Aetna-CVS plans to exit ACA individual exchanges

Duaine

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1000 Post Club
Aetna is once again retreating from the Affordable Care Act market, while its parent company notched a deal with Danish drugmaker Novo Nordisk that should expand access to its in-demand GLP-1.

Dive Brief:

  • CVS Health's insurance division Aetna will stop offering plans for individuals on the Affordable Care Act exchanges in 2026, after the company projected big losses in the business this year.
  • The news was announced in tandem with CVS' first quarter results, which exceeded investor expectations and represent a turnaround for CVS' beleaguered insurance business, analysts said. The Rhode Island-based healthcare company reported net profit of $1.8 billion — up 60% year over year — on revenue of $94.6 billion.
  • CVS' pharmacy benefit manager Caremark also reached an agreement with Danish drugmaker Novo Nordisk to give its weight loss drug Wegovy preferred access on Caremark's standard formulary, which covers tens of millions of Americans. The deal should increase access to Wegovy at the expense of other therapies, such as Eli Lilly's Zepbound.
 
I really liked the niche Aetna filled on the exchange in one of the states I worked in. They had limited network , lower premium silver plans and were the only carrier to offer no deductible for some brand name drugs. Their tech and service were above average compared to the local/regional incumbents. I was hoping they could leverage their national footprint, and the pharmacy/ CVS relationship going forward to offer something unique. They do seem to be bad at forecasting, with big splashes and then hasty retreats in both Medicare and ACA in back to back years.
 
Aetna/CVS had the largest network in the Kansas City. Mo area. Going to have to move a lot of people. Not sure that Oscar or Medica will stay here either.

With the end of some of the subsidies, CSR, no coverage for under $150 of FPL and the Cliff for those who are going over their projected incomes it's now going to be pretty.
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Aetna/CVS had the largest network in the Kansas City. Mo area. Going to have to move a lot of people. Not sure that Oscar or Medica will stay here either.

With the end of some of the subsidies, CSR, no coverage for under $150 of FPL and the Cliff for those who are going over their projected incomes it's now going to be pretty.
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I stopped doing ACA many years ago, but the most fun part was talking to a self-employed person and explaining the tax credit and how they need to project what their income will be the following year.

The other fun part was having the person who was 64 and on Social Security (not working) deciding to withdraw $50k from their IRA/401k to pay off their house and then flabbergasted that they owe $6k on their taxes due to the premium tax credit being clawed back.
 
I stopped doing ACA many years ago, but the most fun part was talking to a self-employed person and explaining the tax credit and how they need to project what their income will be the following year.

The other fun part was having the person who was 64 and on Social Security (not working) deciding to withdraw $50k from their IRA/401k to pay off their house and then flabbergasted that they owe $6k on their taxes due to the premium tax credit being clawed back.

It's an absolute cluster*ck. They need to scrap this shlt system and just go back to regular insurance policies....no more income based BS.
 
  1. New Republican Bill in Congress re: ACA
  2. Preserves popular ACA protections with added penalties to encourage continuous coverage: The proposed bill retains key Affordable Care Act provisions, such as the ban on medical underwriting that prevents insurers from denying coverage based on preexisting conditions. However, it introduces a 20% late-enrollment penalty for individuals who sign up without prior coverage for at least 12 months, aiming to discourage people from waiting until they become ill to purchase insurance and promoting continuous enrollment in health plans.
  3. Expands state flexibility and introduces Roth HSAs for broader coverage options: The bill promotes greater state-level innovation by supporting the creation of association health plans and high-risk pools to help cover individuals with significant health risks. It also proposes replacing current tax-deductible Health Savings Accounts (HSAs) with "Roth HSAs," which would allow consumers to contribute after-tax income in exchange for the ability to pair the account with lower-deductible, more flexible health insurance plans—potentially broadening access to more affordable coverage.
 
  1. New Republican Bill in Congress re: ACA
  2. Preserves popular ACA protections with added penalties to encourage continuous coverage: The proposed bill retains key Affordable Care Act provisions, such as the ban on medical underwriting that prevents insurers from denying coverage based on preexisting conditions. However, it introduces a 20% late-enrollment penalty for individuals who sign up without prior coverage for at least 12 months, aiming to discourage people from waiting until they become ill to purchase insurance and promoting continuous enrollment in health plans.
  3. Expands state flexibility and introduces Roth HSAs for broader coverage options: The bill promotes greater state-level innovation by supporting the creation of association health plans and high-risk pools to help cover individuals with significant health risks. It also proposes replacing current tax-deductible Health Savings Accounts (HSAs) with "Roth HSAs," which would allow consumers to contribute after-tax income in exchange for the ability to pair the account with lower-deductible, more flexible health insurance plans—potentially broadening access to more affordable coverage.
That seems like a step backwards. Aren't HSAs currently tax-free money going in and also tax-free going out as long as you spend it on healthcare?
Taxing it on the way in as a Roth will not be as attractive.
 
Aren't HSAs currently tax-free money going in
Tax deductible, not tax free.

The covered participant uses their after tax dollars to make HSA contributions which are tax deductible.

But to your point, changing the current HSA rules to a Roth HSA makes no sense. But you have to consider most of the folks in Congress have law degrees, and have no real understanding about how the real world works.

And FWIW, currently there is no such thing as a "Roth" HSA.
 
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  1. New Republican Bill in Congress re: ACA
  2. Preserves popular ACA protections with added penalties to encourage continuous coverage: The proposed bill retains key Affordable Care Act provisions, such as the ban on medical underwriting that prevents insurers from denying coverage based on preexisting conditions. However, it introduces a 20% late-enrollment penalty for individuals who sign up without prior coverage for at least 12 months, aiming to discourage people from waiting until they become ill to purchase insurance and promoting continuous enrollment in health plans.
  3. Expands state flexibility and introduces Roth HSAs for broader coverage options: The bill promotes greater state-level innovation by supporting the creation of association health plans and high-risk pools to help cover individuals with significant health risks. It also proposes replacing current tax-deductible Health Savings Accounts (HSAs) with "Roth HSAs," which would allow consumers to contribute after-tax income in exchange for the ability to pair the account with lower-deductible, more flexible health insurance plans—potentially broadening access to more affordable coverage.
Do you have a source here? These are all things that have been tried before and I can't find any recent news about a bill.
 
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