Aetna Plan & Rate Updates Effective January 2026
Aetna announced plan and rate updates for January 1, 2026 effective dates. Rates are available for quoting!
Rates
Quarterly medical rate change (may vary by plan, region or network)
- OAMC/PPO: 0.0%
- HMO: 2.1%
Annual medical rate change (may vary by plan, region or network)
- OAMC/PPO: 9.4%
- HMO: 8.7%
Group Eligibility Updates
Aetna is refining its Small Group ACA medical eligibility guidelines for 2026, focusing coverage on select California regions. These changes only apply to Aetna Small Group ACA medical products and do not affect Aetna Funding Advantage (AFA) or other Aetna segments in California.
Aetna Small Group ACA eligibility rules for 2026 new business and inforce groups at renewal:
- Aetna Small Group ACA will not be available for employers located in Rating Areas 1, 2, 3, 5, 7, 8, 9, 12, 13, and 14.
- Employers in Rating Areas 4, 6, and 10 can only offer employees Aetna OAMC and PPO plans.
- Employers in Rating Area 11 can only offer employees Aetna OAMC, Savings Plus OAMC, and PPO plans.
- Employers in Rating Areas 15, 16, 17, 18, and 19 can offer all plans.
Please note: These changes will apply to inforce Aetna business at the group’s 2026 renewal date.
Impact on your Aetna Small Group ACA business renewing in 2026
Groups located in Rating Areas 1, 2, 3, 5, 7, 8, 9, 12, 13, and 14
- These groups will not be able to renew their Aetna Small Group ACA coverage in 2026.
- They will receive notice 90 days prior to the non-renewal date for their medical plans.
- Ancillary coverage will renew as usual.
Groups located in Rating Areas 4, 6, 10, and 11
- Groups with OAMC/PPO plans will receive their renewal information as usual.
- If a group also has HMO plans, they will receive notice 90 days prior to the non-renewal date for those HMO plans.
- HMO members will appear as waived on the renewal and must enroll in an OAMC or PPO plan to maintain coverage.
- Brokers or groups may contact Aetna for assistance with mapping employees from discontinued HMO plans to available OAMC/PPO options.
Groups located in Rating Areas 15, 16, 17, 18, and 19
- These groups will remain eligible and receive a renewal with no changes to the standard renewal process.
- As long as the employer is located in one of these regions, employees may continue to enroll in any plan design, even if they reside in other regions (for example, employees in the Bay Area may enroll in HMO plans if the employer is located in Rating Areas 15-19).
Small Group ACA to AFA
Aetna will continue to offer its level-funded solution, Aetna Funding Advantage (AFA), to ACA groups that are strong candidates. AFA remains available statewide throughout California.
Book Rates
Book rates for Aetna will be provided on the B&P website when they are available.
For questions, please contact a member of your B&P Sales Team - (888) 722-3373.