Is Aetna doing layoffs?

Aetna and its parent company, CVS Health, are facing profitability challenges driven by rising medical costs, underperforming exchange products, and regulatory pressures.

Key Reasons for Aetna's Struggles

• ACA Exchange Underperformance: Aetna announced it will exit the Affordable Care Act (ACA) individual and family marketplace at the end of 2025. CEO David Joyner noted chronic underperformance and a lack of a clear path to profitability in these products, which resulted in a massive operating loss of $924 million in 2024.
• Uncertainty Over Subsidies: The potential expiration of enhanced federal tax credit subsidies by Congress creates added financial instability and premium uncertainty for individual marketplace plans.
• Medicare Advantage Cutbacks: Aetna is slashing nearly 90 Medicare Advantage plans across 34 states for 2026, dropping certain PPO and dental network options. This reflects broader industry pain points like higher healthcare utilization costs by seniors and stricter Centers for Medicare & Medicaid Services (CMS) regulations on star ratings and billing.
• Regulatory and Legal Scrutiny: The insurer faces potential costs and pressures from ongoing Department of Justice (DOJ) lawsuits concerning Medicare Advantage business and enrollment practices.

CVS Health bought out Aetna.

Acquisition Details

• Date: Completed on November 28, 2018.
• Purchase Price: Valued at roughly $69 billion ($78 billion total including debt).
• Operations: Aetna operates as a subsidiary and standalone business under CVS Health, keeping the Aetna name.
• Goal: The merger combined pharmacy care with health insurance to lower medical costs and expand health services in local stores and clinics.

Aetna has a mixed reputation, earning strong marks for financial stability and industry rankings while receiving heavily negative feedback in consumer review platforms.

Customer Complaints and Online Sentiment

Consumer review platforms and member forums show widespread dissatisfaction with Aetna.

• Review Ratings: Aetna scores very low on consumer-driven review sites, averaging around 1.0 to 1.3 out of 5 stars on platforms like Trustpilot, Better Business Bureau (BBB), and ConsumerAffairs.
• Common Issues: Members frequently report claim denials for prescribed treatments, unexpected out-of-pocket billing amounts, long customer service hold times, and unhelpful support staff.
• Chronic Conditions: Individuals dealing with serious or chronic health issues often express higher frustration regarding prior authorization hurdles and restricted medication coverage.

Industry Rankings and Financial Standing

Despite poor individual user reviews, professional insurance analyses rank Aetna quite differently.

• Industry Scores: Insure.com ranked Aetna as the No. 7 health insurance company for 2026 with an overall score of 4.07 out of 5 stars, citing strong digital tools and easy access to routine care via CVS MinuteClinics.
• Financial Stability: Aetna maintains high financial strength ratings (such as an "A" from A.M. Best) and typically receives fewer formal regulatory complaints relative to its massive size.

Doctors and healthcare systems leave Aetna's network primarily due to disagreements over reimbursement rates, heavy administrative burdens, and failed contract negotiations.

For comprehensive details on why provider networks change, you can review the Aetna Medicare Provider Network Changes guide.

Key Reasons Providers Leave Aetna

• Low Reimbursement Rates: Providers often state that Aetna's payment rates do not keep up with inflation, rising operational costs, or the rates paid by other insurers.
• Administrative Hassles: Doctors face extensive paperwork, prior authorization (precertification) requirements, and claim denials that increase office overhead and delay care.
• Contract Impasses: When annual or multi-year contracts expire, Aetna and large medical groups (such as university health systems or regional hospitals) frequently fail to agree on financial terms, forcing providers out-of-network.
• Aetna's Market Reductions: Parent company CVS Health has pulled back from specific regional markets, scaling back certain Affordable Care Act (ACA) exchange footprints and Medicare Advantage plans, which structurally alters local networks.

Aetna is larger overall by total membership and revenue, but Humana is bigger specifically in the Medicare Advantage market.

Overall Size and Membership

• Aetna (owned by CVS Health) serves over Aetna 39 million commercial and medical members nationwide. It features a larger provider network with more than 1.2 million providers and 5,700 hospitals.
• Humana serves a smaller total membership overall (roughly 17–20 million total members across its segments), focusing heavily on government-sponsored programs.

Medicare Advantage Market Share

• Humana runs the second-largest Medicare Advantage operation in the United States (behind only UnitedHealthcare), holding roughly 20% of the national market share.
• Aetna ranks behind Humana in total Medicare Advantage enrollment, though it maintains a massive overall footprint as part of CVS Health.