Is Aetna leaving Medicare Advantage plans?

Editorial team Published on

No, Aetna is not leaving Medicare Advantage entirely, but the company has scaled back its footprint by cutting nearly 90 plans across 34 states, reducing its presence by 100 counties and one entire state.

Key Details of Aetna's Changes

  • Partial Reductions: Aetna (owned by CVS Health) trimmed its Medicare Advantage offerings to recover profit margins amid rising medical costs and lower government payments.
  • Affected Plans: Most of the discontinued options are PPO (Preferred Provider Organization) plans, and further reductions or narrower networks may continue into subsequent planning cycles.
  • Current Status: You can review active options or log into your account directly through the Aetna Medicare Portal.

What insurance companies are leaving Medicare Advantage plans?

Several major national and regional insurance companies are exiting or scaling back their Medicare Advantage offerings for the 2027 plan year due to rising medical costs and financial pressures, according to an analysis of federal data by Healthcare Dive.

Major National Insurers Scaling Back

  • Humana: Cutting individual Medicare Advantage plans affecting hundreds of thousands of members and pulling out of dozens of counties.
  • UnitedHealthcare: Reducing its service area across multiple counties and discontinuing select plans.
  • Aetna (CVS Health) & Centene: Slashing individual plan offerings and exiting unprofitable geographic regions.

Payers Exiting the Market Entirely or Limiting to Special Needs Plans

According to reports compiled by Becker's Hospital Review, 12 payers are completely exiting the standard Medicare Advantage market, including:

  • Providence Health Plan: Winding down its Medicare operations after failing to find a buyer.
  • Clear Spring Health: Fully departed parts of its regional individual market.
  • Molina Healthcare: Exiting individual Medicare Advantage markets to focus only on Dual Eligible Special Needs Plans (D-SNPs).
  • Presbyterian Health Plan: Transitioning out of standard individual plans to focus exclusively on D-SNPs.
  • Regional and Health System-Owned Plans: Entities like Aspirus Health Plan, Christus Health Plan, Elderplan, Mass Advantage, and several regional Blue Cross Blue Shield affiliates are dropping or scaling back coverage.

Why are doctors dropping Aetna insurance?

Doctors and health systems are dropping or cutting ties with Aetna (and other major insurers) primarily due to disputes over reimbursement rates, excessive prior authorization denials, and administrative burdens.

Key Reasons for Contract Terminations

  • Low and Slow Reimbursements: Providers report that insurance companies delay payments or pay too little for medical services, making it hard to cover operating costs, staffing, and technology upgrades.
  • Prior Authorization Denials: Health systems frequently cite high denial rates for necessary patient treatments and post-acute care as a major friction point with Medicare Advantage plans.
  • Claim "Downcoding": Insurers increasingly use automated systems or third-party vendors to automatically reduce billing codes for office visits, cutting into doctor revenue.
  • Broader Market Retrenchment: Parent company CVS Health and other major insurers are scaling back or exiting specific markets (such as certain Medicare Advantage and ACA exchange footprints) due to rising medical care costs and lower federal margins.

On Reddit, some users note that high paperwork requirements and low pay continually push individual physicians out-of-network, though others point out this is a widespread trend across multiple major insurance providers, not just Aetna.

What states is Aetna leaving?

Aetna is fully exiting the Affordable Care Act (ACA) Marketplace across 17 states and reducing its Medicare Advantage footprint across 34 states for the 2026 plan year.

ACA Marketplace Exits

Aetna (owned by CVS Health) completely stopped offering individual and family ACA Marketplace plans in 17 states:

  • Arizona
  • California
  • Delaware
  • Florida
  • Georgia
  • Illinois
  • Indiana
  • Kansas
  • Maryland
  • Missouri
  • Nevada
  • New Jersey
  • North Carolina
  • Ohio
  • Texas
  • Utah
  • Virginia

Medicare Advantage Reductions

Aetna also discontinued nearly 90 Medicare Advantage plans across 34 states (including specific county pullbacks in states like Pennsylvania and New Hampshire) due to rising medical costs and a strategic shift toward profitability.

Are seniors going to lose their Medicare Advantage plans?

Yes, more than one million seniors will lose or face major changes to their Medicare Advantage plans for 2027 as major insurance companies scale back their footprint.

Why Plans Are Being Cut

According to an analysis by Healthcare Dive, insurers are reducing plan options to deal with high medical spending and rising care costs.

  • Humana is dropping plans that cover about 600,000 members.
  • UnitedHealth Group is discontinuing plans affecting roughly 390,000 members.
  • Other major providers, including CVS Health’s Aetna and Centene, are also reducing their plan offerings.
  • However, as noted by POLITICO, federal regulators maintain that the overall market remains broad, even as specific counties and options are trimmed. Additional details on these market retreats can be found via Yahoo Finance.

What You Should Do

  • Watch your mail: Affected members receive non-renewal notices or an Annual Notice of Change (ANOC) from their insurer.
  • Mark the dates: Medicare open enrollment runs from October 15 to December 7, 2026.
  • Check your options: You can pick a new Medicare Advantage plan or switch back to Original Medicare.

Is Aetna Leaving Medicare Advantage in 2026? What You NEED to Know

9 related questions found

Will Aetna close Medicare Advantage plans in 2026?

Yes, Aetna is scaling back and discontinuing nearly 90 Medicare Advantage plans across 34 states for 2026, driven by rising medical costs and reduced government reimbursements.

Key Details of Aetna's 2026 Reductions

  • Plan Cuts: Aetna is closing close to 90 specific Medicare Advantage plans, with the majority being Preferred Provider Organization (PPO) options.
  • Geographic Footprint: The reductions affect 34 states, cutting availability across roughly 100 counties.
  • Not a Total Exit: Aetna is not closing its entire Medicare Advantage program; rather, it is trimming its footprint in less profitable or higher-cost markets.
  • Broader Industry Trend: Other major insurers, including UnitedHealthcare and Humana, are similarly scaling back their county footprints and reducing plan availability due to higher patient medical use and tighter federal payments.

What Affected Members Should Do

  • Check Mail: Review your Annual Notice of Change (ANOC) letter sent by your plan provider detailing any alterations or terminations.
  • Open Enrollment: Explore and select alternative coverage during the Annual Enrollment Period running from October 15 through December 7.
  • Compare Options: Look for other available Aetna plans (such as HMO options) or switch to alternative providers and Original Medicare.

What company has the highest rated Medicare Advantage plan?

Kaiser Permanente and Alignment Healthcare rank highest for star ratings, with 100% of their members in plans rated four stars or higher.

Top-Rated National Companies

  • Kaiser Permanente: Achieves top marks with 100% of members in 4+ star plans, though its availability is limited to select states.
  • Alignment Healthcare: Also ties at 100% for members in highly rated plans, but operates in a smaller number of states.
  • Aetna Medicare: Leads among major national carriers with wide availability, having over 81% of members in plans rated 4 stars or higher.
  • UnitedHealthcare: Follows closely, with 78% of its members in 4+ star plans and the largest nationwide provider network.

Ratings vary significantly by location, and specific plan performance depends heavily on your local county and ZIP code. You can check specific plan quality using the Official Medicare Plan Finder.

Who will lose Medicare in 2026?

No broad groups of people are losing traditional Medicare in 2026, but some Medicare Advantage enrollees face forced plan terminations, and roughly 100,000 lawfully present immigrants are projected to lose Medicare later due to recent federal legislation.

Medicare Advantage Changes

  • Forced Disenrollment: According to Johns Hopkins Bloomberg School of Public Health, about 1 in 10 Medicare Advantage enrollees face forced plan disenrollment in 2026 as insurers scale back offerings.
  • Network Drops: Major health systems nationwide have dropped specific Medicare Advantage plans due to disputes over prior authorization and reimbursements.

Immigrant Eligibility and Future Cuts

  • Medicaid vs. Medicare: Recent changes from the federal spending law (such as the One Big Beautiful Bill Act) primarily target Medicaid eligibility for certain lawfully present immigrants starting October 1, 2026.
  • Medicare Impact: While Medicaid changes took effect in late 2026, the Congressional Budget Office estimates that roughly 100,000 lawfully present immigrants could eventually lose Medicare coverage, with formal terminations anticipated around February 1, 2027.

Which health insurance company has the most complaints?

Because major health insurance companies vary vastly in size, total raw complaint numbers usually reflect market share rather than customer satisfaction. Large national providers like UnitedHealthcare and Elevance Health often record the highest absolute volume of total complaints filed with state insurance departments simply because they serve tens of millions more members than regional competitors.

To measure complaints accurately, regulatory bodies like the National Association of Insurance Commissioners (NAIC) use a complaint index ratio, which compares a company's share of complaints to its share of the market.

Key Insights on Health Insurance Complaints

  • Total Volume vs. Ratio: Large insurers handle the highest absolute number of grievances due to sheer size, while smaller or specialized regional plans may have higher or lower proportional ratios.
  • Common Grievances: Most consumer and provider complaints center on claim denials, delayed reimbursements, out-of-network billing surprises, and difficulties accessing specialized mental health care.
  • Industry Sentiment: Case managers and patient advocates on platforms like Reddit express a consensus that massive nationwide payers like UnitedHealthcare and Aetna are frequently the most difficult to navigate regarding prior authorizations and claims.

You can review state-specific department of insurance portals—such as the New York Consumer Guide to Health Insurers—to see localized complaint ratios and upheld grievance percentages for carriers operating in your area.

Do doctors prefer Medicare or Medicare Advantage?

Most doctors generally prefer Original Medicare (often paired with a Medigap supplement plan) over Medicare Advantage.

Why Doctors Prefer Original Medicare

  • Less Paperwork: Direct billing to the government means faster payments and fewer administrative hurdles.
  • No Prior Authorizations: Doctors can treat patients based on medical need without waiting for private insurance approval.
  • No Network Limits: Providers do not have to check if a patient's specific plan restricts referrals or covers out-of-network care.

Why Doctors Dislike Medicare Advantage

  • Prior Authorization Delays: Private insurers often require pre-approval for tests and treatments, which physicians say hurts patient care.
  • Denials and Appeals: Dealing with coverage denials and appeals adds extra work for medical staff.
  • Confusing Rules: Every private Medicare Advantage (Part C) plan has different rules and network restrictions.

Note: Some healthcare systems or specific groups partner closely with Medicare Advantage, but individual physician satisfaction is typically higher with Original Medicare and supplemental coverage.