OMAHA, Neb. (AP) — Aetna Health says it will be leaving the individual health plan market in Nebraska.

Aetna had sold policies in only four states this year after quitting 11 states last year, and last month it announced it was pulling out of Iowa and Virginia.

Aetna’s decision leaves only Medica Health in Nebraska’s Affordable Care Act market, and Medica officials said Wednesday that the company had not yet decided whether to remain in the Nebraska market.

Nebraska Insurance Department director Bruce Ramge has said that if no companies participate in the Nebraska exchange next year, it could mean that people who qualify for tax credits don’t get them, although they would still have to find insurance to fulfill the individual mandate should it still be in effect.