Can I Keep My Doctor After Aetna Leaves Florida?
When an insurance company leaves Florida, one of the biggest worries people have is: “Will I still be able to see my doctor?”
With Aetna, a CVS Health company, exiting Florida’s ACA Marketplace after December 31, 2025, and reducing certain Medicare Advantage plans, thousands of Floridians face this exact question. This decision normally will take into consideration business factors which include financial stability, markets, and the financial obligations required to operate in the marketplace of ACA. CVS health will also be eliminating some individual plans in 2026. The atmosphere regarding health insurance plans in Florida will be inconsistent and knowledge on the transition of a major insurance company is just one instance of fluctuation in the overall insurance marketplace.
The good news is that you can keep your doctors and care—if you choose the right replacement plan.
At SWFL Insurance, our licensed agents in Fort Myers, Naples, and Port Charlotte help you compare options like Florida Blue and other carriers to ensure your coverage aligns with your doctors and prescriptions.
Understanding the Change: Why Is Aetna Leaving Florida?
Aetna’s exit from the Florida Affordable Care Act (ACA) marketplace marks a major shift for individuals and families who depend on their health insurance plans for access to careThe primary driver for the insurance company’s decision is the added complexity and financial burden of navigating the ACA marketplace, which has made it difficult for some insurers to provide competitive health insurance plans in the state. Therefore based on this development, Aetna will discontinue offering all individual and family health insurance plans in Florida, and is effective January 1, 2026.
This means that plan members will need to find a new health insurance plan to maintain continuous coverage and avoid unexpected out-of-pocket costs. Transitioning to a new health insurance plan will likely feel like a significant task, but if you break it down, know your options and plan accordingly you may save money and ensure that you and your family will continue to have access to the health care services that you need. Open enrollment for new health insurance plans starts on November 1 the year before, meaning you will be able to review insurance plans that are available and compare benefits, and select a plan that best meets your needs and budget.
The exit of Aetna will also have an impact on health care professionals, like primary care providers and specialists, as many will be seeing changes to patient numbers and insurance plans. With fewer in-network providers contracted into Aetna, both patients and providers will need to become accustomed to an altered world of health care coverage and network providers.
When deciding on a health insurance plan, it is very important to consider items such as prescription drug coverage, whether they can still access a preferred medical provider, and out-of-pocket expenses. The Inflation Reduction Act has provided changes that may ultimately influence the affordability and availability of your health insurance; therefore, it is important to stay informed of what implications these changes will have on your coverage.
To help ease the transition, here are some next steps for plan members:
- Review your current health insurance policy to understand what changes will take effect in 2026.
- Explore new health insurance plans during the open enrollment period starting November 1, 2025.
- Consult with one of our licensed agents to review available insurance plans and find the best coverage for your health care needs and budget.
- Pay close attention to prescription drug coverage, network providers, and out-of-pocket costs when evaluating your options.
- Visit HealthCare.gov or reach out to a licensed agent for personalized assistance and to ensure you don’t miss important deadlines.
By taking these proactive steps, you can maintain access to quality health care, avoid gaps in coverage, and manage your health insurance costs effectively as the Florida insurance landscape evolves.
Why Networks Matter When Aetna Leaves
Every health plan has a network – a group of doctors, hospitals, and pharmacies that contract with the insurance company. If you move from Aetna to another carrier, you’ll need to check if your preferred providers are in that carrier’s network. It’s essential to confirm whether your doctor is included in the plan’s network to maintain continuity of care.
- ACA (Marketplace) Members: Networks vary widely by carrier. Some are HMO-only with smaller networks, others offer broader PPO access.
- Medicare Advantage Members: Networks determine which doctors, specialists, and hospitals you can use. Choosing the wrong plan could mean losing access to your current care team.
How to Make Sure You Can Keep Your Doctor
- Make a list of your current providers. Include your primary care provider, specialists, any medical facility you regularly use, and preferred hospitals.
- Work with a licensed agent. We check each doctor, primary care provider, and facility against multiple carriers’ networks and confirm if each accepts your new insurance. For Medicare plans, we also verify if the provider accepts Medicare.
- Confirm before you switch. Don’t assume your doctor is covered—verify with the carrier or through your agent that your provider is in-network and, if enrolling in a Medicare plan, that the provider accepts Medicare.
- Look at prescriptions too. Medications must be checked against the plan’s drug formulary to avoid surprises.
Will Florida Blue Cover My Doctors?
Florida Blue is one of the largest insurers in the state and partners with many top hospitals and medical groups. While most Floridians find their doctors in-network with Florida Blue, it’s not guaranteed. Florida Blue members have access to member-specific resources, such as the member website and customer support, to help verify provider participation. That’s why it’s critical to confirm before you enroll.
SWFL Insurance will:
- Review your doctor list against Florida Blue’s network.
- Compare with other carriers like Ambetter, UnitedHealthcare, and Humana (if available).
- Ensure your plan covers both your providers and prescriptions.
What Happens If My Doctor Isn’t In-Network?
You have a few options:
- Choose another plan that includes your doctor (best option if available).
- Ask your doctor if they accept multiple insurance carriers.
- Switch providers—not ideal, but sometimes necessary if your preferred doctor is not contracted with any available ACA or Medicare plan in your area. If you need to switch, it’s important to find a new doctor quickly to avoid gaps in care.
If you need to find a new provider, talk with your current doctor or family members for recommendations.
Frequently Asked Questions
Q: Will I lose my doctor when Aetna leaves Florida?
Not necessarily. If your doctor is in-network with another carrier (like Florida Blue), you can keep them by enrolling in that plan. If your provider does not accept Medicare Advantage, you may still have access through original Medicare (Part A and Part B).
Q: How do I check if my doctor is covered?
You can search carrier directories online, but working with a licensed insurance agent ensures your whole provider list is checked before you switch. Some plans require referrals to see a specialist, so it’s important to confirm these details.
Q: Are all Florida Blue doctors the same statewide?
Florida Blue has broad networks, but coverage varies by plan and county. Always verify for your location, as some plans offer different provider networks.
Q: What if I take expensive medications?
Prescription coverage varies by plan. SWFL Insurance checks drug formularies to make sure your medications are affordable under your new plan. Be sure to review premiums and out-of-pocket costs for medications.
Q: Does it cost extra to have an agent check my doctors?
No. SWFL Insurance provides this service free of charge—carriers pay us, not you.
Q: How do I qualify for Medicare or Marketplace coverage?
Eligibility is based on age (usually 65 or older for Medicare), disability, or qualifying life events such as job loss. A person may also be eligible for Marketplace coverage during special enrollment periods.
Q: What is the minimum age to enroll in Medicare?
Most people become eligible for Medicare at age 65.
Q: What are my options for individual coverage or family plans if I lose my employer-sponsored insurance?
If you have lost your employer-sponsored insurance, you can apply for individual coverage through the Marketplace or enroll in family plans (such as a spouse’s or parent’s plan) to continue with health insurance.
Q: Who can enroll in different plans after a qualifying event?
A person who experiences a qualifying event, like job loss or divorce, can enroll in individual coverage, family plans, Medicaid, or Medicare, depending on their circumstances.
Q: How do I find out which plans are available to me?
You can fill out a form online or contact a licensed insurance agent to review your options and compare available plans.
Q: Why is my ID card important?
Your ID card is important because it allows you to access your health care services and also acts as proof of your coverage when you visit your providers and pharmacies.
Q: How can I get help with my plan?
You can call the plan’s toll-free number for support, ask questions, or get assistance with your benefits.
Q: What is the difference between original Medicare and Medicare Advantage?
Original Medicare includes Part A and Part B and allows you to see any provider that accepts Medicare. Medicare Advantage plans offer additional benefits but may have network restrictions.
Q: What is the difference between HMO and PPO health insurance plans?
HMO plans provide a network of providers and most of the time prior authorization is required to see a specialist. PPO plans are more flexible and do not require referrals to see specialists.
Q: What costs should I expect with health insurance?
Key expenses include premiums, deductibles, copays, and coinsurance. You may also have to consider paying out of pocket for some services, and there are various payment options available.
Q: How does Medicare pay providers, and how does it impact participation?
Providers are paid by Medicare based on set payment rates. Sometimes, Medicare payments are lower than those of private insurance, which can affect whether providers choose to participate. What Medicare pays and the overall payment process influence provider decisions and patient access to care.
Why Work With SWFL Insurance?
- Local offices in Fort Myers, Naples, and Port Charlotte.
- Independent advice—we’re not tied to one insurer.
- Personal service—we check your doctors, medications, and budget to find the right plan. We also encourage you to consult with family members for recommendations and support when choosing new providers or plans.
- Free enrollment help—we handle the paperwork, at no cost to you.
Let Us Help
Don’t risk losing your doctors or prescriptions when Aetna leaves Florida. Let SWFL Insurance review your provider list and match you to a plan that keeps your care intact.
