AultCare to Discontinue Some ACA Plans Amid Subsidy Uncertainty for 2026

AultCare, a health insurer affiliated with Aultman Health Systems in Ohio, has announced it will discontinue some individual, family, and small group Affordable Care Act (ACA) health insurance plans starting in 2026. The affected plans include both On-Marketplace and Off-Marketplace products for individuals and families, as well as small group plans for employers with fewer than 50 employees. This change impacts approximately 6,000 enrollees out of AultCare's total insured population of around 100,000.

The primary reason cited for this decision is the uncertainty surrounding the future availability of ACA premium subsidies, particularly enhanced premium tax credits currently scheduled to expire at the end of 2025 unless Congress acts to extend them. AultCare has experienced financial losses with these products and projects ongoing challenges in maintaining affordability if subsidies are reduced or eliminated.

This move aligns with broader market trends where many insurers anticipate premium increases and potential participation changes in the ACA Marketplace for 2026. Preliminary rate filings analyzed by the Kaiser Family Foundation indicate a median 15% rise in premiums next year, driven by the expiration of enhanced tax credits and tariffs on pharmaceuticals and medical goods. Consequently, some insurers are adjusting their coverage footprints anticipating possible enrollment declines, especially among healthier individuals.

While individuals enrolled in the discontinued plans will maintain coverage through December 31, 2025, they must select new plans during the upcoming open enrollment period starting November 1, 2024. AultCare has advised affected members to explore alternative coverage options, including other Marketplace plans or those offered by employers, noting that other AultCare insurance products such as Medicare Advantage, commercial group plans, and self-funded arrangements remain unaffected.

This development underscores the ongoing regulatory and financial pressures on insurers in the ACA market driven by subsidy policy uncertainties and cost factors. It also highlights the importance for brokers, employers, and policyholders to proactively assess insurance options amidst evolving market dynamics and regulatory frameworks.