Aetna Employees Could Face Triple Impact from 2026 Health Insurance Price Increases

Healthcare Provider Update: Healthcare Provider Information for Aetna Aetna, part of the CVS Health family, has been a key player in the Affordable Care Act (ACA) marketplace, providing health insurance plans to individuals and families. However, significant changes are on the horizon for 2026, as Aetna will exit the ACA marketplace in 17 states, impacting approximately 1 million members. This withdrawal is attributed to the company's challenges in maintaining competitiveness and providing value in a rapidly evolving healthcare landscape. Potential Healthcare Cost Increases in 2026 As the healthcare landscape shifts, substantial premium hikes are anticipated for those enrolled in ACA marketplace plans, with projections of up to 75% increases in out-of-pocket costs due to the potential loss of enhanced federal subsidies. In some states, insurers have filed for rate increases exceeding 60%, driven by surging medical costs and the expiration of premium tax credits established under the American Rescue Plan. For Aetna's former members, this change further complicates their healthcare landscape as they seek new insurance options amid heightened financial pressures. Click here to learn more

'Aetna employees should recognize that rising health care costs in 2026 highlight the importance of reviewing benefits closely during open enrollment and budgeting carefully for higher out-of-pocket expenses.' – Paul Bergeron, a representative of The Retirement Group, a division of Wealth Enhancement.

'Aetna employees facing the steepest health insurance increases in over a decade can benefit from proactively comparing plan options and aligning coverage with long-term health care needs during enrollment.' – Tyson Mavar, a representative of The Retirement Group, a division of Wealth Enhancement.

In this article, we will discuss:

1. Why group health insurance costs are expected to rise sharply in 2026.

2. How employers may shift health care expenses to employees through plan changes.

3. Key steps individuals can take during open enrollment to manage higher costs.

The cost of group health insurance is expected to rise at the fastest pace in 15 years, ¹  creating significant challenges for both companies and their employees. Aetna employees may soon see higher co-payments, larger deductibles, and greater payroll deductions. Employers across the country are also preparing to make structural adjustments to their health plans, which could mean less prescription drug coverage or tighter provider networks. With Baby Boomers working later into their careers and medical costs continuing to rise, these changes reflect a broader transformation in the American health care system.

According to Brent Wolf, CFP of Wealth Enhancement, “the biggest increase in health insurance costs in over ten years is about to hit both employers and employees. This affects almost everyone and is structural and demographic in nature; it is not just about inflation.”

Factors behind rising prices

While cost hikes in employer-sponsored health insurance have generally been modest, forecasts for 2026 point to a sharp rise. Average benefit costs per employee are expected to grow by over 6.5%, the steepest jump since 2010. ¹  This rise is being driven by several key elements:

• An aging workforce: Many Baby Boomers are working well into their 60s and 70s. Their growing medical needs—from advanced oncology treatments to cardiac care—place heavy cost pressure on employer health plans.

• High-cost claimants: Roughly 20% of employees generate over 80% of health care expenses, ²  concentrating costs and making them hard to manage.

• Medical inflation: New therapies, industry consolidation, and complex billing practices are fueling rising medical inflation.

• Regulatory changes: Recent legislation such as the “One Big Beautiful Bill” adds complexity and unpredictability for employer planning.

• Increased utilization and postponed care: Many delayed care during the pandemic. As people return for elective procedures, overall costs have surged.

Wolf observes, “This is a triple whammy. Employers have few options to control costs, medical costs are climbing, and older workers are using more care.”

Employers’ cost management tactics

Nearly 60% of companies are expected to adjust health plan designs in 2026 to help with rising costs ¹ —a much larger share than in prior years. For Aetna employees, these modifications may translate into a higher out-of-pocket load, particularly if companies pursue cost cutting strategies such as:

• Increased payroll deductions: Premium contributions may go up about 6% to 7%, ¹  leading to larger deductions from wages.

• Higher out-of-pocket costs: Changes to deductibles, copayments, and coinsurance will raise what individuals pay when getting care.

• Narrower provider networks: Employers might limit access to certain doctors or prescription medications.

• Plan design shifts: A move toward high-deductible health plans is expected, placing more load on employees to make cost-conscious choices.

According to Wolf, “Employers may quietly reduce benefits because they don't want to annoy employees with premium hikes.” The result is the same: higher household costs.

Getting ready for enrollment

As open enrollment season approaches, careful planning will be very important. Wolf suggests a few key actions:

• - Track open enrollment dates so you don’t miss your chance to make selections.

• - Review all details beyond the monthly premium, including prescription lists, provider networks, and out-of-pocket maximums.

• - Match coverage with personal health needs—chronic conditions may justify higher premiums, while healthier people might prefer high-deductible plans.

• - Use tax-advantaged accounts like flexible spending account (FSAs) or health savings accounts (HSAs) to help offset costs with pre-tax funds.

• - Take advantage of wellness programs that promote preventive care and healthier lifestyles.

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The broader context

The demographic reality of an aging workforce will keep pushing health care costs higher for employers and employees alike. Aetna employees, like others across the workforce, will feel these changes beyond 2026.

Wolf emphasizes, “This is not a one-year story.” The cycle of rising costs will affect employers, employees, and retirees for years to come. Planning ahead, budgeting for cost increases, and making informed enrollment choices will be essential.

In addition, Medicare costs are projected to rise significantly in 2026: the Part B monthly premium is expected to climb 11.6%, from $185 in 2025 to $206.50. ³  Part D premiums are forecast to go up 6%, from $36.78 to $38.99, while deductibles increase to $615. ⁴  The Part B deductible is also set to go up nearly 12%, from $257 to $288. ³

Employer-sponsored plans overall are expected to see employee health benefit costs rise by about 6.5% in 2026, the most rapid climb in 15 years. ¹  For Aetna employees, the combination of higher copays, deductibles, and premiums mirrors the national trend driven by medical inflation, expensive therapies, and regulatory shifts.

An analogy for what lies ahead

Dealing with these changes is much like planning for a road trip where fuel prices suddenly jump, tolls multiply, and detours force you onto costlier routes. The journey still has to happen, but it now demands more foresight, budget planning, and careful choice-making. Employees will need to carefully evaluate their open enrollment options, just as travelers must adapt their maps and decisions to reach their destination under changed conditions.

Sources:

1. Mercer. ' Employers prepare for the highest health benefit cost increase in 15 years ,' by Beth Umland and Sunit Patel. September 3, 2025. 

2. Employee Benefit Research Institute (EBRI).  Fast Facts: A Small Number of Workers Account for Most Health Costs .  4 Sept. 2025.

3. AARP. ' Medicare Part B Premium Expected to Top $200 a Month in 2026 ,' by Tony Pugh. September 9, 2025.

4. KFF. ' A Current Snapshot of the Medicare Part D Prescription Drug Benefit ,' by Juliette Cubanski. Oct. 7, 2025.