2026 Rate Changes

2026 Rate Changes - Kentucky: +30.8%; ~101,000 Kentuckians facing MASSIVE rate hikes starting in January

Thu, 08/07/2025 - 3:20pm

Overall preliminary rate changes via SERFF database, state insurance dept. website and/or the federal Rate Review database.

Anthem Health Plans of KY:

This filing includes an average rate change of 24.0%, excluding the impact of aging, effective January 1, 2026. At the individual plan level, rate increases range from 11.1% to 28.9% for renewing plans. A subscriber’s actual rate could be higher or lower depending on the geographic location, age characteristics, dependent coverage, and other factors.

Unfortunately, Anthem doesn't provide their actual 2025 individual market enrollment; I've had to estimate this based on marketwide estimated enrollment; see below.

Caresource Kentucky Co:

(CareSource announced that they are dropping out of the Kentucky individual market next year. I estimate they have perhaps 26,000 individual market enrollees in the state who will have to shop around for a new carrier.)

Molina Healthcare of KY:

Molina Healthcare of Kentucky, Inc. is a managed care organization that provides healthcare services for individuals eligible for Medicaid, Medicare, and Marketplace throughout the State of Kentucky. Molina is a licensed state health plan managed by its parent corporation, Molina Healthcare, Inc.

1. Scope and range of the rate increase: Molina’s proposed rates represent an average rate increase of 15.1% for the 4,346 Molina members enrolled in continuing plans effective March 2025. The proposed rate changes vary by metal tier. Members would receive premium changes of approximately 11.8% to 21.7% depending on their geographic location, metal tier, and age.

WellCare Health Plans of KY:

The proposed rate change of 37.0% applies to approximately 44,064 individuals. WellCare Health Plans of Kentucky’s projected administrative expenses for 2026 are $80.36 PMPM. Administrative expense does not include $8.70 for taxes and fees. The historical administrative expenses for 2025 were $68.87 PMPM, which excludes taxes and fees. The projected loss ratio is 85.7% which satisfies the federal minimum loss ratio requirement of 80.0%.

As noted above, one carrier is dropping out of the individual market, while another has redacted their enrollment figure. This means I can't run a fully weighted average rate change and instead have to use estimated enrollees for these two.

Total 2025 Open Enrollment Period (OEP) on-exchange enrollment was 97,374; assuming roughly another ~4,000 off-exchange enrollees (based on 2024 liability risk score data from CMS) gives a total of around ~101,000 individual market enrollees.

This leaves around ~52,000 exchange enrollees unaccounted for. If I assume equal enrollment in each of the 2 "blank" carriers, that means roughly 26,000 apiece, with the CareSource enrollees not being included in the weighted average at all.

Overall, this gives a semi-weighted average rate hike being requested by individual market carriers in Kentucky of 30.8%.

It's important to remember that this is for unsubsidized enrollees only; for subsidized enrollees, ACTUAL net rate hikes will likely be MUCH HIGHER for most enrollees due to the expiration of the improved ACA subsidies & the Trump CMS "Affordability & Integrity" rule changes.