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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 anticipating rising health care expenses should take a proactive approach by reviewing their income plans and health care budgets now, as thoughtful preparation can help reduce uncertainty during subsidy transitions.' – Paul Bergeron, a representative of The Retirement Group, a division of Wealth Enhancement.
'Aetna employees facing potential changes to ACA subsidies should revisit their retirement income and health care strategies now, as early planning can help them stay adaptable amid evolving costs.' – Tyson Mavar, a representative of The Retirement Group, a division of Wealth Enhancement.
In this article, we will discuss:
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How ACA subsidies expiring in 2025 could affect health care costs for Aetna employees and retirees.
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Why 2026 health insurance premiums may increase dramatically for pre-Medicare retirees.
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What steps individuals can take now to prepare and manage future health care expenses.
The ACA Shockwave: What Aetna Employees, Families, and Retirees May Expect from Increasing Health Insurance Costs
Each fall, millions of Americans, including those transitioning from Aetna, prepare for open enrollment—the period when health insurance options can be reviewed and selected. In most states, open enrollment for Affordable Care Act (ACA) marketplace plans begins on November 1.
Final elections must be submitted by December 15, 2025 for coverage beginning January 1, 2026. Coverage will start on February 1 for those who enroll or make changes between December 16 and January 16. Early enrollees still have the option to adjust plans any time before the enrollment window closes.
What Is the Main Concern for 2026?
Enhanced premium tax credits, which began in 2021 and are scheduled through 2025, currently lower what households pay for ACA coverage. If these enhanced subsidies expire on December 31, 2025, many Aetna retirees using ACA coverage before Medicare eligibility could face significantly higher premiums.
According to research from KFF, average net premiums—what individuals pay after subsidies—could rise by roughly 114% in 2026 if current subsidies are not renewed. 1
Of the 24.3 million Americans expected to enroll in ACA marketplace plans for 2025, about 22 million qualify for premium subsidies. 2
Analysts caution about a potential “coverage cliff,” where individuals drop health care plans due to affordability concerns. The Urban Institute notes that millions could lose insurance coverage if current subsidy enhancements end. 3
How This May Impact Households and Retirees
Financial professionals report rising concern among retirees, small business owners, and individuals who rely on ACA coverage before turning 65. Higher premiums may lead to adjustments in retirement timing, withdrawal strategies, or monthly spending.
Even those not enrolled in ACA plans could be affected. If healthier individuals leave the marketplace due to cost increases, the remaining pool becomes older and less healthy, which may lead to higher premiums for others.
Why Timing Matters
The ACA enrollment period runs from November 1 to January 15. If Congress extends subsidies, individuals can select a plan based on available data and adjust their selection before December 15. Policyholders still retain the ability to make changes any time before the enrollment window closes.
Why Retirees Could Be Most Vulnerable
Aetna retirees in their early 60s often rely on ACA plans until they reach Medicare eligibility at age 65. Without extended subsidies, these retirees may need to revise budgets, modify withdrawal plans, or consider part-time employment to maintain coverage.
What You Can Do Right Now
Stay Updated Through Reliable Sources
Follow updates from HealthCare.gov and KFF.
Review Budget Scenarios
Compare premium costs with and without subsidies to understand the potential effect on monthly expenses.
Evaluate Your Health Care Strategy
Make sure your medical, dental, and prescription benefits work together effectively.
Maintain Coverage
Unexpected medical expenses can be difficult to manage without at least basic health insurance.
Plan Tax and Withdrawal Strategies Carefully
Because ACA subsidies are based on adjusted gross income, retirees may continue to qualify by using approaches such as Roth conversions or structured IRA withdrawals.
Support from The Retirement Group
The Retirement Group works with current and former Aetna employees to review how health care expenses may relate to pension choices, income distribution, tax planning, and Social Security. For more information, call (800) 900-5867.
Looking Ahead
Policies and markets may shift, even if subsidies are not extended. Reviewing health care costs annually and remaining flexible may help retirees adapt to future changes.
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Sources:
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1. Cox, Cynthia, Karen Pollitz, and Justin Lo. ACA Marketplace Premium Payments Would More than Double on Average Next Year If Enhanced Premium Tax Credits Expire . KFF, 30 Sept. 2025.
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2. yahoo!news. ' Millions could go without health care coverage in 2026 ,' by Karissa Waddick and Stephanie Innes. 19 Nov. 2025.
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3. Buettgens, Matthew, Clare Pan, and Christine Monahan. 4.8 Million People Will Lose Coverage in 2026 if Enhanced Premium Tax Credits Expire . Urban Institute, Sept. 2025.
- Other Resources:
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1. Centers for Medicare & Medicaid Services. Health Insurance Exchanges 2025 Open Enrollment Report. U.S. Department of Health & Human Services, 2025.
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2. Fernandez, Bernadette. Enhanced Premium Tax Credit Expiration: Frequently Asked Questions. Congressional Research Service, 24 Sept. 2025.
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3. Ku, Leighton, et al. Expiring ACA Premium Tax Credits Could Lead to Nearly 340,000 Jobs Lost Across the U.S. in 2026. The Commonwealth Fund, 16 Oct. 2025.
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How does Aetna Inc.'s frozen pension plan affect employees' eligibility for benefits, and what specific criteria must current employees meet to qualify for any benefits from the Retirement Plan for Employees of Aetna Inc.?
Eligibility for Benefits: Aetna Inc.'s pension plan has been frozen since January 1, 2011, meaning no new pension credits are accruing. Employees who were participants before this date remain eligible for benefits but cannot accrue additional pension credits. To qualify for benefits, participants need to have been vested, which generally occurs after three years of service(PensionSPD).
In what ways can employees at Aetna Inc. transition their pension benefits if they leave the company, and what implications does this have for their tax liabilities and retirement planning?
Transitioning Pension Benefits: If employees leave Aetna, they can opt for a lump-sum distribution or an annuity. Employees can roll over their lump-sum payments into an IRA or other tax-qualified plans to avoid immediate taxes. However, direct rollovers must follow the tax-qualified plan's rules. If not rolled over, employees are subject to immediate tax and potential penalties(PensionSPD).
What steps should an Aetna Inc. employee take if they become disabled and wish to continue receiving pension benefits, and how does the company's policy on disability impact their future retirement options?
Disability and Pension Benefits: Employees who become totally disabled and qualify for long-term disability can continue participating in the pension plan until their disability benefits cease or employment is terminated. No additional pension benefits accrue after December 31, 2010, but participation continues under the plan until employment formally ends(PensionSPD).
Can you explain the implications of the plan amendment rights that Aetna Inc. retains, particularly concerning any potential changes in the pension benefits and what this could mean for employee planning?
Plan Amendment Rights: Aetna reserves the right to amend or terminate the pension plan at any time. If the plan is terminated, participants will still receive benefits accrued up to the date of termination, protected by ERISA. Any future changes could impact employees' planning and retirement options(PensionSPD).
How does the IRS's annual contribution limits for pension plans in 2024 interact with the provisions of the Retirement Plan for Employees of Aetna Inc., and what considerations should employees keep in mind when planning their retirement contributions?
IRS Contribution Limits: The IRS sets annual contribution limits for pension plans, including defined benefit plans. In 2024, employees should ensure that their pension contributions and tax planning strategies align with these limits and the provisions of Aetna's pension plan(PensionSPD).
What are the options available to Aetna Inc. employees regarding pension benefit withdrawal, and how can they strategically choose between a lump-sum distribution versus an annuity option?
Withdrawal Options: Aetna employees can choose between a lump-sum distribution or various annuity options when withdrawing pension benefits. The lump-sum option allows for immediate access to funds, while annuities provide monthly payments over time, offering a more stable income stream(PensionSPD).
How does Aetna Inc. ensure compliance with ERISA regulations concerning the rights of employees in the retirement plan, and what resources are available for employees to understand their rights and claims procedures?
ERISA Compliance: Aetna complies with ERISA regulations, ensuring employees' rights are protected. Resources are available through the Plan Administrator and myHR, providing information on claims procedures, plan rights, and how to file appeals if necessary(PensionSPD).
What documentation should employees of Aetna Inc. be aware of when applying for their pension benefits, and how can they ensure that they maximize their benefits based on their years of service?
Documentation for Benefits: Employees should retain service records and review their benefit statements to ensure they receive the maximum pension benefits. They can request additional documents and assistance through myHR to verify their years of service and other relevant criteria(PensionSPD).
How do changes in interest rates throughout the years affect the annuity payments that employees at Aetna Inc. might receive upon retirement, and what strategies can they consider to optimize their retirement income?
Impact of Interest Rates on Annuities: Interest rates significantly affect annuity payments. Higher interest rates increase the monthly annuity amount. Employees should consider the timing of their retirement, especially at the end of the year, when interest rates for the following year are announced(PensionSPD).
If employees want to learn more about their pension options or have inquiries regarding the Retirement Plan for Employees of Aetna Inc., what are the best channels to contact the company, and what specific resources does Aetna provide for assistance?
Contact for Pension Inquiries: Employees can contact myHR at 1-888-MY-HR-CVS (1-888-694-7287), selecting the pension menu option for assistance. Aetna also provides detailed resources through the myHR website, helping employees understand their pension options and benefits(PensionSPD).
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