(Access to Care Health Plan is a division of Sendero; unfortunately, they've heavily redacted their actuarial memo and I can't find a justification summary)
Aetna Health:
Aetna is dropping out of the individual market nationally in 2026. In texas, they've provided a market withdrawl letter which includes the exact number of current enrollees in each region of the state:
"Aetna is totally withdrawing from the individual (off and on-exchange) market, effective December 31, 2025. Individuals currently covered under an Aetna plan will need to make a different plan selection for 2026. In accordance with Texas and federal law, consumers will be given 180 days’ notice of the termination of their policy."
(Unfortunately, Avera hasn't provided a justification summary and has almost completely redacted their actuarial memo, making it impossible for me to know what their current enrollment is; see below)
(Aetna/CVS is pulling out of the ACA individual market in every state; I've made an educated guess as to their current enrollees, who aren't counted as part of the weighted average as they'll have to shop around for a new carrier this fall. See below.)
Antidote Health Plan:
(Antidote's actuarial memo is heavily redacted so I don't know their current enrollment; I've had to make an educated guess. See below.)
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.
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.
Blue Cross and Blue Shield of Nebraska (BCBSNE) is setting new rates for its Individual ACA market business in Nebraska. The rate change will take effect January 1, 2026, and will impact an estimated 22,300 members. On average, rates will go up by 20.5% compared to 2025 individual rates. Depending on the network and plan, rate changes will range from a decrease of 1.1% to an increase of 33.3%. Additionally, premiums will go up a bit each year as people get older, even if their plan rates stay the same.
BCBSNE used its own claims and enrollment data, and other publicly available information to set these rates.
NJ Department of Banking and Insurance Releases Initial Health Insurance Rates for the Individual Market for Plan Year 2026
Federal Inaction on Enhanced Premium Tax Credits Among Issues Impacting Consumer Costs
TRENTON — The New Jersey Department of Banking and Insurance today announced that plan year 2026 health insurance initial rates have been submitted by insurance carriers operating in the individual market, which includes Get Covered New Jersey, the State’s Official Health Insurance Marketplace.
Plan year 2026 health and dental insurance rate filings, as proposed, are available for the companies listed below. These filings are subject to actuarial review. Additional companies will be listed as their filings are received. Any insurance filings already approved are available to the public through the NAIC’s System for Electronic Rate and Form Filing (SERFF) interface. There is no fee for using SERFF. Rate info can also be accessed at the Rate Review page at Healthcare.gov
AmeriHealth Caritas VIP Next, Inc:
Company Legal Name AmeriHealth Caritas VIP Next, Inc.
Market for which proposed rates apply (Individual or Small Group) Individual
Total proposed rate change (increase/decrease) 46.20% increase
Effective date of proposed rate change January 1, 2026
This actually came out a couple of weeks ago but ironically, I've been too swamped analyzing & posting 2026 rate filings for other states to get around to posting it here until now.
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.
