Within the past year, the healthcare industry in the United States has been experiencing a period of significant transition. You may have seen news about insurance companies pulling certain plans, or retail giants closing health clinics, and we are here to inform you that these changes are very real. Across insurance, pharmacy, and provider networks, major players are exiting select markets. These exits aren’t just business headlines—they affect employees, employers, and families who depend on consistent and stable healthcare access.

 In this post, let’s explore why these exits are happening, what sectors are the most affected, and what steps you can take to stay prepared.

Why Are Companies Pulling Back?

Rising Healthcare Costs

One of the primary drivers behind market exits is the increasing cost of care. Many patients postponed medical treatment during the pandemic due to Covid-19 fears and delayed procedures, and now they’re seeking services again at more advanced stages of illness. This increase in demand, combined with labor shortages and higher drug costs, has raised the overall cost of delivering care to patients.

For insurers and providers, these rising expenses make it more difficult to maintain certain plans or clinics without risking financial loss. For example, some rural hospitals have cut back services or shut down entirely, leaving communities with fewer options for emergency care. If your local hospital closed, how far would you need to travel for treatment?

Shifts in Medicare Advantage and ACA Markets

Medicare Advantage (MA) and Affordable Care Act (ACA) plans are particularly affected. The federal government has slowed the growth of payments to MA plans, meaning insurers are receiving smaller yearly increases even while medical costs climb. This reduces revenue for insurers even as medical claims rise. As a result, companies like UnitedHealthcare, Humana, and Centene are scaling back their MA offerings in some states and counties.

Similarly, ACA exchange markets in certain regions are seeing insurers exit because reimbursement levels no longer align with operating costs. If you’ve ever logged into an open enrollment portal only to find fewer plans than the year before, you’ve already seen this shift firsthand.

The Impact of the Inflation Reduction Act (IRA)

As discussed in our previous blogs, The Inflation Reduction Act introduced important cost-saving measures for patients, such as drug price negotiations and caps on out-of-pocket costs. While these changes are beneficial to individuals, insurers and drugmakers say they reduce profit margins. For some insurers, this adds another reason to withdraw from less profitable markets. While the IRA isn’t the only factor driving exits, it has added pressure to an already challenging financial landscape. 

Strategic Refocusing

It’s not just insurance plans that are changing. Retail healthcare providers are also adjusting their strategies. For instance, Walmart recently closed all of its health clinics, leaving patients in some areas scrambling to find alternatives. CVS Health has pulled back from infusion services, while Walgreens is downsizing its VillageMD clinics and moving more toward virtual care.

These changes highlight how even large corporations are reevaluating where and how they deliver healthcare. If a household-name company like Walmart can decide to exit healthcare clinics, it’s worth asking: what could that mean for smaller, local providers trying to navigate these changes?

Who Is Affected?

These healthcare market exits don’t just stay on the business side—they directly touch individuals, families, and employers. Seniors who rely on Medicare Advantage may suddenly find their plan no longer available in their county. People purchasing coverage through the ACA marketplace might log in at open enrollment and notice fewer options than before. In some rural communities, families are losing access to nearby hospitals or clinics, meaning a routine check-up could now involve a long drive. Employers also feel the impact, since fewer insurance carriers in a region can limit the choices they can offer their teams. These ripple effects show that no matter where you sit—employee, employer, or patient—you could be affected when companies pull out of markets.

What Can You Do?

Even though you can’t control company decisions, there are proactive steps you can take:

• Stay Informed: Watch for updates from your insurer or pharmacy about changes to coverage or locations.

• Review Annually: Revisit your plan during open enrollment to make sure it still meets your needs.

• Check Networks: Confirm your doctors and hospitals remain covered under your plan.

• Plan Alternatives: If your local clinic is closing, identify backup care locations ahead of time.

The Bigger Picture

The healthcare industry is evolving rapidly, and these market exits serve as a reminder to stay engaged with your coverage options. Rising costs, new regulations, and shifting business strategies will continue to shape how care is delivered. By staying informed and reviewing your benefits regularly, you can ensure that you, your employees, or your family remain covered and prepared for changes ahead.

If you’d like to discuss how these shifts may affect your organization or personal coverage, reach out—we’re here to help you navigate the changing healthcare landscape.

Guiding you through healthcare, one post at a time — Jaiden Logan, Elite Medicare Specialists.