior authorizations for certain cancer-related scans and tests, making it one upfront approval instead of multiple approvals over a period of months,” CVS Health wrote. “In addition, a new Aetna Clinical Collaboration program partners with hospitals to support members as they change care settings, reducing readmissions and improving outcomes.”
Total revenues for CVS Health have increased to $94.6 billion, up 7.0% so far since last year. Its stock rose 4% on the week, hovering at roughly $69.45 a share on Thursday.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.