Aetna to Stay in ACA Markets, May Add More States

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While final decisions will come in Septembers, Aetna's early word comes in contrast with that of other large insurers heading into 2017.

The health insurer Aetna said Wednesday it plans to stay in the 15 states where it offers coverage on health exchanges under the Affordable Care Act (ACA). It may even go into a few more states, but final decisions will come in September.

Aetna’s news was part of its first quarter earnings call, according to several news reports. Spokesmen for the company said that rate filings have been submitted in all states where Aetna currently operates on the exchanges. The possible new markets were not disclosed.

The insurer’s posture contrasts with that of UnitedHealthcare (UHC) and Humana, which will scale back their presence on the ACA exchanges in 2017. UHC had announced it lost $475 million on the exchanges in 2015 and could lose as much as $500 million this year. Next year the insurer will only have ACA business in a handful of states.


Of note, Aetna and Humana have a pending merger before state and federal regulators; the joint announcement on the union said Humana’s headquarters in Louisville, Kentucky would be take the lead in providing managed care services for Medicare and Medicaid, while the current Aetna headquarters in Hartford, Connecticut, would be the lead for commercial coverage.

According to Reuters, Aetna operates on exchanges in Arizona, Delaware, Florida, Georgia, Illinois, Iowa, Kentucky, Missouri, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Texas, and Virginia.

The insurer has previously announced losses of around 4% for 2015 but has hopes to break even on ACA business for 2016.

Now, the big question is what Aetna and other insurers will seek in rate hikes for 2017. A report from the Kaiser Family Foundation (KFF) noted that hikes in 2016 reflected the need for insurers to better match rates with the health status of patients using the exchanges. Many had been uninsured for some time—if ever—and arrived with pent-up medical needs.

The question is whether the 2016 rates accurately captured all that or whether more adjusting will be needed for next year.

“This still is a new market, with insurers still finding their way, and as with 2016, it is likely that we will see a wide range of requests for rate changes and new product approvals across insurers and geographic areas,” wrote KFF’s Gary Claxton and Larry Levitt, MPP.

Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, predicted last month that the ongoing uncertainty in the market would lead to higher rates in 2017. Tavenner was previously the administrator of CMS during the rollout of the ACA.