Cigna Healthcare to Exit Individual & Family Plan Markets in 2025: What Providers Need to Know

03/06/2025

Cigna Healthcare to Exit Individual & Family Plan Markets in 2025 

 


Starting Jan. 1, 2025, Cigna Healthcare will no longer offer Individual & Family Plans (IFPs) in select states and counties, impacting patients and healthcare providers. This change will affect providers who currently serve Cigna IFP members in the following areas: 

  • Pennsylvania 
  • South Carolina 
  • Utah 
  • Leon County, Florida 
  • Lake County, Illinois 
  • McHenry County, Illinois 

 

Key Implications for Providers 

1. Loss of Covered Patients 

Patients enrolled in Cigna IFPs in these markets will no longer have coverage through Cigna Healthcare after Dec. 31, 2024. This means providers treating these patients will see a shift in the payer mix, as affected individuals transition to new insurance carriers or alternative coverage options. 

2. Continuity of Care Considerations 

Providers should prepare for potential disruptions in continuity of care. Patients may need assistance finding new coverage or understanding their options during open enrollment, which begins on November 1, 2024. It’s crucial to educate affected patients on the need to select a plan that includes their preferred providers to avoid gaps in care. 

3. Impact on Claims and Reimbursement 

Providers must ensure that all services rendered through December 31, 2024, are properly billed and submitted in a timely manner. Claims for services provided before the coverage termination date should still be processed under Cigna Healthcare's policies, but after that date, claims will need to be directed to new insurance carriers chosen by patients. 

4. Network Participation Considerations 

For providers who work extensively with Cigna IFP members, it may be beneficial to explore contracts with other insurers entering or expanding in these markets. Understanding the competitive landscape will help maintain patient volume and financial stability. 

 

How to Prepare 

  1. Inform Affected Patients 

Proactively communicate with patients currently covered by Cigna IFPs about their need to transition to a new plan. Encourage them to check network participation when selecting a new insurer. 

  1. Coordinate with Staff 

Train front desk and billing teams on how to handle patient inquiries regarding coverage changes, claims processing deadlines, and alternative insurance options. 

  1. Review Alternative Payer Options 

Consider evaluating partnerships with other insurers in these markets to ensure continuity of care for patients who transition to different plans. 

  1. Update Administrative Processes 

Ensure that electronic health records (EHR) and billing systems are updated to reflect these changes, minimizing claim denials and administrative delays. 

 

Cigna’s exit from these IFP markets presents challenges but also opportunities for providers to reassess their payer mix and strengthen patient relationships. By staying informed and proactive, providers can navigate this transition smoothly while continuing to deliver high-quality care. If you have Cigna IFP patients, now is the time to prepare for the upcoming changes and help guide them toward uninterrupted care coverage. 

For more information, providers should monitor updates from Cigna Healthcare and state health insurance marketplaces as the transition date approaches. 

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