Aetna Retirees Face Rising Premiums: Why 2026 Health Care Costs May Challenge Household Budgets

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 facing rising health care costs can benefit from reviewing their broader income and coverage strategies early given that policy changes may create uncertainty.” – Wesley Boudreaux, a representative of The Retirement Group, a division of Wealth Enhancement.

“Aetna employees navigating potential premium increases may find it helpful to reassess their long-term health care and budget plans early, as preparation can provide clearer direction during periods of policy uncertainty.” – Patrick Ray, a representative of The Retirement Group, a division of Wealth Enhancement.

In this article, we will discuss:

1. How the expiration of enhanced ACA subsidies may affect 2026 premiums.

2. Why many households are delaying enrollment decisions.

3. What retirees and pre-Medicare individuals should consider when reviewing coverage options.

Why Many Americans May Have Trouble Paying 2026 Premiums When Health Care Costs Increase

Households that rely on premium subsidies under the Affordable Care Act are preparing for significant changes. Unless Congress acts, the ACA’s enhanced premium tax credits, extended under the Inflation Reduction Act and expanded by the American Rescue Plan, will expire after the 2025 plan year. If these subsidies lapse, estimates show average net premiums may increase by roughly 75–115% in 2026, ¹  creating financial strain for millions of Americans.

“When a household sees its premium rise dramatically, families can be forced into difficult choices about how to allocate limited income,” explains Wesley Boudreaux, a financial advisor at Wealth Enhancement.

Consumer Uncertainty and Enrollment Pressures

Many Aetna households are delaying their 2026 Marketplace enrollment decisions as they wait to see if Congress will renew the enhanced subsidies. Postponing enrollment increases the risk of missing deadlines and entering the new plan year without coverage.

Some states, such as Pennsylvania, estimate that if subsidies end in 2026, nearly one-third of current enrollees may drop coverage. ²  These estimates reflect affordability concerns, not confirmed enrollment data.

According to Wesley, households are navigating uncertainty rather than disengaging: “Families must make difficult decisions about their health coverage when premiums rise significantly.”

Less Expensive Options May Have Drawbacks

When premiums climb, some Aetna employees may turn to lower-cost alternatives outside the ACA. However, short-term limited duration insurance and other non-ACA-compliant policies often exclude pre-existing conditions, impose annual or lifetime limits, and may not include guaranteed comprehensive benefits. These gaps may leave individuals exposed to significant medical bills during serious illness.

“Lower premiums only matter if the coverage is there when you need it,” Wesley emphasizes. Many non-ACA policies lack essential health benefits and pre-existing condition protections.

Challenging Decisions for Important Groups

If subsidies are not renewed, households may find themselves evaluating difficult choices:

• - Moving to ACA plans with higher deductibles

• - Paying substantially more in premiums

• - Dropping coverage entirely

• - Considering non-ACA options with limited protections

Middle-class families, self-employed individuals, and pre-Medicare retirees may feel the greatest financial pressure if enhanced subsidies disappear.

“Many responsible, hardworking families are severely strained by large premium increases,” observes Wesley.

The Function of Subsidies in a Changing Market

Many households currently benefit from subsidies that may reduce premiums by hundreds of dollars each month. If enhanced subsidies expire, out-of-pocket expenses could increase sharply. Insurers have already priced 2026 plans based on current law, contributing to the “sticker shock” consumers are experiencing, even if Congress ultimately restores subsidies.

In this unsettled environment, reviewing coverage options and planning ahead becomes even more important.

How The Retirement Group Can Assist

For individuals not yet eligible for Medicare—including those leaving the Aetna workforce—health care costs remain a major part of retirement planning.

The Retirement Group can help you review your health insurance choices in the context of your broader retirement income strategy.
Call (800) 900-5867  to speak with someone about preparing for rising health care expenses.

Create a Plan Before Policies Change Again

Marketplace premiums for 2026 reflect a combination of insurer cost increases and legislative uncertainty, and future health care policies may continue evolving. Thoughtful preparation can help households reduce the likelihood of coverage gaps and build a clearer understanding of the alternatives available to them.

Featured Video

Articles you may find interesting:

Sources:

1. Peterson-KFF. ' How much and why ACA Marketplace premiums are going up in 2026 ,' by J. Ortaliza et al. Aug. 6, 2025. 

2. The Hospital and Healthsystem Association of Pennsylvania.  “5 Things to Know: Pennie Open Enrollment.”  HAP Blog , 30 Oct. 2025,  www.haponline.org/News/HAP-News-Articles/HAP-Blog/5-things-to-know-pennie-open-enrollment-1 .

Other Resources:

1. Center on Budget and Policy Priorities.  “Five Key Changes to ACA Marketplaces Amid Uncertainty over Premium Tax Credit Enhancements.”  Written by Jennifer Sullivan and Nicole Rapfogel, 22 Sept. 2025,  www.cbpp.org/research/health/five-key-changes-to-aca-marketplaces-amid-uncertainty-over-premium-tax-credit .

2. Evans, Michael.  “2026 Health Insurance Hike Sparks Concern Among Early Retirees: ‘We Cannot Afford This.’”  Investopedia , 12 Sept. 2025,  www.investopedia.com/2026-health-insurance-hike-sparks-concern-among-early-retirees-we-cannot-afford-this-11808938 .

3. KFF.  “Calculator: ACA Enhanced Premium Tax Credit.”  KFF, 29 Oct. 2025,  www.kff.org/interactive/calculator-aca-enhanced-premium-tax-credit/ .

4. United States Departments of the Treasury, Labor, and Health and Human Services.  “Short-Term, Limited-Duration Insurance.”  Federal Register , 21 Feb. 2018,  www.federalregister.gov/documents/2018/02/21/2018-03208/short-term-limited-duration-insurance .