2026 Rate Changes - District of Columbia: +11.2%; unknown amount due to IRA subsidy expiration (preliminary)

via the District of Columbia Department of Insurance, Securities and Banking:

This page contains proposed health plan rate information for the District of Columbia’s health insurance marketplace, DC Health Link, for plan year 2026.

The District of Columbia Department of Insurance, Securities and Banking (DISB) received 188 proposed health insurance plan rates for review from CareFirst BlueCross BlueShield, Kaiser Permanente and United Healthcare in advance of open enrollment for plan year 2026 on DC Health Link, the District of Columbia’s health insurance marketplace.

The three insurance companies filed proposed rates for individuals, families and small businesses for the 2026 plan year. Overall, 188 plans were filed, compared to 198 last year. The number of small group plans decreased from 171 to 161, and the number of individual plans remained at 27.

In the individual market, CareFirst proposed an average increase of 4.1 percent for HMO plans, and 12.6 for insurance plans. Kaiser proposed an average increase of 12.9 percent. For small group plans, CareFirst filed average rate increases of 10.1 percent for HMO plans and 8.4 percent for PPO plans. Kaiser proposed an average increase of 10.1 percent. Finally, United proposed an average increase of 8.5 percent and 10.1 percent for its two HMOs and 7.8 percent for its PPO plans.

CareFirst BlueChoice:

Base rates are changing 4.1% on average. The range is -1.8% to 5.6%. This filing applies to all new and renewing, in-force business in the guaranteed renewable, non-grandfathered, ACA, metaled benefit plans. The number of policyholders affected by this rate change is 2,022.

Reason for Rate Change(s):

The main drivers supporting the rate change are 1) increase in the base period claims experience of the combined pool, 2) trend, 3) lower projected risk adjustment payable, and 4) increase in the admin factor. For our initial submission, we have not adjusted 2026 rates to reflect potential impacts of the expiration of enhanced premium tax credits at the end of 2025 or potential changes to the Federal Medical Assistance Percentage. We will continue to evaluate and monitor regulatory chang

CareFirst GHSMI:

Base rates are changing 12.6% on average. The range is 11.1% to 14.9%. This filing applies to all new and renewing, in-force business in the guaranteed renewable, non-grandfathered, ACA, metaled benefit plans. The number of policyholders affected by this rate change is 6,544.

Reason for Rate Change(s):

The main drivers supporting the rate change are 1) increase in the base period claims experience of the combined pool, 2) trend, 3) lower projected risk adjustment receivable, and 4) decrease in the admin factor. For our initial submission, we have not adjusted 2026 rates to reflect potential impacts of the expiration of enhanced premium tax credits at the end of 2025 or potential changes to the Federal Medical Assistance Percentage. We will continue to evaluate and monitor regulatory changes for these items through the review period and reserve the right to make adjustments if necessary.

Kaiser:

The proposed average rate change is 12.9%. The average rate change does not indicate that every member’s rate will change by this amount as rates are affected by the ages of those covered and benefits chosen.

While it's frustrating that the DC carriers haven't taken the expiring IRA subsidies into account yet, it's likely to be a fairly nominal factor there in particular because only ~30% of ACA exchange enrollees in DC receive federal APTC subsidies to begin with. This is because DC has a uniquely high Medicaid income cut-off: 210% of the Federal Poverty Level (FPL), which means relatively few exchange enrollees who earn more than that.

In any event, the weighted average requested rate hike for the individual market is 11.2%, while small group carriers are asking for a 9.5% average increase.