As Aetna Leaves the ACA Marketplace, Will You Lose Your Doctor?

For people who have purchased Aetna health insurance plans through the Affordable Care Act marketplace, the company’s recent announcement that it will be withdrawing from 17 states’ exchanges at the end of 2025 is an unwelcome shock. The truth is that insurance carriers have entered, exited, and even re-entered the ACA marketplace since the exchanges first opened at the end of 2013—Aetna itself exited in 2018 and returned in 2021. Aetna’s latest move will mean 1 million members will need to find new coverage for 2026, potentially forcing those affected to find new doctors as well as a new health insurance plan.

What prompts insurance carriers to exit the individual marketplace? For them, it is business. Possible changes being discussed in Congress and by the Trump administration may prompt other carriers to re-examine their rates or whether they will stay in the exchange as well. This includes the future of enhanced marketplace subsidies that were introduced under the American Rescue Plan and extended by the Inflation Reduction Act, the length of the open enrollment period, the availability of special enrollment periods, and the documentation required of enrollees. To the extent these may depress enrollment or increase costs, such shifts can persuade insurance companies that they are better out than in.

For their plan members, however, the calculation is much more personal. Any change of insurance means possibly having to change medical providers, as doctors don’t necessarily accept every insurance plan available. If you’ve been seeing the same doctor for years, especially if you have ongoing medical conditions to manage, having to possibly start at square one finding a team of providers you trust can be terrifying. Here’s what to do if you’re facing the possible loss of your doctor due to insurance changes.

Navigating Insurance and Doctor Changes

Learning that you have to change insurance plans is disheartening and stressful, as each plan is different and determining how each plan’s features will affect your care and your out-of-pocket costs can be difficult. When you also may have to change providers, the hassle is only amplified. Don’t panic—here is how to approach the problem.

Explore which new plans would allow you to keep your doctor: If you are being forced to change plans, this is an opportunity to review new options that would allow you to keep your existing relationships with your primary care provider and/or specialists you see regularly. Rather than relying on online databases of in-network providers, however, it is best to talk to your doctors about what insurance plans they accept as well as the insurance company, as lists are not always accurate and up to date. At Medical Insurance Today, we help our clients go over and understand their options so they know the full range of plans where their existing providers are in network.

If you must change plans to one your doctor doesn’t accept: Unfortunately, changing health insurance plans typically comes with challenges, and it may be that the plan you would need to choose to stay with your current providers is unaffordable. In such situations, we work with our clients to guide them through the long lists of doctors available on the new plan they will be enrolling in. Typically, all carriers have hundreds of doctors to choose from within a 10- to 20-mile radius of the client’s home.

Narrowing your choices to find a new doctor: One of the best ways to narrow down your list when you’re looking for a new doctor is to get referrals. Your current doctors may be able to provide suggestions, especially if you are looking for specialists with knowledge of specific medical conditions. However, family, friends, and neighbors whose opinions you trust can be your best resources, as they will be able to give you a view of their doctor’s practice from the patient’s perspective.

Helping You Find the Coverage You Deserve

Having to find a new insurance plan can feel confusing and overwhelming. Medical Insurance Today, a Covered California Enrollment Center, is here to help provide the guidance and plain-language explanations you need to make the right choice for yourself and your family. Our agents speak both English and Spanish, and we will help you get qualified for all the financial assistance you are entitled to. If you have to change plans, don’t panic—contact us here to get started on finding a new one today.