Health Insurance Expansion in 2023

ACA Expansion

Back in 2017, the Affordable Care Act (ACA) exchange marketplace seemed to be dying. Insurers were leaving state marketplaces – as many as 20% of enrollees only had access to one insurer in their county. Nearly two-thirds – 62% – of counties had two or fewer insurers offering plans. Many felt we were seeing the demise of the exchanges.

In five years, the outlook has changed. Buoyed by new subsidies, enrollment in exchange plans has grown to record highs. Those enrollment gains have led many insurers to enter the exchanges or expand their territories to soak up new enrollees.

This year is no different, as several payers have announced health insurance expansion plans for 2023 in ACA markets. Here’s a look at those expansion plans:

Aetna CVS Health

Aetna once sold plans in 15 state marketplaces. By 2018, citing losses nearing $650 million in 2016 and 2017, the company decided to exit all state marketplaces.

Fast-forward to 2023, and the company may be almost back. Aetna, now a CVS Health company, recently announced they would offer plans in 12 states in 2023. In those states – Arizona, California, Delaware, Florida, Georgia, Illinois, Missouri, North Carolina, New Jersey, Nevada, Texas, and Virginia – Aetna CVS Health will offer its network of primary care doctors, specialists, and hospitals as well as $0 in-network virtual and walk-in clinic care. The expansion may be surprising given CVS Health reported “lower than expected” enrollment in the eight states it entered in 2022.


Like Aetna, UnitedHealthCare suffered significant losses – perhaps as much as $1 billion – in the ACA exchanges in 2016 and 2017. As a result, they exited most markets.

Like Aetna CVS Health, UnitedHealthCare reentered many of its original exchange markets. They’ll offer plans in 4 new states – Kansas, Missouri, Ohio, and Mississippi – bringing their total to 22 states. It’s less than the 33 states where the company offered plans in 2016 but a significant increase from the two states where it sold plans in 2018.


Unlike Aetna and UnitedHealthcare, Cigna didn’t dive headfirst into the state ACA exchanges. Instead, they took a more measured approach, offering plans in 7 states in 2017 and 6 in 2018.

That number will triple in 2023, as Cigna recently announced it will offer plans in 363 counties spanning 16 states in 2023. In addition to selling plans in three new states – Texas, Indiana, and South Carolina – Cigna expanded the number of counties plans will be available in Georgia, Mississippi, and North Carolina. Cigna added access to MDLIVE’s primary care physician network for video visits, including $0 virtual urgent-acute care and $0 virtual wellness screenings through MDLIVE.

Other large insurers with a national footprint haven’t yet announced plans to grow their footprint. Notably, Humana exited state exchanges in 2018 and hasn’t returned. Centene has traditionally been one of the largest providers of ACA exchange plans and offers plans in 27 states. It’s uncertain if that will grow in 2023.

Medicare Advantage Expansion in 2023

Unlike the ACA exchanges, Medicare Advantage markets are stable, and enrollment has continued to climb. Most insurers announce those expansions in October each year. More expansion announcements may be forthcoming. But below are two startup health plans as well as some of the industry’s largest insurers that plan to expand in 2023.

Alignment Health

Startup health plans selling Medicare Advantage plans have grown their market share even as they compete with industry giants. Startup health plans now share 1.3% of the market, up from 0.9% a year ago. Alignment Health is one startup that has seen consistent enrollment growth since 2019.

They’re hoping to continue that growth by expanding into two new states – Florida and Texas – in 2023. Additionally, the company plans to grow its reach in states where it sells Medicare Advantage plans – California, North Carolina, Arizona, and Nevada.

Clover Health

Clover Health plans to expand its Medicare Advantage territory in 2023, adding 13 new counties in Georgia, South Carolina, and Tennessee. It won’t sell plans in new states, however.


After missing enrollment gain expectations in 2022, Humana vowed to find savings it could leverage to invest back into its Medicare Advantage and CenterWell services. In addition to investments in supplemental benefits like dental coverage, Humana plans to expand HMO offerings into 260 new counties while also introducing LPPO plans into 260 new counties. It will also expand Dual Eligible Special Needs Plans (D-SNPs) to 184 counties. Humana will be offering LPPO plans for the first time in California, Rhode Island, and Wyoming.


UnitedHealthcare has more than 8.2 million individuals enrolled in Medicare Advantage plans. In 2023, it will expand its footprint by offering Medicare Advantage plans in 314 additional counties. In 2023, the company’s footprint will reach 95% of Medicare consumers nationwide, the largest of any health insurer.


Cigna announced that it will expand its Medicare Advantage footprint into 106 new counties and add a presence in New York and Kentucky. That expansion includes metro areas New York City, Asheville, Cincinnati, Corpus Christi, Jacksonville, Pittsburgh, and Richmond. Those expansions represent a 22% growth in Cigna’s geographic footprint.

Aetna/CVS Health

Aetna currently has 3.2 million Medicare Advantage enrollees and plans to expand its prescription drug plans to 141 new counties throughout the country. Those plans are available in 46 states and accessible to 55 million individuals. The insurer also plans to expand its Dual Eligible Special Needs plan (D-SNP) to new markets in South Carolina, South Dakota, and Utah. Aetna plans to introduce an Institutional Special Needs Plan (I-SNP) in Pennsylvania. Finally, the insurer plans to offer its Medicare Eagle plans targeting veterans in 42 states.


Centene’s subsidiary Wellcare announced that it will offer plans in 209 new counties. The company today serves nearly 1.5 million Medicare Advantage members across 36 states. Wellcare also announced that Amazon will serve as a preferred retail pharmacy provider in 2023.

Providence Health Plan

Providence Health Plan announced it will offer Medicare Advantage plans in Orange County, California in 2023. The non-profit will also offer Medicare Advantage plans in Oregon and Washington, including expansion into three new counties in Southeast Washington.

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