CVS Health to Exit ACA Individual Market in 2026, Impacting 1 Million Aetna Members

CVS Health announced its plan to exit the individual health insurance market, specifically its Aetna brand plans offered on the Affordable Care Act (ACA) exchanges, effective in 2026. This decision impacts approximately 1 million Aetna members across 17 states who will need to secure alternative coverage during the upcoming enrollment period.

CVS attributed this strategic move to a refocus of its portfolio toward areas that better serve members through other health benefit solutions and cost control efforts. The company continues to experience rising healthcare costs within its insurance operations, particularly in Medicare Advantage and individual exchange segments, prompting the shift away from the ACA individual market.

CVS's medical benefit ratio improved in Q1 2025 partly due to better Medicare Advantage star ratings, signaling progress in managing medical costs. The exit aligns with broader market uncertainties including potential changes in federal subsidies for ACA plans after 2025, amid political debates over health insurance funding.

While CVS is not a dominant player in the ACA individual market, with individual plans constituting a small fraction of its 27.1 million total members, the withdrawal reflects a broader trend of insurance providers reassessing their ACA market participation. CVS also reported strong financial results in Q1 2025 with rising revenues and net income, although it adjusted its full year earnings guidance reflecting various operational and strategic factors.

The company's focus remains on integrating its pharmacy, benefit management, and health services segments to deliver value across its large consumer base.