Blue Cross and Blue Shield of New Mexico (BCBSNM) is filing new rates to be effective January 1, 2026, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate changes for these plans is an increase of 18.4% to an increase of 49.6%.
The cost relativities among plans are different from the experience period to the prospective rating period due to anticipated non-uniform changes in network reimbursement levels. Additionally, the rates vary by plan due to the leveraging and utilization differences driven by variations in member cost sharing. Therefore, the proposed rates and rate changes may vary by plan.
Changes in allowable rating factors, such as age and geographical area, may also impact the premium amount for the coverage.
(Aetna/CVS is pulling out of the entire individual market nationally; I've estimated their current enrollment, see below for methodology)
AmeriHealth HMO:
AmeriHealth HMO, Inc. ("AHNJ”) is revising premium rates for the New Jersey Individual Health ACA compliant products, effective from January 1, 2026. Rate increases average 16.8%, ranging from 16.8% to 16.8%. The proposed revisions to each plan are shown on the last page of this exhibit. About 35 members will be affected.
Blue Cross and Blue Shield of Montana (BCBSMT) filed rates to be effective January 1, 2026, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate changes for these plans is an increase of 0.9% to an increase of 42.5%.
Product Blue Preferred Blue Focus Changes in allowable rating factors, such as age, geographical area, or tobacco use, may also impact the premium amount for the coverage.
There are currently 44,116 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.
Consistent with the filed URRT, earned premiums for Individual plans during calendar year 2024 were $252,957,302 and total claims incurred were $235,192,937. The proposed rates effective January 1, 2026, are expected to achieve the loss ratio assumed in the rate development.
The proposed rate change of 39.0% applies to approximately 142,324 individuals. Ambetter of Magnolia Inc.’s projected administrative expenses for 2026 are $89.76 PMPM. Administrative expense does not include $34.22 for taxes and fees. The historical administrative expenses for 2025 were $73.84 PMPM, which excludes taxes and fees. The projected loss ratio is 84.4% which satisfies the federal minimum loss ratio requirement of 80.0%.
Blue Cross Blue Shield of MS:
The 2026 monthly health insurance premium is made up of four pieces: estimated claim costs, administrative costs, taxes and fees, and risk/profit margin.
Overall preliminary rate changes via SERFF database, state insurance dept. website and/or the federal Rate Review database.
Ambetter Health of LA:
The proposed rate change of 16.4% applies to approximately 97,401 individuals. Ambetter Health of Louisiana’s projected administrative expenses for 2026 are $91.51 PMPM. Administrative expense does not include $17.45 for taxes and fees. The historical administrative expenses for 2025 were $79.64 PMPM, which excludes taxes and fees. The projected loss ratio is 81.4% which satisfies the federal minimum loss ratio requirement of 80.0%.
CHRISTUS Health Plan:
(as far as I can tell, CHRISTUS is dropping out of the Louisiana individual market...they aren't listed on the federal Rate Review database website, nor do they show up in the LA SERFF filings or on the LA Insurance Dept. website.)
Overall preliminary rate changes via SERFF database, state insurance dept. website and/or the federal Rate Review database.
Aetna Life Insurance Co:
(Aetna/CVS is dropping out of the individual market in all states; I estimate they have around 35,000 enrollees in Kansas who will have to find a different carrier for 2026)
Blue Cross Blue Shield of Kansas City:
Blue Cross and Blue Shield of Kansas City (BCBSKC) is requesting an average rate change of -6.1% for 2025 individual rates as compared to 2023 individual rates and calculated by the URRT. The changes vary by plan, with a minimum rate change of -10.8% and a maximum rate increase of 1.8%.
Table 2.1 summarizes proposed rate increases effective January 1, 2026, and displays significant factors driving the proposed rate increases. Note that this rate buildup is illustrative of changes occurring from 2025 to 2026, and is therefore not reflective of factors displayed in Worksheet 1, Section II of the URRT, which pertains to changes from the experience period (2024) to the projection period (2026). Factors found in The URRT are discussed in later sections.
Overall preliminary rate changes via SERFF database, state insurance dept. website and/or the federal Rate Review database.
Hawaii Medical Service Association:
Our requested rates include only the amounts needed to cover the expected health care benefits of our members, the cost of administering their benefits, expected Affordable Care Act (ACA) fees, and a small charge to help manage the risk of offering benefits to this population.
We based our rate increase request on a review of past costs of benefits and other expenses. These historical costs are adjusted for trend, to account for expected changes in use of medical services, cost inflation, and other factors that affect the cost of care. We also adjusted costs for benefit changes, which were largely made to comply with government mandated plan designs. Administrative expenses have been relatively flat over the past couple of years.
Initial Affordable Care Act Rates for 2026 have been posted
The North Carolina Department of Insurance has posted the rate changes requested by insurers for the 2026 plan year individual and small-group market plans offered under the Affordable Care Act.
Posting of the requested rates is part of the rate review process required by the Centers for Medicare and Medicaid Services (CMS). Unlike some types of insurance, the NCDOI does not set rates for health insurance.
The projected average rate change for plans effective January 1, 2026 is 16.0% which is an average rate change of about $87 per member per month (pmpm). Because 16.0% (or about $87) is an average, it is possible to have a different rate change. Factors affecting a member's premium are age, tobacco use, family composition, plan, and geographic area. Expected cost differences by product are updated every year to ensure premium differences are appropriate. BridgeSpan has approximately 200 members enrolled in this line of business as of March 2025.
...The rate change described above is driven by the following factors:
Medical Trend : 9.1%
Change in Benefits, Age, Area, and Network : -1.5%
Change in Market Morbidity : 5.0%
Exchange User Fees : 1.0%
Other : 2.0%
Other includes: actual results vs. expected, changes to admin expenses, and rx rebates. Actual results vs. expected reflect differences between actual results and past assumptions, including a true-up of market morbidity estimates
Healthy Alliance Life Insurance Company (HALIC) has filed for premium rate changes for its Affordable Care Act (ACA) compliant Individual health insurance plans. This filing includes an average rate change of 21.23%, effective January 1, 2026, with plan prices changing between 18.75% and 24.73%. The price changes will impact about 52,000 people that have HALIC plans now and will keep HALIC plans next year. An insured person’s actual rate increase could be higher or lower depending on their benefit, where they live, how old they are, number of children, and if they use tobacco.
