Aetna will exit the individual ACA exchange market in 2026, citing continued underperformance.
CVS Health reported its first quarter earnings May 1. On a call with investors, CEO David Joyner said the company determined there is “not a near or long-term pathway for Aetna to materially improve its position in the market.”
“We must recognize what is and is not working, and will focus on the areas we have a clear right to win,” Mr. Joyner said. “This was not a decision we made lightly, as we recognize the importance of this product to millions of members.”
Here are three things to know:
- CVS established a $448 million premium deficiency reserve for its individual exchange business related to anticipated losses for 2025. The company is projecting it will lose between $350 and $400 million in its individual business in 2025, CFO Tom Cowhey told investors.
- Aetna has around 1 million individual members in 17 states, according to Forbes. Its individual membership is a small fraction of CVS Health’s 27.1 million members.
- CVS Health’s decision to exit the individual market comes amid uncertainty for the program. Enhanced subsidies have spurred record enrollment in the program, but these subsidies will expire at the end of 2025 unless Congress votes to extend them.
“We are committed to supporting our individual exchange members for as long as we have the privilege to serve them, and we’ll also work closely with our partners to ensure a smooth transition and that these members continue to have access to quality, affordable care,” Mr. Joyner said.
