Insurance giant Aetna has notified customers this month that it will exit Arizona’s individual health-insurance market in 2018, citing financial risk and an uncertain outlook.

People who purchased health insurance directly from Aetna can keep their plans through the end of this year but will need to search for other options in 2018.

Aetna did not offer subsidized plans through the Affordable Care Act marketplace this year, but it did sell “off-exchange” insurance directly to individuals. It’s unclear how many people are affected by Aetna’s decision to exit the individual market in Arizona.

Blue Cross Blue Shield of Arizona and Centene’s Ambetter from Health Net, the two insurance companies that sold plans on Arizona’s health-insurance marketplace this year, have taken steps to again offer plans in 2018. Both notified the Arizona Department of Insurance of their intent to sell Affordable Care Act insurance next year.

Arizona also will have at least one other non-marketplace offering in the state.

Cigna confirmed that it will continue to sell individual plans off-exchange in Arizona next year, but the Connecticut-based insurer will narrow its options.

Cigna will discontinue its “open access plus” plans that it sold to individuals and families this year. These PPO-style plans offer a broader network of medical providers, but the insurer said the “relative instability” of these plans in Arizona prompted it to pull the offering for 2018.

Cigna spokesman Joe Mondy said the insurer could not develop a combination of affordability, quality and value to keep the plans next year.

However, Cigna will continue to sell an HMO-style plan in Maricopa County with a narrower network of providers that includes Cigna Medical Group.

It’s unknown how rates will change for either the marketplace or off-exchange plans for Arizona. The Arizona Department of Insurance will not release details about the insurer filings, including requested rate increases, until the state agency reviews the documents.

Most people get health insurance through an employer or government insurer such as Medicare, Medicaid, Tricare or the Department of Veterans Affairs and are not affected by the individual insurance market.

But an estimated 4 percent of Arizonans purchased insurance directly from an insurer or through the ACA marketplace in 2015, according to Kaiser Family Foundation estimates based on survey data from the U.S. Census Bureau.

Consumers who depend on the individual market lament the narrowing options. Mesa resident Linda Baird, 61, said she purchased Aetna this year because she considered the network of providers better than what Cigna or Ambetter offered. Now, with Aetna no longer available, she said she’s not sure what she’ll do for coverage next year.

“I paid a third of my income this year in premiums, prescriptions, and copays,” Baird said. “I object to paying $1,007 a month for my plan now, but expect more of my retirement funds to be wasted next year on narrow network, expensive, high deductible limited options.”

Last year, insurer after insurer announced plans to drop coverage in the months leading up to the Nov. 1 start of open enrollment. The ACA marketplace for insurance had far fewer options than when the marketplace launched in 2014.

The narrowing choices and large premium increases last year prompted several Republican leaders to cite Arizona as evidence that the ACA needed to be replaced.