Anthem plans to leave the Obamacare exchange in Virginia, an announcement that comes only days after the company said it was leaving the exchanges in Nevada and Georgia.

The move means that people who had Anthem coverage this year will have to shop for a new healthcare plan beginning in November if they have the option, and the change in coverage could mean patients will have to see new doctors and change hospitals.

Other insurers, including Anthem, UnitedHealthcare, and Aetna have made similar announcements about Virginia, which would have left 50 counties in the state without an insurer to buy tax subsidized coverage from. Optima Health, however, plans to offer coverage in all of those counties and has asked for rate increases of 19.3 percent for next year.

Most Obamacare customers who buy coverage on the exchange will not feel the increase because federal subsidies will increase to cover the difference in price. Those making more than $48,000 a year for an individual, however, generally do not qualify for subsidies and may have to pay more for coverage.

The rate increases do not apply to people who get medical coverage through work or through programs such as Medicare or Medicaid.

Anthem said Friday that the uncertainty about the future of Obamacare had led to its decision, as had an unbalanced risk pool.

The Trump administration has not said what it will do about insurer payments that it has been issuing under the law, and the president has threatened to cut the funding off as a way to bring lawmakers together to devise a healthcare plan. On Thursday, the Department of Health and Human Services issued a memo saying it would give insurers more time to file premium rate requests, but that it did not have additional information about whether the payments would be made.

Without the funds, insurers would price their premiums higher for next year, but because they don't know whether to expect the payments, they have said they are wary about doing business in the exchanges next year. Many of them already have claimed hundreds of millions of dollars in losses from selling the plans.

"Today, planning and pricing for [Obamacare]-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost-sharing reduction subsidies and the restoration of taxes on fully insured coverage," Anthem said Friday. "As a result, the continued uncertainty makes it difficult for us to offer individual health plans statewide in Virginia."