Aetna’s CVS Health business will leave the Affordable Care Act (ACA) market in 2026, closing out its life on Obamacare exchanges and leaving about 1 million members in 17 states to seek new coverage. The first-ever move, revealed on May 1, 2025, comes amid more general corporate restructuring as healthcare costs climb and regulatory stress increases. This move highlights the instability of the ACA marketplace and highlights concerns of decreased insurance availability prior to foundational subsidy deadlines.
Strategic exit and affected states timeline
CVS Health indicated that Aetna will stop writing individual ACA policies from January 1, 2026, with operations continuing during the year. Enrollees in the following 17 states will be required to choose new coverage during the fall 2025 open enrollment period: Arizona, California, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Maryland, Missouri, Nevada, New Jersey, North Carolina, Ohio, Texas, Utah, and Virginia. The withdrawal will have varying effects on states with different levels of health care infrastructure, which may intensify current gaps in rural and urban access.
The timing is consistent with CVS’s overall cost-cutting initiative, which includes the closure of 900 retail pharmacies by the end of 2025. Most significantly, Arkansas loses more than 20 CVS stores as a result of a state prohibition on Pharmacy Benefit Manager-owned stores, setting the stage for further disruptions. CEO David Joyner cited the company’s focus on “high-value care experiences,” including a new joint venture with Novo Nordisk to market weight-loss drug Wegovy for $499 a month.
Financial drivers and market pressures
Aetna’s ACA business consisted of only 3.7% of the 27.1 million CVS medical members but represented a forecasted 2025 $400 million loss. Increasing medical rates, especially for Medicare Advantage, and lost federal subsidies during the Biden administration added financial burdens. Halted premium tax credits, doubled in 2021, are to expire in 2026, raising concerns over affordability for millions. CVS cited a 173% growth in Aetna’s Q1 2025 operating income to $1.8 billion, although the ACA segment was loss-making.
The news follows after CVS competitor Aetna retreated from ACA markets in 2017–2018 and UnitedHealth reduced Medicare Advantage plans in recent times. Regulatory pressures such as Arkansas’ House Bill 1150 also rendered CVS’ retail-pharmacy integration model ever more challenging, necessitating divestment.
Impact on enrollees and healthcare systems
Impacted members stand to lose more limited provider networks and potential premium hikes. Aetna’s exit from Florida, home to 21.3 million people, potentially adds more stress to safety-net hospitals already grappling with uncompensated care. Rural areas of Ohio and Texas may experience diminished competition, allowing remaining carriers to charge higher rates.
CVS committed to supporting enrollees through 2025, but increasing cuts to funding for patient navigators by the Trump administration have left hundreds of them adrift. Contingency plans are still unannounced by the Centers for Medicare & Medicaid Services (CMS), although nonprofits such as Enroll America can fill gaps.
Wider implications for the ACA marketplace
Aetna’s exit is a sign of systemic problems in the ACA individual market, where insurer participation rises and falls with political and economic tides. Although enrollment hit a record 23.6 million in 2025, sustainability is precarious without permanent subsidies. CVS’s focus on profitable offerings like Wegovy and Medicare Advantage is a sign of an industry-wide shift toward higher-margin segments.
Policymakers are being pressed to shore up markets by continuing subsidies or adding reinsurance programs. Partisanship in Congress, however, diminishes hopes for legislative fixes prior to the 2026 coverage cliff.
Enrollment and alternatives
Enrollees in the 17 states need to take action during the November 1–January 15 open enrollment period to prevent gaps in coverage. Alternatives are:
- State-based exchanges: California (Covered California) and Nevada (Nevada Health Link) both have solid plans.
- Medicaid expansion: Available in 12 affected states for low-income residents.
- Employer-sponsored plans: For those who meet qualification via employment or family members.
CVS’s retreat marks a watershed for the ACA, compelling it to prove its resiliency in the face of corporate shake-ups and evolving healthcare environments. As Joyner penned, “We want to be the most trusted healthcare company, but that means making hard portfolio choices”. To 1 million Americans, those choices now mean instant reevaluations of insurance.
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