(unfortunately, CareSource WV's actuarial memo is heavily redacted)
Highmark BCBS WV:
Highmark West Virgina (“Highmark WV”) is requesting an average ACA individual market rate increase of 17.0%, ranging from 15.2% to 23.3%. Products submitted with this filing will have effective dates from January 1, 2026 to December 31, 2026. This rate change is projected to affect 28,179 members.
Historical Financial Experience:
Highmark WV incurred an underwriting gain in its ACA individual market programs in 2024.
Change in Medical Service Costs:
The projected average cost of medical care for the projected population is expected to increase. The increase will emerge in utilization and average cost per service and is spread across all types of services.
The proposed rate change of 27.3% applies to approximately 204,837 individuals. Absolute Total Care’s projected administrative expenses for 2026 are $90.21 PMPM. Administrative expense does not include $17.94 for taxes and fees. The historical administrative expenses for 2025 were $78.35 PMPM, which excludes taxes and fees. The projected loss ratio is 82.6% which satisfies the federal minimum loss ratio requirement of 80.0%.
Scope, Range, and Best Estimate of the Rate Increase
Blue Cross and Blue Shield of Oklahoma (BCBSOK) 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 increases for these plans is 12.3% to 51.5%.
...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 128,181 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.
(Unfortunately, BCBSND's actuarial memo is heavily redacted, so I don't know their current enrollment. I've had to make an educated guess on that; see below.)
(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.
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.
Arizona has around 423,000 residents enrolled in ACA exchange plans, 88% of whom are currently subsidized. I estimate they also have perhaps another ~8,000 unsubsidized off-exchange enrollees.
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.
Open Enrollment Period through Get Covered New Jersey Begins November 1, 2025
TRENTON — New Jersey Department of Banking and Insurance Commissioner Justin Zimmerman today announced a total of $5 million in available grant funds for community organizations to apply to serve as state-certified Navigators for the Get Covered New Jersey Open Enrollment Period and throughout 2026. Navigators offer free, unbiased, community-based education and assistance to consumers seeking to enroll in health insurance through Get Covered New Jersey, the State’s Official Health Insurance Marketplace.
Delaware has ~53,000 residents enrolled in ACA exchange plans, 91% of whom are currently subsidized. They also have an unknown number enrolled in off-exchange plans. Overall, with net attrition, I estimate current total enrollment is down a bit to perhaps 52,000 today.
