Blue Cross Blue Shield of Texas is the immovable behemoth of the Texas market with more than 4.2 million members, but the race for second place is hotly contested, and Aetna has earned silver by leaping over UnitedHealthcare-the perennial Number Two. With a total membership of 1.92 million, Aetna's PPO gained more than 600,000 new members, adding validity to assertions by Aetna leadership that Texans prefer an open access design and no gatekeepers. CDHPs with health savings accounts are attracting a fast-growing number of employers. Texas is the top CDHP market for CIGNA, which boasts almost 65,000 CDHP members and for Aetna with almost 47,000 members. Meanwhile in the Medicare market, CIGNA and HealthSpring will expand into new territories and offer more Medicare Advantage products in Texas next year. HealthSpring is moving into north Texas to launch a new product, NTX Healthy/Advantage PPO. It will be offered in 13 counties including the Dallas/Fort Worth area. CIGNA is adding new plan options in almost every county in which it operates and moving into new territories.