Aetna, in announcing last week that it will not participate in the state-based health insurance exchange in New Jersey, is just the latest insurer to pull out of such exchanges.  A big deal?  Maybe.  As noted by CNN, while Aetna has 1.1 million customers, just 2600, that’s .2 per cent, buy individual plans.  But, this could signal a larger trend.  Neither Aetna nor Conventry Health Plans will be represented on exchanges in Georgia, Maryland, Connecticut, New York, West Virginia or New Jersey.  The company is reviewing its filings in other states.

Similarly, UnitedHealthcare and Cigna have also indicated that they are limiting their participation to a handful of exchanges.  Why are these large insurers opting out?  One oft-cited reason is the concern that previously uninsured and unhealthy Americans will flood the exchanges and run up large health care bills.

However, not all insurers are following suit.  A licensee of Blue Cross Blue Shield, WellPoint, is on record as going all-in with the exchanges.

What does this mean for the individual looking for insurance?  Even if some insurers will not participate in the exchange, for 2014, individuals need not buy insurance through the exchanges.  This will give those insurers who have declined to participate time to evaluate, crunch their numbers, and possibly opt in down the road.