The leaders of The Cigna Group will wind down the company’s individual insurance exchange business at the end of 2026, exiting a market that has shrunk significantly this year due to the ending of enhanced subsidies and which they say will let them focus better on core parts of Cigna’s portfolio.

“We did not make this decision lightly and appreciate the importance of ensuring patients have continuity through the transition,” President and COO Brian Evanko said on an April 30 conference call. “There are no changes to coverage or networks related to this announcement and we will support members through their open enrollment transitions into 2027.”

Cigna finished the first quarter with 355,000 customers enrolled in Affordable Care Act marketplace plans. That figure was down from 432,000 a year earlier and Evanko and his team said in February that they expected to finish this year with fewer than 300,000 individual exchange customers.

The move by Cigna executives follows a similar decision by their peers at Aetna, which is owned by CVS Health Corp., last spring. It is likely to add to dislocation in the exchange market, which had 23.1 million members at the end of 2026’s open-enrollment window, a drop of 5% from a year earlier. For Cigna’s leaders, the decision came down to balancing their attention with the opportunities for growth.

“We did not see a clear path to scale this business to achieve meaningful impact within the context of The Cigna Group’s aggregate size,” Evanko said on the conference call. “The second factor is management focus for the organization. This is a small business for us today and it’s been shrinking in recent years. So the decision will allow us to further intensify focus on our core growth platforms.”

Other notable healthcare names also provided commentary on today’s insurance exchange market. Here’s a rundown of some highlights:

HCA Healthcare

The most prominent publicly traded hospital company saw same-facility adjusted admissions of exchange-covered patients fall some 15% in the first quarter, CFO Mike Marks told investors late last month. That figure translated into a roughly $150 million ding to HCA’s earnings before interest, taxes, depreciation and amortization compared to early 2025.

HCA executives are sticking to their full-year profitability impact estimate of $600 million to $900 million, with Marks saying “the exchange environment remains dynamic and has not fully settled.” Two parts of the equation, he added, is that plan members have moved to lower bronze-level coverage and that silver-level plans also have trimmed benefits and are leaving patients with larger outstanding balances due HCA.

“We’re going to continue to learn more as we go along,” Marks said. “I think what that looks like is studying how much of the anticipated 2026 full year volume decline came through during the first quarter, which is a bit difficult to predict.”

Tenet Healthcare

Executives at Tenet Healthcare said first-quarter activity from ACA-covered patients didn’t drop off as much as they had expected. CEO Saum Sutaria said same-store admissions from that group were down about 10% from early last year and wondered if marketplace plans’ three-month grace period for overdue premiums played a role.

“We’re in this transitionary period, where there’s some coverage changes that are occurring,” he said. “We’ll see how all that settles out.”

Sutaria and CFO Sun Park said they’re sticking with their full-year forecast that exchange patient volumes will drop 20% by year’s end. The path to that number, they added, may not be a very straight line, though.

Universal Health Services

That’s also the take from Universal Health Services. CFO Steve Filton recently told analysts that Q1 admissions of patients enrolled in exchange plans fell about 5% from the first three months of 2025, a drop that cost the company about $15 million in EBITDA.

Like Sutaria and Park, Filton expects trends to worsen throughout 2026 as more people drop their coverage. He’s maintaining his forecast that UHS will lose $75 million in EBITDA compared to 2025 and “assumes the exchange declines will steepen somewhat as the year progresses.”

Pediatrix

Not seeing any impact yet is the team at Pediatrix Medical Group, which provides prenatal, neonatal and pediatric services at hospitals and offices. Executive Chairman and CEO Mark Ordan told analysts on May 4 that his team remains comfortable not including an estimate for 2026 losses due to exchange patient trends even though hospital systems saw notable drops.

“We don’t see any signs of weakness and we have looked carefully by geography, by type of service,” Ordan said. “I wouldn’t say we’re surprised; we’re pleased. We’ve speculated that perhaps people are making a cost-benefit calculation when it comes to pregnancy that keeps them in the exchanges. […] It could be that there’ll be a delayed effect or it could be that we can get through this as we have been.”