
In this article
- How widespread are carrier exits?
- My health insurance company is leaving the market in my area. What should I do?
- How do I choose a new exchange plan?
- When can I enroll in a new plan if my carrier is exiting the market?
- Will I still receive a premium subsidy if my carrier exits the market?
- Do I still need to pay my premium if my carrier is exiting the market?
- Should I let my exchange auto-enroll me in a new health plan?
- It pays to look at replacement health plan options.
Over the years, there has been quite a bit of fluctuation with insurer participation in various areas, with some insurers exiting certain markets and others entering. In May 2025, CVS Health Corporation announced that its subsidiary, Aetna (“Aetna/CVS”), will no longer offer Marketplace coverage after the end of 2025.1 Aetna offers Marketplace plans in 17 states in 2025,2 covering about 1 million enrollees.3
How widespread are carrier exits?
In addition to Aetna’s exit, the following insurers are leaving the individual market and/or Marketplace at the end of 2025 in the following states:
- Illinois: Health Alliance and Quartz4
- Kentucky: CareSource5
- Michigan: Molina6 and UM Health Plan/Michigan Care7
- Mississippi: Primewell Health Services8
- North Carolina: Celtic/Wellcare 9
- Ohio: AultCare10
- Wisconsin: Molina6 and Chorus Community Health Plan11
- Wyoming: Mountain Health CO-OP12
In addition to the full market exits described above, Blue Cross Blue Shield of Arizona is terminating Marketplace PPOs at the end of 2025.13 BCBSAZ will continue to offer HMOs, but PPO enrollees will need to select new plans.
And as is always the case, there are also some Marketplace insurers that are changing their coverage areas for 2026. So while a carrier might continue to offer plans in a given state, some enrollees will need to select new coverage because the insurer stops offering coverage in a particular area. This is the case, for example, with Cigna in Illinois: Cigna will continue to offer Marketplace plans, but not in Cook County.14 So Cook County residents with Cigna Marketplace plans will need to select new coverage for 2026.
Aetna is exiting the individual market in Arizona, California, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Maryland, Missouri, Nevada, New Jersey, North Carolina, Ohio, Texas, Utah, and Virginia15 (including Innovation Health).16
My health insurance company is leaving the market in my area. What do I need to do?
If you have an individual/family plan and your insurer is leaving the market in your area, you need to select a new health plan. The termination of your old plan will trigger a special enrollment period that will allow you to sign up for a new individual/family plan. The special enrollment period will allow you to have uninterrupted coverage as long as you pick a new plan no later than the last day that your old plan is in effect (assuming the old plan ends on the final day of a month).
Your special enrollment period will also continue for 60 days after the old plan ends. But if you enroll during that window, you'll have a gap in coverage, as the new plan will not be retroactively effective. Coverage will take effect as early as the first of the month following your enrollment.
(If an employer-sponsored health plan is available to you, the loss of your individual/family plan would trigger a special enrollment period for the employer-sponsored plan. The rules are different for SEPs for employer-sponsored health plans.)
How do I choose a new exchange plan?
If your insurer is leaving the market, you'll need to pick a new health plan. Here are some tips for picking the plan that will best fit your needs and budget. If you're undergoing treatment for a health condition, you'll want to make sure that the new plan includes your doctors in its network and your prescriptions in its formulary.
In most cases – including the Aetna/CVS exit and all of the other end-of-2025 carrier exits listed above – carriers exit the market at the end of the year. So you'd have been starting over with a new deductible and out-of-pocket maximum on January 1 even if your plan had been able to renew. (All ACA-compliant individual/family health plans follow the calendar year.)
If your carrier is leaving the market mid-year, you'll need to prepare yourself for the fact that you'll likely be starting over at $0 in out-of-pocket spending when your new plan takes effect. As of late September, 2025, however, no Marketplace insurer had announced a mid-year 2025 exit.
When can I enroll in a new plan if my carrier is exiting the market?
Your special enrollment period starts 60 days before your plan ends and continues for 60 days after it ends. In most cases, this is centered around the end/start of the new calendar year. But if your carrier is exiting the market mid-year, your special enrollment period will depend on when your plan ends.
Regardless of whether the carrier exits the market at year-end or mid-year, you need to enroll in a new plan before your old plan ends, to have uninterrupted coverage. If you enroll during the 60 days after your plan ends, you'll have a gap in coverage, as the new plan will not have a retroactive effective date.
Will I still receive a premium subsidy if my carrier exits the market?
If you choose a new plan through the Marketplace, you may be required to prove your ongoing eligibility for a subsidy during the process of updating your enrollment application. You should remain eligible for a subsidy if none of your circumstances have changed (income, dependents, employment benefits, etc.) However, the amount you pay each month will likely change, depending on the cost of the new plan you select.
And if the new plan is taking effect on January 1, the amount of your subsidy will also change if the price of the benchmark plan in your area has changed for the new year. Here's how the premium subsidy math works, and here's a subsidy calculator you can use.
Do I still need to pay my premium if my carrier is exiting the market?
Yes, you need to continue to pay premiums when they're due in order to keep your coverage. In most cases, carrier exits happen at the end of the year, so you'll pay your premiums through December 31. (If you stop paying your premiums, your policy will terminate once your grace period ends.)
Should I let my exchange auto-enroll me in a new health plan if my carrier is exiting the market?
In general, no. If your carrier is exiting the market at the end of the year, it's generally an option to let the exchange automatically select a new plan for you that will start on January 1. But it may not be in your best interest to rely on the exchange's algorithm. Instead, you may be better served by selecting your own replacement plan that most closely meets your needs.
If your insurer is leaving the market mid-year, the exchange might not have an available mechanism for automatic re-enrollment mid-year. Therefore, it is important to understand the options available to avoid becoming uninsured.
If your carrier is exiting the market on December 31, here's how the automatic re-enrollment process works if you don't select your own replacement plan by December 31:
- If you bought your existing coverage through the Marketplace in your state, the exchange will select a new plan for you if you don't take any action. The protocol that’s used in most states essentially moves people to the lowest-cost plan that has the same metal level , product type (HMO, EPO, PPO, or POS), and provider network as the plan that’s terminating.
- If you obtained your existing coverage outside the exchange, there is no entity that can automatically select a new plan for you if your insurer is leaving the market. If you don’t pick your own replacement plan, you’ll be uninsured on January 1. If your carrier has been bought by another carrier, the new carrier may transition you to one of their plans.
But again, even if you have a plan that you obtained through the exchange, you may not want to rely on the exchange to pick a new plan for you using an automatic algorithm. They won’t be able to prioritize the coverage aspects that are most important for you, which might include having an HSA-eligible plan (note that this will include all Bronze and Catastrophic Marketplace plans as of 2026) or a certain out-of-pocket structure.
It pays to look at replacement health plan options.
The points discussed above are why it’s so important that you look at all of the replacement plan options that are available to you, and make your own selection. You may find that there are new options that weren’t available the last time you shopped for coverage.
The American Rescue Plan’s subsidy enhancements have been extended through 2025, so the larger subsidies continue to be available to offset the cost of coverage. But as of May 2025, there has been no Congressional action to extend these subsidy enhancements again, which means they’re still scheduled to sunset at the end of 2025. That will result in smaller premium subsidies in 2026, so it will be important for enrollees to actively comparison shop during open enrollment, to find the plan that offers the best value.
If you don’t get around to choosing a new plan by the end of December, you’ll generally still have a chance to pick a plan in the early part of the new year if your previous plan ended on Dec. 31. The special enrollment period runs for 60 days after the old plan ends.
Although this is better than being stuck with a plan you didn’t choose, enrolling after the first of the year isn’t ideal, as it will mean starting over with a new plan after the year is underway. And if you had off-exchange coverage that terminates at the end of the year, you’ll be uninsured for at least a month if you wait until January to re-enroll, since enrollments completed after December 31 will be effective no earlier than February 1.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- “CVS Health Corporation Reports First Quarter 2025 Results and Updates Full-Year 2025 Guidance” CVS Health. May 1, 2025 ⤶
- “Looking for ACA plan info for your state?” AetnaCVSHealth.com Accessed May 5, 2025 ⤶
- “Aetna to exit the ACA exchanges in 2026” Fierce Healthcare. May 1, 2025 ⤶
- “Insurer Changes for 2026 Marketplace Coverage” Get Covered Illinois. Accessed July 11, 2025 ⤶
- “Broker Brief, Q2 2025” CareSource. Accessed Aug. 6, 2025 ⤶
- “Breaking News – Molina Healthcare Announces Significant Changes to 2026 ACA Marketplace Service Area” Agility Insurance Services. Sep. 19, 2025 ⤶ ⤶
- “UM Health Plan, Michigan Care to end after 2025” University of Michigan. Nov. 27, 2024 ⤶
- Author confirmed via phone, Sep. 11, 2025 ⤶
- “SERFF tracking number CELT-134533905” North Carolina SERFF Filings. Accessed Sep. 24, 2025 ⤶
- “Individuals and families” AultCare. Accessed Sep. 19, 2025 ⤶
- “2026 Marketplace Exit” Chorus Community Health Plan. Accessed Sep. 21, 2025 ⤶
- “Your Health Coverage with us in Wyoming is ending on December 31, 2025” Mountain Health CO-OP. Accessed Aug. 18, 2025 ⤶
- “2026 Blue Cross Blue Shield PPO Plan Exit” Phoenix Health & Life Insurance. Sep. 16, 2025 ⤶
- “Insurers Seek Massive Rate Hikes For 2026 Obamacare” Accounting Solutions. Aug. 25, 2025 ⤶
- “Aetna Drops Out of ACA Exchange In 2026—Here’s How It Could Affect You” Forbes. July 15, 2025 ⤶
- “SERFF Filing AETN-134522152” Virginia SERFF. Accessed Sep. 2, 2025 ⤶