Nostr notes by ACA Signups (Unofficial)

2027 Rate Changes - Wisconsin: +21.7% indy market (FINAL); +13.3% ...

2026-10-24T01:26:36Z

2027 Rate Changes - Wisconsin: +21.7% indy market (FINAL); +13.3% small group (prelim)

Fri, 10/23/2026 - 9:25am
Originally posted 08/26/2026
ACA exchange enrollment has dropped by over 15% in Wisconsin since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were down 7% vs. OEP 2025...but effectuated enrollment was 11% lower year over year in January, rising to 15.6% lower as of February.
That's over 45,000 Wisconsinites who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the federal Rate Review database:
ASPIRUS ARISE:
The average proposed rate increase of 24.3%, effective January 1, 2027, is expected to impact 15,196 members, based on membership as of March 31, 2026. The rate increase varies by plan, ranging between 19.5% and 27.9%. Rate changes vary by plan due to the impact of changes in benefits and rating adjustments to account for the non-funding of Cost Sharing Reduction (CSR) payments.
Financial Experience of the Product
After accounting for payments into the risk adjustment program, Aspirus has an overall risk-adjusted MLR of approximately 106% in 2025. The proposed rate increase is intended to account for expected claims activity in 2027 given historical experience and any anticipated changes. With the proposed rate increase, the anticipated risk-adjusted MLR is expected to be 86% overall in 2027.
Changes in Medical Service Costs
Medical and prescription drug trend for these products is anticipated to be an average of 6.9% per year on allowed claims. This was developed based on historical experience, as well as consideration of information available on changes in the cost of services due to general medical and prescription drug inflation and changes in the anticipated utilization of services. For 2027 cost projections, adjustments to 2025 allowed claims consider population changes and costs. This includes factoring in expected disenrollments and non-effectuated membership resulting from the expiration of enhanced premium subsidies established in the American Rescue Plan Act at the end of 2025. The expiration of these subsidies may lead to higher average statewide morbidity, potentially increasing overall medical costs. We assumed a comparable impact as in 2026 pricing, resulting in no additional impact to 2027 rates.
Changes in Benefits
Changes in benefits have been made to these plans, leading to an aggregate 2.0% decrease in costs compared to 2025 experience. Any impact of benefit changes is reflected in the proposed rate changes.
Administrative Costs and Anticipated Profits
Aspirus anticipates having comparable administrative costs as a percent of premium compared to 2026. The federal exchange fees decreased from 2.5% to 1.9% of premium. Aspirus applies a risk margin of 2.0%, compared to 0% in 2026 pricing. Aspirus made a business decision in setting 2026 rates to accept a lower margin and minimize the rate increase impact to members, with consideration for the company’s capital position and financial viability. The lower 2026 rate increase was intended to provide greater stability of membership and allow Aspirus to continue to drive improvements to profitability. 2027 pricing reflects a risk margin shifting closer toward market norms. The overall impact of these changes is an increase to rates of 1.6%.
COMMON GROUND CO-OP:
This document contains the Part II written description justifying the rate increase subject to review on Common Ground Healthcare Cooperative’s (CGHC) individual medical block of business in Wisconsin, effective January 1, 2027. The average proposed rate increase is 30.9% and varies based on age, geographic region, and plan selection. There are 25,735 members currently enrolled that will be affected by the rate change.
Both costs and the number of services for medical and pharmacy benefits have increased significantly, which is the major contributor to this rate action. Changes in benefits are not a major contributor to the rate action and are within the bounds defined by CMS’ Final AV Calculator instructions. The expiration of ARPA and the resulting assumed reduction in total marketplace membership is a driver of increased administrative expenses in this filing.
COMPCARE/ANTHEM:
Compcare Health Services Insurance Corporation (Compcare) has made an application to the Wisconsin Office of the Commissioner of Insurance for a rate change of 16.4 percent, excluding the impact of aging, for its ACA-compliant individual health plan products effective January 1, 2027. At the individual plan level, the rate changes range from 6.7 percent to 30.0 percent. This increase will impact approximately 43,950 Wisconsin members renewing in 2027 with Compcare. The actual rate change for a subscriber could be higher or lower depending on the benefit plan selected, geographic location, age characteristics, and dependent coverage.
FINANCIAL EXPERIENCE
Compcare expects the proposed rate increase will cover projected medical trends and yield a medical loss ratio of 87.9 percent on an ACA basis, meaning at least eighty-seven cents of each premium dollar are expected to go to covering medical expenses and improving health care quality for our members. Please note that this MLR calculation is purely an estimate and not meant to be a true measure for Federal or State MLR rebate purposes. Also note that the projected Federal MLR presented here does not capture all adjustments, including but not limited to: three year averaging, credibility, and deductible. The projected MLR for Compcare is expected to meet or exceed the minimum MLR standards at the market level after including all adjustments. If the actual MLR is less than the Federal required minimum, Compcare will refund the difference to policyholders.
CHANGES IN MEDICAL SERVICE COSTS
The primary driver of the rate increase in the filing is the continued increase in the cost of healthcare. This is driven by increases in the price of services, or unit costs, primarily from hospitals, physicians and pharmaceutical companies, coupled with increases in the consumption of services, or utilization, by members. Increases in the unit costs of services are driven by technology advances, general inflationary pressures, and a variety of other factors. Changes in utilization of services can be driven by the aging of the population, benefit design and many other factors.
ADMINISTRATIVE COSTS AND ANTICIPATED PROFITS
Compcare continues to effectively manage administrative and selling costs. Anticipated profits are not expected to materially change such that the changes would impact the proposed rate increase. The Affordable Care Act requires that no less than 80 percent of a health insurer premiums go to medical expenses and improving health care quality, otherwise a premium rebate to subscribers must be generated to refund the difference. Accordingly, Compcare is filing premium increases targeting compliance with that requirement.
DEAN HEALTH PLAN:
Dean Health Plan (DHP) is requesting rate change for its individual market business in Wisconsin. The rate change will take effect on January 1, 2027 and will impact an estimated 43,412 members. The average rate change will be 19.40% by product and will result in rate changes that vary across plan designs.
DHP uses 2025 data from Wisconsin, which includes estimates of changes to the below through 2026:
Population DHP expects to insure
Cost of medical services
Cost of pharmacy services
Taxes and fees
The significant factors that impact the rate change include those listed above.
2) Financial Experience of the Product
In 2025, 88.0% of premium dollars went towards medical services after taxes and fees were removed. Under the ACA, individual products are required to pay at least 80% of premium dollars, after taxes and fees are removed, towards medical services. For 2027, DHP is expecting that 87.4% of premium dollars will be spent on medical services in Wisconsin
after taxes and fees were removed.
3) Changes in Medical Service Costs
Medical cost changes, in both number of services and costs of services, make up the largest increase to DHP’s premium rates. Additionally, impacts due to better rates with hospitals and doctors and reviewing recent experience also aid in determining premium changes. Finally, relationships with providers are helping to improve premium rates through a lower overall cost for care.
June 9, 20264) Changes in Benefits
DHP updates the plan designs offered each year, which impacts each plan’s cost-sharing (e.g. deductibles, copayments, etc.). These updates follow federal rules for how much of costs the insurance company will cover under that plan. Because these updates will be different for each plan, the rate changes will also be different by plan.
5) Administrative Costs and Anticipated Margins
DHP expects the cost to administer coverage per member per month (PMPM) for 2027 to be $79.20 which is higher than the 2026 cost. The main drivers of DHP’s administrative expenses are employee salaries and benefits, agent commissions, claim processing/IT, and clinical/network services.
GROUP HEALTH CO-OP:
This represents the average rate increase, including modifications to prior year benefits and other pricing adjustments. The average premium increase to consumers, before reflecting changes in age, is expected to be 16.4%. The range of rate changes, before reflecting changes in age, which consumers will experience, is approximately 13.1% to 19.5%.
(note that the effectuated enrollment number isn't included here)
2. CHANGES IN EXPERIENCE BASIS
GHC-SCW’s 2025 claims experience (with a loss ratio of 107.2%) was unfavorable relative to the 2024 claims experience used in developing 2026 rates.
3. CHANGES IN MEDICAL SERVICE COSTS AND TREND ASSUMPTIONS
The projection of claims from GHC-SCW’s experience period to 2027 includes an expected increase in the cost of all medical and pharmacy services. We developed these trend assumptions using general industry knowledge regarding recent trends in medical inflation, industry research, and judgment.
4. CHANGES IN BENEFITS
GHC-SCW will make cost sharing modifications by plan to comply with the final 2027 Actuarial Value Calculator and to align with GHC-SCW’s desired market position. To the extent the plan changes lead to a higher or lower level of benefit richness, the premium rates would increase or decrease, respectively.
5. CHANGES IN RISK ADJUSTMENT PROJECTION
GHC-SCW’s projected 2027 risk adjustment payable increased relative to the payable assumed in the 2026 rates.
6. CHANGES IN WIHSP RECEIVABLE PROJECTION
GHC-SCW’s projected 2027 WIHSP receivable decreased relative to the receipt assumed in the 2026 rates.
HEALTHPARTNERS:
The 2027 proposed average rate increase, as calculated in the URRT, is 15.59 percent. This rate increaseimpact s approximately 10,300 members. The increases vary by plan option, ranging from 12.7 percent to 18.5 percent for continuing bronze, silver and gold plans. The actual rate change for members will be different depending on the benefit plan, area, network, and age. Two Bronze plans have increases over 15% in 2027. These plans are 20173WI0130027 and 20173WI0130038 with increases of 17.1% and 18.5% respectively. Total membership on these two plans is 3,492 members.
HealthPartners is also terming off-exchange only HIOS IDs and crosswalking silver on-exchange Select NE WI plans to the broader Oak network for 2027.
Off-exchange W WI Atlas silver members (HIOS IDs 20173WI0140006, 20173WI0140018, 20173WI0140002 and 20173WI0140034) would experience rate increases of 27%-33% if they enroll in the plan they are crosswalked to. The increase is due to the addition of silver loading which is included on the off-exchange rate.
On-Exchange NE WI Select Silver members (HIOS IDs: 20173WI1030033, 20173WI0130034, 20173WI0130037) would experience increases of 32%-35% if they enroll in the Silver NE WI Oak network plan they are being crosswalked to for 2027. The increase is due to the broader network silver plans are offered under in 2027.
Off-Exchange NE WI Select Silver members (HIOS IDs: 20173WI0140035, 20173WI0140022, 20173WI0140025 and 20173WI0140036) would experience increases of 50%-58% if they enroll in the Silver NE WI Oak network plan they are being crosswalked to for 2027. The increase is due to the broader network silver plans are offered under in 2027 as well as silver loading which is being added to the off-exchange plan.
Financial experience of the product:
According to the Supplemental Health Care Exhibit – Part 1 of the HealthPartners Insurance Corporation 2025 Annual Statement, HealthPartners experienced a 2025 loss on Wisconsin Individual products of $8.5 million with approximately $60 million in revenue and $68 million in claims. Higher than expected claims experience and risk adjustment charges led to the loss. The requested increase is projected to result in revenue that is adequate to cover claims and expenses in 2027.
Changes in medical service costs:
The projection of claims from the experience period to the rate effective period assumes a medical and pharmacy trend of 6.9 percent to 2026 and 8.5 percent to 2027 in W WI and 5.6% to 2026 and 10.8% to 2027 in NE WI. This includes both medical inflation and utilization increases; it reflects contractual changes in the payment to healthcare providers, expected increases in the costs of prescription drugs, and expected changes in the volume and types of services utilized by members. Additional increases in costs due to the termination of enhanced ARPA subsidies also result in higher rates.
Changes in benefits:
All ACA benefit plans must follow federal guidelines regarding the Actuarial Values allowed within each metal level. Every year as the Actuarial Value calculator is updated many plans need minor changes tocost-sharing to bring the plans back into the metal level ranges. This results in some premium increases and some premium decreases relative to the overall average rate change.
Administrative costs:
Our average annual administrative cost trend is lower than medical trend, thus administrative costs have a slight downward impact on the rate increase.
MEDICA:
Medica Community Health Plan (Medica) is requesting a rate change for its individual market business in Wisconsin. The rate change will take effect on January 1, 2027 and will impact an estimated 15,266 members. The average rate change will be 24.6% and will result in rate changes that vary across plan designs. This includes changes to the costs of care.
Medica uses 2025 data from Wisconsin, which includes estimates of changes to the below through 2027:
Population Medica expects to insure
Cost of medical services
Cost of pharmacy services
Taxes and fees
The significant factors that impact the rate change include those listed above. Claim costs per member per month are expected to change from $1,034.42 in 2025 to $1,223.98 in 2027.
2) Financial Experience of the Product
In 2025, 104.3% of premium dollars went towards medical services after taxes and fees were removed. Under the ACA, individual products are required to pay at least 80% of premium dollars, after taxes and fees were removed, towards medical services. For 2027, Medica is expecting that 89.3% of premium dollars will be spent on medical services in Wisconsin after taxes and fees were removed.
3) Changes in Medical Service Costs
Medical cost changes, in both number of services and costs of services, make up the largest increase to Medica’s premium rates. Additionally, impacts due to better rates with hospitals and doctors and reviewing recent experience also aid in determining premium changes. Finally, relationships with providers are helping to improve premium rates through a lower overall cost for care.
June 9, 20264) Changes in Benefits
Medica updates the plan designs offered each year, which impacts each plan’s cost-sharing (e.g. deductibles, copayments, etc.). These updates follow federal rules for how much of costs the insurance company will cover under

https://acasignups.net/rate_changes/2027/wi

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Hobbling towards Enrollment: My 2027 ACA Open Enrollment Guide ...

2026-10-23T20:49:33Z

Hobbling towards Enrollment: My 2027 ACA Open Enrollment Guide (Part 2)

Fri, 10/23/2026 - 3:30pm
In Part 1 of my 2027 ACA Open Enrollment Guide, I covered:
The Federal Poverty Level (FPL) household income guidelines for calendar year 2027
The Open Enrollment Period (OEP) deadlines for every state, including exceptions/special cases
The official ACA Exchange/Marketplaces to use to shop for & enroll in healthcare coverage
The 2027 Advance Premium Tax Credit (APTC) household income table for calculating subsidy eligibility
Ways to legally keep your Modified Adjusted Gross Income (MAGI) below the 400% FPL subsidy eligibility cut-off threshold, and...
A reminder that starting this year, there's no longer any caps on what portion of those subsidies you might have to pay back if your actual MAGI ends up being higher than you anticipated.
Today I'm moving on to...
6. IF YOU'RE ENROLLED OFF-EXCHANGE, SEE IF YOU CAN ENROLL ON-EXCHANGE INSTEAD.
As far as I can figure, up to ~2 million Americans are still enrolled in OFF-exchange, ACA-compliant individual market policies. Historically, the main reason for this has been that they didn't qualify for financial help, so they didn't see the point of filling out any additional forms by enrolling on-exchange.
The reality, however, is that even with the subsidies being severely weakened, some of these off-exchange enrollees may have been eligible for ACA subsidies after all if they had enrolled in the exact same plan but had done so via their ACA exchange instead of directly through the carrier.
With the enhanced tax credits having expired, there's a lot fewer people who benefit by moving from off-exchange to on-exchange plans, but I'd still strongly urge people to at least check into it, especially if there's any chance of your 2027 household income being being less than 400% FPL (see the table in Part 1 for how much that will be).
Full-price/unsubsidized ACA premiums are increasing by another 15% on average nationally next year, so I can't stress this enough: If you enroll off-exchange, there's a chance you'll be leaving thousands of dollars in savings on the table.
7. MULTIPLE STATES ARE OFFERING THEIR OWN EXTRA SUBSIDIES TO MITIGATE THE DAMAGE:
CALIFORNIA:
California has had their own supplemental state-based financial assistance program for ACA enrollees for several years now, although they retooled the way it works last year in response to the expiration of the enhanced federal tax credits.
In July, Covered California, the state-run ACA exchange, announced that they’ll be expanding their existing supplemental financial assistance program to cancel out a portion of the lost federal funding:
…Gov. Newsom and the California Legislature increased the amount of state funds available for the Covered California State Subsidy Program, appropriating $300 million in Health Care Affordability Reserve Fund (HCARF), up from $190 million. As a result, Californians with incomes up to 200 percent of the federal poverty level in 2027 ($31,920 for an individual or $66,000 for a family of four) will be eligible for financial help to lower the cost of monthly premiums.
While the state subsidy program is not enough to fill the gap left by the expiration of enhanced federal subsidies, more than 500,000 Californians are projected to receive a state subsidy in 2027, about 30 percent of all enrollees. Additionally, nearly 200,000 can choose from two Silver-tier plans with a $0 premium.
…Covered California estimates the state subsidy program will open financial help to an additional 200,000 Californians who weren’t eligible in 2026 and prevent 90,000 people from dropping coverage in 2027.
The exact subsidy amounts will vary depending on the enrollee and what their circumstances are, but overall, it should look like this:
Under 150% FPL: Avg. state subsidy is $63/month (no y/y change)
150%-165% FPL: Avg. state subsidy is $33/month (up from $23/mo)
165%-200% FPL: Avg. state subsidy is $36/month (new for 2027)
This effectively means that all enrollees earning up to 150% FPL should be eligible for $0-premium Silver plans, while the benchmark Silver plan for those earning between 150 - 200% FPL will cost 1.5% less of their household income than it would without the state subsidies in place.
COLORADO:
Last year Colorado passed emergency legislation to generate up to $100 million in funding to replace a portion of the lost federal subsidies for 2026. For 2027, they’ve passed additional legislation which extends this state assistance, although it will be at a slightly reduced rate:
Subsidy Structure for Households Below 400% FPL:
1. For the first enrollee in a household, the enhanced premium subsidy shall be the lesser of $70 per member per month (PMPM) or the premium balance after federal APTC has been applied.
2. For each additional member in the household who is subject to a premium, the enhanced premium subsidy shall be the lesser of $25 per member per month (PMPM) or the premium balance after federal APTC has been applied.
These amounts are down from $80/mo for the first enrollee and $20/mo for each additional enrollee in each household.
Colorado also has their unique “OmniSalud” program for a limited number of undocumented immigrants & DACA recipients, with some changes for 2027:
SilverEnhanced Savings: Eligibility and Lottery Information
SilverEnhanced Savings is a financial assistance program for Coloradans regardless of documentation status, funded by the Health Insurance Affordability Enterprise (HIAE). The program requires a monthly $15 premium contribution per enrollee and requires issuers to pay 73% of covered out-of-pocket costs.
To be eligible for re-enrollment in SilverEnhanced savings for 2027, applicants must:
Be currently enrolled in OmniSalud and receiving SilverEnhanced Savings (e.g., enrolled in a special SilverEnhanced Savings 73% plan)
Live in Colorado
Meet income requirements based on the size of household (household income < 150% FPL)
Not qualify for Health First Colorado (Medicaid), Child Health Plan Plus (CHP+), or Connect for Health Colorado due to immigration status
After eligible existing SilverEnhanced Savings customers re-enroll, Colorado Connect chooses recipients through a random selection process called the OmniSalud lottery.
To be eligible to enter the random lottery to receive SilverEnhanced savings for 2027, applicants must meet the last 3 requirements above.
CONNECTICUT:
The Covered Connecticut program has been in place for several years for qualifying residents who earn up to 175% FPL. CoveredCT enrollees pay literally nothing in either premiums or out of pocket expenses!
In addition, in response to the expiration of the enhanced federal tax credits, Connecticut also allocated $70 million in state subsidies for other enrollees this year which covers the full amount of lost federal tax credits for those earning 100 - 200% FPL and half of the lost federal tax credits for those earning 400 - 500% FPL. Unfortunately, as of this writing it looks like this program will not be extended into 2027.
HOWEVER, Connecticut is launching a new subsidy program specifically targeting residents who are early childhood educators:
Connecticut officials on Wednesday announced that eligible staff in the early childhood sector can now apply for a subsidy toward health insurance plan premiums, a benefit connected to the ambitious endowment created to expand and make affordable the state’s childcare and preschool network.
The subsidy will provide educators and staff employed by licensed child care centers or operating licensed family child care homes with $1,000 to $1,200 annually toward insurance premiums for plans through the state’s healthcare insurance exchange, Access Health CT. An estimated 7,200 to 8,800 early childcare workers are eligible for the program.
DISTRICT OF COLUMBIA:
While this isn’t technically a “state-based subsidy,” DC residents earning between 138 - 200% FPL are eligible for Healthy DC, the Districts Basic Health Plan program:
There are no monthly payments and no costs when you get care. All plans cover doctor visits, urgent care visits, hospital stays, prescription drugs, mental health care, and more.
I believe there’s around 15,000 DC residents enrolled in Healthy DC.
MARYLAND:
This year Maryland launched a fairly robust arrangement to backfill lost federal assistance for most enrollees:
…the state has created a new subsidy program for all ages for those who are under 400% of the federal poverty level to help offset the expiration of the enhanced federal subsidies. The state subsidy program will replace 100% of the enhanced federal subsidies for those under 200% of federal poverty level and will replace 50% of the enhanced federal subsidies for those between 200% and 400% of the federal poverty level. Those over 400% of the poverty level will not receive a state subsidy.
There was some debate earlier this year about whether to keep this program the same for 2027 or to water it down somewhat, but in the end it looks like they’re keeping the subsidy thresholds the same for a 2nd year.
Maryland also has their Young Adult Subsidy program which reduces the expected contribution for young adults 19-33 by 2.5 percentage points, phasing down by 0.5 points for each year above 33 until the young adult subsidy fully phases out at age 38. This represents a significant savings for those eligible.
MASSACHUSETTS:
Massachusetts has long had their “ConnectorCare” program in place for residents who earn up to 300% FPL. They extended this out to enrollees who earn up to 500% FPL a few years ago, but due to the expiration of the enhanced federal subsidies at the end of 2025, in practice the income cut-off is only 400% FPL.
Here’s the details on ConnectorCare:
ConnectorCare plans have $0 or low monthly premiums, low out-of-pocket costs, and no deductibles. Plus, you may be able to fill certain prescription medicines at no cost for chronic health conditions like asthma, coronary artery disease (a type of heart disease), diabetes, hypertension (high blood pressure), and opioid addiction.
ConnectorCare plans offer great coverage with important benefits like doctor visits, prescription medications, and emergency care. ConnectorCare plans have low monthly premiums, low co-pays, and no deductibles. There are different ConnectorCare Plan Types, which are based on your income. All of the plans offered for each Plan Type will have the same benefits and co-pays for covered services. You can see the co-pays for different services for 2026* in the chart found here for each Plan Type…
ConnectorCare plans are offered by some of the leading insurers in the state. Each insurer’s plan may have different doctors or hospitals in its provider network. Before you enroll, use our online tools to see if the providers you want and the prescription drugs that you need are covered in the plan’s network.
*(I assume the 2027 co-pay chart will be posted soon)
MINNESOTA:
Around 100,000 Minnesota residents with household income is up to 200% FPL are enrolled in the states expanded MinnesotaCare Basic Health Plan program.
Minnesotacare features $0 premiums for households earning up to 160% FPL and $4 - $28 premiums on a sliding scale for households earning 160 – 200% FPL. Children up to 20 years old have no cost sharing, and adults 21+ only pay $100 for ER visits and have very low co-pays for other typical services.
NEW JERSEY:
Last year New Jersey was an other state which retooled and enhanced their existing supplemental state-based subsidy program to help cancel out as much of the damage from the expiring federal funding as possible:
...The state marketplace launched in 2020 with a state subsidy – called New Jersey Health Plan Savings – to further lower monthly premiums for consumers, beyond the tax credits offered by the federal government. The Department is estimated to provide $215 million this year to support state subsidies, New Jersey Health Plan Savings, providing greater affordability in the market by lowering premiums for hundreds of thousands of New Jerseyans.
The NJ Health Savings program reduces premiums by anywhere between $20 - $100/month per enrollee depending on their household income:
Income up to 150% FPL: $20/mo
150 - 200% FPL: $40/mo
200 - 250% FPL: $50/mo
250 - 400% FPL: $100/mo
400 - 500% FPL: $50/mo
I don’t know for certain whether this program will have any changes in 2027, but it does appear to be continuing according to this July 2026 press release from the NJ Dept. of Banking & Insurance, which states:
Despite reduced federal help, most residents enrolling through Get Covered New Jersey qualify for financial help. State subsidies, called New Jersey Health Plan Savings, are available to eligible consumers with an annual household income of up to 600 percent of the federal poverty level.
NEW MEXICO:
Unlike the other states on this list which have only been able to backfill a portion of the federal tax credits which are set to expire, last year New Mexico pulled of something of a miracle:
While it appears that Congress will allow enhanced federal Premium Tax Credits to expire, New Mexico’s Health Care Affordability Fund (HCAF) will cover the loss of the enhanced premium tax credits for households with income under 400% of the Federal Poverty Level (or $128,600 for a family of four), providing up to $68 million in premium relief for working families who enroll in coverage through BeWell in 2026. Federal and state premium assistance will continue to reduce the impact of the rate increases.
This means they're covering 100% of the lost subsidies for every enrollee under 400% FPL who currently qualifies for them...but then they went one step further and passed additional legislation which means that ALL New Mexico ACA exchange enrollees are fully protected from the expired tax credits in 2026!
What's more impressive still is that also unlike other states, NM has somehow managed to find the funding to do this without cannibalizing their existing "Turquoise Plan" supplemental subsidy program:
This program was introduced in 2023; it reduces benchmark Silver premiums for enrollees earning up to 200% FPL down to $0, while also reducing them by lesser amounts for enrollees earning between 200 - 400% FPL. It also dramatically upgrades the cost sharing reduction subsidies while rebranding Silver CSR plans as “Turquoise Plans” for easier consumer marketing.
There was some question as to whether or not New Mexico would be able to continue this extremely generous program beyond December, but sure enough, earlier this year…
The New Mexico Senate passed a bill to protect affordable health care coverage for tens of thousands of residents facing the loss of federal support, sending the measure to Gov. Michelle Lujan Grisham, who intends to sign it.
House Bill 4 increases revenue to the state’s Health Care Affordability Fund, the primary tool New Mexico uses to keep premiums manageable for working families and small businesses. The bill comes as expiring federal tax credits and Medicaid cuts threaten to price tens of thousands of New Mexicans out of coverage.
…The FY27 Executive Budget Recommendation includes funding for health care affordability programs supported by the fund. These investments would protect health coverage for up to 46,600 New Mexicans and reduce health care costs for up to 122,000 people statewide.
NEW YORK:
Like Minnesota (and more recently DC), New York has long had their own Basic Health Plan (BHP) program in place for residents earning 138 - 200% FPL, called the Essential Plan:
NY State of Health’s Essential Plan includes comprehensive benefits with $0 monthly premiums and very low-cost sharing. The Essential Plan:
Has no deductible, so the plan starts paying for your health care right away.
Covers comprehensive benefits, including dental and vision, inpatient and outpatient hospital care, prescription drugs and more.
Covers free preventive care like routine exams and screenings.
Has continuous open enrollment, meaning you can enroll at any time during the year through NY State of Health.
Eligibility:
Individuals are eligible for the Essential Plan if they are:
New York State residents
Lawfully present in the U.S.
19-64 years old
Not eligible for Medicaid or Child Health Plus
Not eligible for employer and other coverage
Able to meet the Essential Plan ann

https://acasignups.net/26/10/23/hobbling-towards-enrollment-my-2027-aca-open-enrollment-guide-part-2

#openenrollment #enrollmentguide #acaopen #part #acaexchange #california #coveredcalifornia #povertylevel #adjustedgross #modifiedadjusted

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2027 Rate Changes - Arizona: +27.9% indy market, +19.7% sm. group ...

2026-10-22T20:40:09Z

2027 Rate Changes - Arizona: +27.9% indy market, +19.7% sm. group (FINAL)

Thu, 10/22/2026 - 10:40am
Originally posted 08/10/2026
ACA exchange enrollment has dropped by nearly 30% in Arizona since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were already down 15.6% vs. OEP 2025...and effectuated enrollment was 23% lower year over year in January, rising to nearly 30% by February.
That's over 107,000 Arizonans who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the federal Rate Review database:
ANTIDOTE HEALTH PLAN OF AZ:
Antidote’s average proposed rate increase of 3.26%, effective January 1, 2027, is expected to impact 11,094 members based on May 2026 membership. The rate increase is the same for all adult members within a given plan, though it varies by plan, ranging between 1.30% and 16.11%. Rate changes vary by plan due to the impact of changes in benefits and changes to the Cost Sharing Reduction (CSR) shortfall load.
HIOS ID 68445AZ0010120 has a proposed rate change of 16.11%, which is above the threshold limit requiring a Part II – Written Description Justifying the Rate Increase. All other renewing HIOS IDs offered in 2027 have proposed rate increases below this threshold.
Changes in Medical Service Costs
Medical trend for these products is anticipated to be an average of 7.5% per year on allowed claims. Medical trends include a combination of utilization and costs of services. This is an increase in annual trend from the 2026 rate development and is included in the calculation of the rate increase.
Morbidity
We include a morbidity increase to claims relative to Antidote’s manual rate to account for the expiration of enhanced subsidies at the end of the 2025 plan year, consistent with current regulations. This adjustment results in a net 8.1% increase to the manual rate.
Risk Adjustment
We include a risk adjustment transfer payment based on Antidote’s anticipated competitive position in 2027, with the expectation that Antidote’s competitive positioning may garner substantial new enrollment. We expect the newly enrolled population to have a health status similar to the Arizona statewide average, but given Antidote has no prior experience with these new members, we anticipate Antidote will have less ability to fully capture all applicable diagnoses information. We expect this will ultimately lead to a payable into the risk adjustment program for 2027.
Retention
We include retention as provided by Antidote for 2027, including a reduction to profit from 5.0% in 2026 to 4.0% in 2027 and a required federal exchange fee decrease relative to 2026. This impact slightly offsets the increases noted above.
BLUE CROSS BLUE SHIELD OF AZ
BCBSAZ is filing an average rate increase for plans in the Arizona Individual market of 29.59%, varying between 19.38% and 32.62%, excluding federally prescribed age factors. The average increase is calculated from the most recently implemented rates which were effective January 1, 2026. This increase will be effective on January 1, 2027 and will affect 33,957 Arizona policyholders (as of March 2026). The following considerations were included in the development of the filed rates.
Financial Experience of the Product
The Affordable Care Act requires insurance companies in the Individual market to spend at least 80% of premium dollars on medical care, and to issue rebates to members if less than 80% of premium dollars are spent on medical care. AZ Blue historical rates have exceeded these minimum loss ratio requirements. Likewise, AZ Blue 2027 filed rates are projected to exceed minimum loss ratio requirements.
AZ Blue has been a plan sponsor in the ACA Individual market in Arizona since 2014. AZ Blue offers plans with competitive rates while consistently exceeding minimum loss ratio requirements. Likewise, 2027 AZ Blue filed rates are expected to exceed minimum loss ratio requirements.
Changes in Medical Service Costs
Medical trend rates have continued to increase in many markets including the Individual market in Arizona. AZ Blue filed rates reflect the anticipated utilization patterns for our Individual enrollees and fee increases for facilities and providers in AZ Blue networks and out-of-network.
Changes in Benefits
AZ Blue will offer a streamlined portfolio of plans in 2027 with continued focus on providing high quality affordable coverage. AZ Blue benefit designs are updated annually to align with federal requirements by metal level for actuarial plan values. Variations in the benefits offered in 2027 from those offered in 2026 are the primary cause of variation in rate changes between plans.
Administrative Costs and Anticipated Margins
In addition to the cost of medical services, there are a number of administrative costs associated with providing policies to members. These costs include items such as commissions, employee salaries, quality initiatives, fraud waste & abuse prevention, regulatory costs, utilities, member services and provider services. AZ Blue’s administrative costs support our commitment to providing affordable and high-quality Individual health plans in the Arizona market.
HEALTH NET COMMUNITY SOLUTIONS OF AZ:
Scope and Range of the Rate Increase
Health Net Community Solutions of Arizona (HNCS) currently provides health care coverage for over 2,000 members enrolled in our Ambetter Health Solutions plans. Premium rates are expected to increase on average by 28.0% for members on renewing plans, effective January 1, 2027. Annual rate changes may range between 19.2% and 31.0%, depending on what county current enrollees reside in and their current plan selection. Variations are primarily driven by underlying cost differences between different plan designs and regional cost trends. Note that these rate changes do not reflect any additional increases in a member’s calculated premium driven by aging an additional year at the point of renewal.
Financial Experience of the Product
HNCS does not have sufficient historical experience to base projections using issuer specific data. Projected costs were instead developed using 2025 experience from Health Net of Arizona Inc., dba Arizona Complete Health (AZCH), an affiliate company which covered over 110,000 lives in Arizona’s Individual market during 2025, adjusted for HNCS’ expected population in 2027.
For reference, AZCH incurred $730,934,241 in estimated paid claims costs, gross of an estimated risk transfer payable of $706,318 from the federal risk adjustment program in 2025. AZCH collected $645,406,792 in premium revenue, resulting in an estimated loss ratio of 113.4% inclusive of federal risk transfer payments for 2025.
Changes in Medical Service Costs
The claims experience used as a starting point in our pricing is trended forward for projected changes in medical service costs and calibrated to HNCS’ expected population in 2027. Medical service costs are projected to increase at an annualized rate of 10.1% due to medical inflation, expected changes in contracted reimbursement rates to providers, and increased utilization of health care services. Other factors related to expected changes in the demographics of HNCS’ population and overall population health are expected to drive additional increases in medical costs. Emerging trends that indicate the overall health of the insurance pool is worsening, in addition to elevated claims experience emerging in 2026 is a key driver for the proposed rate increase.
Changes in Benefits
Changes in plan benefits and member cost sharing also impact the proposed rate change. Some benefits have been adjusted, such as coverage for acupuncture, vision, and dental care. Changes in covered benefits and cost sharing can also influence how often members use medical services.
Overall, benefit changes are expected to drive a 2.2% decrease to total projected medical costs. Additionally, changes to deductibles, copayments, and other cost sharing features affect how these medical costs are split between plans and members. Based on the proposed mix of plan designs for 2027, HNCS is expected to cover approximately 81% of claims costs in 2027, with the remainder being covered by members through cost sharing.
Administrative Costs and Anticipated Margins
HNCS anticipates administrative costs to increase by $26 per member per month compared to what was assumed for 2026 rates. Taxes and fees are expected to decrease as a percentage of premium by 0.4%. The target profit margin for 2027 is set to 0.8% of premium, decreasing compared to the margin targeted for 2026 rates.
HEALTH NET OF AZ (AZ COMPLETE):
Arizona Complete Health (AZCH) currently provides health care coverage for over 43,000 members enrolled in our Ambetter plans. Premium rates are expected to increase on average by 24.5% for members on renewing plans, effective January 1, 2027. Annual rate changes may range between 17.0% and 29.8%, depending on what county current enrollees reside in and their current plan selection. Variations are primarily driven by underlying cost differences between different plan designs and regional cost trends. Note that these rate changes do not reflect any additional increases in a member’s calculated premium driven by aging an additional year at the point of renewal.
Financial Experience of the Product
AZCH incurred $730,934,241 in estimated paid claims costs, gross of a risk transfer receivable of $29,099,851 from the federal risk adjustment program in 2025. AZCH collected $645,406,792 in premium revenue, resulting in an estimated loss ratio of 108.7% inclusive of federal risk transfer payments for 2025.
Changes in Medical Service Costs
Medical service costs are projected to increase at an annualized rate of 10.3% due to medical inflation, expected changes in contracted reimbursement rates to providers, and increased utilization of health care services. Other factors related to expected changes in the demographics of AZCH’s population and overall population health are expected to drive additional increases in medical costs. Emerging trends that indicate the overall health of the insurance pool is 1worsening, in addition to elevated emerging claims experience in 2026 is a key driver for the proposed rate increase.
Changes in Benefits
Benefit changes are not a material contributor to the proposed rate change.
Administrative Costs and Anticipated Margins
AZCH anticipates administrative costs to increase by $20 per member per month compared to what was assumed for 2026 rates. Taxes and fees are expected to decrease as a percentage of premium by 0.6%. The target profit margin for 2027 is set to 3.95% of premium, remaining the same as what was set for 2026 rates.
IMPERIAL INSURANCE COMPANIES:
Imperial Insurance Companies, Inc. (Imperial) has submi ed its 2027 filing for its Individual HMO product. The weighted average premium increase is 30.0%, with a minimum and maximum increase by plan of 25.2% and 34.1% respectively.
Key Drivers for this Filing
Changes in Medical Service costs:
A main driver of premium increases includes changes to anticipated medical costs and utilization of services. The estimated impact is approximately 9% to the filed increase. The main driver of trend are medical unit cost increases and pharmacy unit cost and utilization increases.
Administrative Costs:
Imperial’s estimated risk adjustment liability is expected to increase with the estimated impact of 12%.
Changes in Benefits:
The 2027 premiums contain benefit changes including changes to:
cost sharing provisions
out of pocket maximums
Standard plan’s benefit changes were mandated by law.
Unfortunately, Imperial Insurance didn't include the number of effectuated enrollees as of spring 2026; I've come up with a guesstimate of around 43,000 enrollees based on the number of effectuated exchange enrollees statewide in February. Even if this estimate is off significantly it would only move the needle slightly on the overall weighted average, however, since it would still be ~28.9% without any Imperial enrollees (see table below).
OSCAR HEALTH PLAN:
The purpose of this document is to present rate change justification for Oscar Health Plan, Inc. (Oscar’s) (HIOS ID 13877) Individual Affordable Care Act (ACA) products, with an effective date of January 1, 2027, and to comply with the requirements of Section 2794 of the Public Health Service Act as added by Section 1003 of the Patient Protection and Affordable Care Act (ACA).
Using in-force business as of March 2026 , the proposed average rate increase for renewing plans is 33.9%. Rate increases vary by plan due to a combination of factors including shifts in benefit leveraging and cost-sharing modifications. This rate increase is absent of rate changes due to attained age.
The rate increase impacts an estimated 86,934 members.
2. Reason for Rate Increase(s)
The significant factors driving the proposed rate change include the following:
Medical and Prescription Drug Infl ation and Utilization Trends
The projected premium rates reflect the most recent emerging experience which was trended for anticipated changes due to medical and prescription drug inflation and utilization.
Administrative Expenses, Taxes and Fees, and Risk Margin
Changes to the overall premium level are needed because of required changes in federal and state taxes and fees. In addition, there are anticipated changes in both administrative expenses and targeted risk margin.
Prospective Benefit Changes
Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value Calculator and state requirements, as well as for strategic product considerations.
Anticipated Changes in the Average Morbidity of the Covered Population due to the ending of the enhanced premium tax credit subsidies as well as the finalization of the 2025 Marketplace Integrity and Affordability Rule Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.
Anticipated Changes in the Network Confi guration
Changes to the overall premium level are needed because of anticipated changes in the underlying network configuration and associated unit costs.
UNITEDHEALTHCARE:
UHCAZ is filing 2027 rates for individual products. The proposed rate change is 28.63% and will affect 40,179 individuals. The rate changes vary between 25.83% and 30.72%. Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes.
Financial Experience of the Product
The premium collected in plan year 2025 was $498,686,045. Incurred claims during this period were $428,498,127 and UHCAZ expects payments of $53,533,196 for risk adjustment. The loss ratio, or portion of premium required to pay medical claims, for plan year 2025 is 96.26%.
Changes in Medical Service Costs
There are many different healthcare cost trends that contribute to increases in the overall U.S. healthcare spending each year. These trend factors affect health insurance premiums, which can mean a premium rate increase to cover costs. Some of the key healthcare cost trends that have affected this year’s rate actions include:
Increasing cost of medical services: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies.
Increased utilization: The number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected using expensive procedures such as surgery versus simply monitoring or providing medications.
Higher costs from deductible leveraging: Healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year.
Impact of new technology: Improvements to medical technology and

https://acasignups.net/rate_changes/2027/az

#rate #rateincrease #antidote #arizona #final #changes #plan #congressionalrepublicans #enrollment #ratereview

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CMS posts July 2026 Medicare data; 70.7 million total Thu, ...

2026-10-22T18:56:17Z

CMS posts July 2026 Medicare data; 70.7 million total

Thu, 10/22/2026 - 11:48am
via Wikipedia:
Medicare Advantage (technically "Medicare Part C" & originally called "Medicare+Choice") is a type of health plan in the United States offered by private companies as part of the original Social Security Act of 1965 that created Medicare. It permits a private insurance option that wraps around traditional Medicare. Medicare Advantage plans attempt to fill some coverage gaps and offer alternative coverage options.
Under Part C, Medicare pays a plan operator a fixed payment for each enrollee. The operator then pays for their medical expenses. Traditional Medicare directly compensates providers on a fee-for-service basis. Plans are offered by integrated health delivery systems, labor unions, non profit charities, and health insurance companies, which may limit enrollment to specific groups of people (such as union members).
Medicare Part C/Advantage only covered around 2.8% of total Medicare enrollment as of 1986, then gradually grew to around 18% by 1999. After that it dropped off before growing again to cover roughly 1 out of 4 Medicare enrollees as of 2010, when the Affordable Care Act was passed. Since then, it has grown to the point that as of a year or so ago it crossed the 50% threshold, making it the default choice of Medicare enrollees.
The Centers for Medicare & Medicaid Services (CMS) just published updated enrollment data for Medicare, adding July 2026 to the data archive.
Whether the data posted since the Trump 2.0 Regime took power is accurate or not, I can't say for certain, but at least they're updating it...and so far, at least, I don't see anything in their monthly reports which is setting off any obvious red flags.
According to the latest report, as of July 2026:
Total Medicare beneficiaries hit ~70.7 million, up ~80,000 month over month.
Traditional/FFM Medicare beneficiaries are at 34.6 million (up ~11,000)
Medicare Advantage beneficiaries are at 36.2 million (up ~69,000)
12.0 million Medicare enrollees (17.0% of the total) were "Dual Eligibles"...that is, enrolled in both Medicare and Medicaid.
The number of Medicare enrollees under the age of 65 has dropped by ~290,000 since July 2025. Huh.
Here's how Medicare Advantage enrollment has grown (and how traditional "Fee for Service" Medicare has shrunk) over time:
It's also worth noting that, given the Musk/Trump Admin's obsession with erasing any reference or data regarding gender, race or ethnicity, the Medicare enrollment reports still include breakouts of those demographic factors.
Medicare
Medicare Advantage
CMS
<<

https://acasignups.net/26/10/22/cms-posts-july-2026-medicare-data-707-million-total

#medicare #totalmedicare #advantage #july #traditionalmedicare #million #cms #part #data #socialsecurity

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Republican Healthcare Disaster Update: Up to TWELVE MILLION ...

2026-10-22T00:52:33Z

Republican Healthcare Disaster Update: Up to TWELVE MILLION Americans have already lost healthcare coverage under Trump 2.0 (updated)

Wed, 10/21/2026 - 3:43pm
Originally posted 10/08/26
Last month I ran a detailed analysis of the most comprehensive, up-to-date effectuated enrollment data for Medicaid, CHIP, Medicare & ACA exchange healthcare coverage changes since January 2025 (when Donald Trump returned to power).
All of the enrollment data was based on official reports via the Centers for Medicare & Medicaid Services (CMS) through May 2026 for Medicare, Medicaid & CHIP and through February 2026 for ACA exchange coverage. I included estimated ACA enrollment data for March, April & May 2026 by extrapolating the limited hard data I did have for about a dozen or so states out nationally, including both a lower- and upper-bound range.
My conclusion at the time was that from January 2025 through May 2026...
Medicaid/CHIP enrollment dropped by nearly 5.9 million people
Medicare enrollment increased by around 1.6 million
ACA individual market enrollment dropped by somewhere between 4.5 - 6.0 million
Meanwhile, the total U.S. population grew by around 1.5 million
...all of which adds up to a net reduction of between 10.27 - 11.75 million Americans having some form of public healthcare coverage.
Today I'm updating this estimate with more recent official Medicare, Medicaid & CHIP reports & additional limited state-level ACA enrollment data. I'm also adding one more category of public healthcare coverage which I forgot about last month: Basic Health Plan (BHP) coverage in MN, NY, OR & DC, which is a small number overall but which is especially important in New York, where the BHP program changed radically starting in June...which also happens to be the same month that this update runs through:
Medicaid/CHIP enrollment: ~6.22 million lower
Medicare enrollment: Up ~1.76 million higher
ACA individual market enrollment: (see below)
BHP enrollment: Down ~272K (see below)
Total U.S. population: Up ~1.57 million
For BHP enrollment, I'm using the official data reports from NY State of Health, the MN Dept. of Human Services, the Oregon Health Authority and the DC Health Benefit Exchange Authority.
I have official June enrollment data for all of the other categories, so it's the ACA exchange estimate which requires me to extrapolate based on known data. First, I fill in the numbers I do have for each month, like so (see the prior post for more details on the methodology):
NEXT, I use the estimated (or actual) enrollment numbers for March, April, May & June for each of the states I have either hard or estimated enrollment data for to extrapolate what the monthly enrollment changes might look like nationally:
All told, if this is accurate nationally, it means that ACA enrollment dropped by another ~1.52 MILLION people from February through June 2026.
KEEP IN MIND, HOWEVER, that nine of the 21 states that I'm basing this on, including the largest (California), also offer their own supplemental financial subsidies to enrollees!
I can't overstate how critically important this is, since some of these states are very generous with those subsidies, especially New Mexico! ACA enrollees in these states have been harmed far less (or not at all, in the case of NM!) than most of the other states.
In addition, the BHP programs in MN, NY, OR & DC for residents earning between 138% - 200% FPL heavily skews the financial demographic makeup of exchange enrollees relative to most states.
Combined, this means that I'd expect the drop in enrollment across the remaining 30 states (which collectively comprise ~2/3 of total ACA enrollment) to be considerably higher.
So, how much higher could the actual national drop since February be? That's difficult to say, but I'd put my 1.53 million estimate above as a lower bound limit, with perhaps double that, or ~3.05 million, as a realistic upper bound limit as of June 2026.
BUT WAIT, THERE'S MORE!
This is where I'm bringing in population growth. For that I'm utilizing the U.S. Census Bureaus Monthly Population Estimates for the United States: April 1, 2020 to December 1, 2026, which I don't think has been messed with by the Trump Regime as of yet (I could be wrong, of course.
According to this report, the U.S. population as of June 2026 (again, only including the 50 states +DC) was around 342,541,458 people, versus 340,971,336 as of January 2025. That's net population growth of right around 1.57 million people.
If you add this population to the mix, you get a grand total of...
Medicaid/CHIP: ~6.22 million lower
Medicare: ~1.76 million higher
ACA exchange: 4.57 - 6.09 million lower
BHP enrollment: ~272K lower
Population growth: ~1.57 million
...between 10.88 million and 12.40 million fewer Americans enrolled in a public healthcare coverage program as of June 2026 than in were as of January 2025.
This isn't quite the same thing as counting how many lost coverage in that time, but that's a bit of semantics.
Of course, I could eliminate (or at least vastly narrow) the upper/lower bound estimates if CMS would actually update the actual Health Insurance Exchanges Monthly Effectuated Enrollment database, which is supposed to be updated monthly but which has been stuck at February 2026 for the past four months...
In my prior post I also delved into the question of whether some of these coverage losses might be being due to more people gaining healthcare coverage via their employer (whether private employers, federal/state/municipal governments or the military)...but concluded that this is extremely unlikely to account for more than a tiny portion of it since unemployment is higher than it was in January 2025, there are fewer government employees nationally and military enrollment has remained essentially flat.
My guess is that several million people have been forced to turn to things like the so-called "short-term, limited duration" plans; association plans; farm bureau plans; "sharing ministries" and the like...which are, for the most part, pretty much junk.
Keep in mind that this only brings things up through June of this year. While it's theoretically possible that Medicaid & ACA enrollment saw (or will see) a miraculous turnaround in the second half of the year, somehow I doubt it very much...
UPDATE 10/21/26: This morning, Paul Krugman referenced this post in his own post about the devastation to U.S. healthcare coverage already caused by Trump 2.0 & the Republican-controlled Congress over the past year and a half:
The redoubtable Charles Gaba, putting these numbers together with other information, estimates that around 12 million Americans have lost health insurance under Trump 2.0.
I greatly appreciate the shout-out, but he inadvertently linked to a different analysis of effectuated ACA individual market enrollment by healthcare policy/data analysis firm KFF published a week after mine and using completely different methodology…
…which, as it happens, came to a similar conclusion:
…Although more current data for the ACA Marketplace population are not yet available, data on the individual market—of which roughly nine in ten people are enrolled through the ACA Marketplaces—suggest enrollment continued to decline, falling 16% as of March and 18% as of June. This decrease includes both on- and off-exchange coverage. In total, we estimate that individual market enrollment has fallen by over 4.6 million people, from 25.2 million in June 2025 to 20.5 million in June 2026.
If you take their “90% are enrolled via the marketplaces” estimate literally, KFF is saying that effectuated enrollment as of June 2026 stood at just 20.5 million. 90% of that would put ACA exchange enrollment at around 18.45 million…or somewhere between 800K - 2.3 million higher than my estimate.
However, again, taking KFF’s “90% on exchange” literally, this would also put total January 2025 individual market enrollment (on + off-exchange) at around 24.7 million, which means a net drop of ~4.2 million as of June 2026.
This would be around 400K less of a net drop than my range, putting the total at somewhere between 10.5 - 12.0 million…meaning my headline above would still be accurate.
CMS
ACA
Effectuated Enrollment
Medicaid
CHIP
Medicare
Effectuation Report
U.S. Census Bureau
Population Growth

https://acasignups.net/26/10/21/republican-healthcare-disaster-update-twelve-million-americans-have-already-lost-healthcare

#disasterupdate #healthcaredisaster #millionamericans #aca #republicanhealthcare #medicare #chip #coverage #donaldtrump #may

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Another good healthcare idea in Michigan: Express Lane Enrollment ...

2026-10-22T00:27:40Z

Another good healthcare idea in Michigan: Express Lane Enrollment for kids

Wed, 10/21/2026 - 4:09pm
via Michigan House Democrats:
Xiong Announces Express Lane Health Enrollment for Eligible Michigan Kids
“Express Lane Enrollment” legislation would enact a streamlined health care enrollment process for eligible children and young adults under 21
LANSING, Mich., April 23, 2026 — State Rep. Mai Xiong (D-Warren) recently introduced legislation that would enact a streamlined enrollment process for children and young adults under 21 who may be eligible for Medicaid and health care programs administered through the Michigan Department of Health and Human Services (MDHHS). Xiong’s House Bill 5884 provides a common sense fix: Express Lane Eligibility (ELE), already authorized under federal law, which allows DHHS to use existing Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) data to streamline Medicaid enrollment for kids and young adults.
“At a time when too many Michigan children are losing health coverage not because they are ineligible but because of administrative hurdles, my legislation ensures that kids who already qualify don’t fall through the cracks,” Xiong said.
Rather than having to re-analyze eligibility for Medicaid under separate rules, ELE would enable MDHHS to identify, enroll and recertify children and young adults by relying on data that the state already has. This process reduces the risk of eligible children losing coverage due to paperwork barriers.
“Children deserve safeguards to ensure they don’t lose out on coverage for the primary care, mental health, dental and vision benefits they are eligible for. My legislation would remove unnecessary roadblocks for families, strengthen continuity of care and reduce costly coverage gaps,” Xiong continued.
The bill mirrors successful auto-enrollment systems that have already been implemented in other states to specifically reduce gaps in coverage for children and families.
Michigan
Medicaid
CHIP
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https://acasignups.net/26/10/21/another-good-healthcare-idea-michigan-express-lane-enrollment-kids

#expresslane #laneenrollment #michigan #announcesexpress #children #lanehealth #xiong #kids #laneeligibility #eligible

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Fantastic! Michigan House Dems introduce bill to make MI the 5th ...

2026-10-21T07:05:31Z

Fantastic! Michigan House Dems introduce bill to make MI the 5th state to launch a Basic Health Plan program!

Tue, 10/20/2026 - 6:25pm
via the Michigan House Democratic Caucus (this is actually from back in August):
Xiong, Cherry Introduce Medicaid Buy-In Program to Make Healthcare More Affordable for Michigan Workers
LANSING, Mich., Aug. 26, 2026 — State Rep. Mai Xiong (D-Warren) and state Sen. John Cherry (D-Flint) introduced legislation this week to create a Medicaid buy-in program to make affordable healthcare available for more Michiganders. House Bill 6274 and its companion, Senate Bill 1152, would enable Michiganders earning between 138-200% of the federal poverty level to enroll in the program, giving working class families who don’t typically qualify for Medicaid assistance a more cost-effective alternative to other marketplace plans.
“Health premiums are skyrocketing and too often workers on the frontlines of the construction, food service and home care industries are forced to budget out the largest percentage of their paycheck just to keep their families covered,” Xiong said. “Our legislation gives hardworking Michiganders who don’t qualify for public healthcare assistance programs an affordable option. No matter what job or industry someone works in or income level, they deserve access to healthcare.”
This is fantastic news, sincerely...but before you get too excited, it's important to understand that no, this is technically not a "Medicaid buy-in" program. What it is, instead, is...
Similar Medicaid buy-in legislation, otherwise known as a Basic Health Program (BHP), has been implemented by three other states and Washington, D.C., through the use of federal funding.
“Michiganders are already stretched thin with ever-increasing costs,” Cherry said. “Our constituents should never have to choose between keeping food on the table or seeking care. With the introduction of this legislation, we take an important step toward reducing healthcare costs for those individuals stuck at wit’s end in the marketplace.”
OK, so what exactly is the difference here? As always, here's my friend Louise Norris with the best explainer of BHP programs:
...Under the ACA (aka Obamacare), states have the option to create a Basic Health Program for people with incomes a little above the upper limit for Medicaid eligibility, and for legal immigrants who aren’t eligible for Medicaid because of the five-year waiting period.
In short, if you earn up to 138% FPL, you enroll in Medicaid; from 138 - 200% FPL, you enroll in a Basic Health Plan policy (BHP); at 200% FPL or higher, you enroll in a Qualified Health Plan policy (QHP).
Federal funding for BHP programs is supposed to be equal to 95% of the total amount of advance premium tax credits (APTC) and cost sharing reduction (CSR) assistance that the enrollees would otherwise have been eligible for had they otherwise enrolled in a QHP using the ACA exchange.
Of course, the state itself can also throw in additional funding to make the BHP plans more generous if they wish...which is a key point to keep in mind. The coverage has to be at least as affordable and at least as good as a benchmark silver plan with Cost-sharing reduction benefits applied.
Unfortunately, one of the casualties of the so-called One Big Beautiful Bill Act (OBBBA) passed by Republicans last year is that legal immigrants not eligible for Medicaid due to the 5-year waiting period are no longer eligible for federal APTC subsidies, which has caused a major blow to the funding of BHP programs...but I believe they're still eligible to enroll in the BHP program if they otherwise qualify:
11. Question: Does H.R.1 have any implications for a state’s Basic Health Program (BHP)?
Answer: While H.R.1 does not directly modify BHP statutory provisions, there are implications for the program because states are provided funding for BHP coverage based on enrollees’ PTC eligibility. In general, the BHP funding formula for states provides a payment of 95% of the value of the PTC and cost-sharing reduction (CSR)[11] for each eligible individual with income up to 200% FPL. As H.R.1 ends PTCs for lawfully present non-citizens with incomes below 100% FPL beginning in 2026, their coverage garners $0 in the state’s BHP payment formula.
However, this group remains statutorily eligible for BHP coverage. Because of the misalignment between CMS reimbursement and the coverage requirement, in December 2025, CMS announced that BHP states can discontinue coverage for this group without penalty. Specifically, CMS said it would exercise enforcement discretion for three years (January 1, 2026 through December 31, 2028) and not take action against a state that chooses not to provide BHP coverage to lawfully present non-citizens with income below 100% FPL.[13] CMS has not indicated whether it will permit a similar coverage exception beginning in 2027 for lawfully present non-citizens with income between 100% and 200% FPL who are no longer eligible for PTC but are still statutorily eligible for BHP.
In any event, BHP programs provide very low-cost, comprehensive healthcare coverage for around 1.5 million Americans across New York, Minnesota, Oregon and the District of Columbia. Michigan joining this list would be very helpful to perhaps ~240,000 low-income Michiganders (nearly half the ACA enrollment population, in fact), plus an unknown number of additional currently uninsured residents.
Of course there's zero chance of this program passing until next year at the earliest, assuming Democrats are able to achieve a trifecta in the state government. Stay tuned...
Michigan
Basic Health Plan
Medicaid Buy-in
Public Option
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https://acasignups.net/26/10/20/fantastic-michigan-house-dems-introduce-bill-make-mi-5th-state-launch-basic-health-plan

#basichealth #healthplan #michiganhouse #housedems #medicaid #program #bill #make #bhp #healthcare

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2027 Rate Changes - South Carolina: +22.1% indy market; +8.9% ...

2026-10-20T01:11:32Z

2027 Rate Changes - South Carolina: +22.1% indy market; +8.9% small group market (FINAL)

Mon, 10/19/2026 - 9:10am
Originally posted 08/20/2026
ACA exchange enrollment has dropped by nearly 30% in South Carolina since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were only down 7% vs. OEP 2025...but effectuated enrollment plummeted by 14% in January and a whopping 29.1% as of February vs. a year earlier.
That's nearly 160,000 South Carolina residents who lost coverage in just the first two months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the federal Rate Review database:
ABSOLUTE TOTAL CARE:
Absolute Total Care is filing rates for the individual block of business, effective January 1, 2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum.
This information is intended for use by the South Carolina Department of Insurance, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in South Carolina to assist in the review of Absolute Total Care’s individual rate filing. The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions.
In 2025, earned premium was $550.70 per member per month (PMPM). Incurred claims in 2025 were $517.43, or 93.96% of premium. Netting risk adjustment from the claims results in an estimated loss ratio (incurred claims net of estimated risk adjustment transfers, divided by earned premiums) of 84.80%. We expect unit costs to increase for 2027. Further, we have updated underlying experience for the single risk pool, expected administrative expense, and assumptions for federal risk adjustment. These factors, as well as changes to the assumed morbidity of the single risk pool and medical trend, result in a premium rate increase.
Medical trend, or the increase in health care costs over time, is composed of two components: the increase in the unit cost of services and the increase in the utilization of those services. Unit cost increases occur as care providers and their suppliers raise their prices. Utilization increases can occur as people seek more services than before. Additionally, simple services can be replaced with more complex services over time, which is known as service intensity trend. An example of service intensity trend would be the replacement of an X-ray with an MRI scan. Replacing the service with a more intense service causes the total cost of medical services to increase.
The proposed rate change of 22.1% applies to approximately 67,070 individuals. Absolute Total Care’s projected administrative expenses for 2027 are $103.58 PMPM. Administrative expense does not include $16.12 for taxes and fees. The historical administrative expenses for 2026 were $90.21 PMPM, which excludes taxes and fees. The projected loss ratio is 83.1% which satisfies the federal minimum loss ratio requirement of 80.0%.
BLUECROSS BLUESHIELD OF SC:
Depending on the plan selected, approximately 300,000 members currently enrolled in a BlueEssentials, BlueExtend, BlueConnect, Blue Cooper, Blue Reedy, Blue Congaree, Blue Beaufort, or Blue Pee Dee Individual health plan will see an adjustment to premiums effective January 1st, 2027. The average premium increase across all products is projected at 14.8%.
Financial experience of the product:
During 2025, premiums received have likely been sufficient to cover claims paid, administrative costs, commissions, taxes, and fees. The rate adjustment effective January 1, 2027, is needed to cover future changes in medical costs as well as impacts of regulatory policy changes in the Individual market. If, in 2027, paid claims are significantly less than anticipated, rebates will be paid to Individual ACA members.
Changes in medical service costs:
BlueCross BlueShield of South Carolina will likely pay more claims in 2027 for the following reasons:
Hospitals and doctors charging more for services.
More individuals seeking treatment.
Higher drug costs.
Changes in benefits:
Changes to deductibles, copayments, and out-of-pocket maximums on some products were implemented to limit the amount of the necessary rate change without sacrificing coverage.
Administrative costs and anticipated margins:
Administrative costs were set based on internal corporate estimates of normal operating costs. Federally required fees also apply. BlueCross BlueShield of South Carolina is working hard to find ways to lower these costs through intensive review of current practices.
BLUECHOICE HEALTHPLAN OF SC:
Depending on the plan selected, approximately 4,600 members currently enrolled in an Individual health plan will see an adjustment to premiums effective January 1st, 2027. The average premium increase across the block is projected at 23.4%.
Financial experience of the product:
During 2025, premiums received have likely been sufficient to cover claims paid, administrative costs, commissions, taxes, and fees. The rate adjustment effective January 1, 2027 is intended to cover future changes in medical costs. If, in 2027, paid claims are significantly less than anticipated, rebates will be paid to Individual ACA members.
Changes in medical service costs:
BlueChoice HealthPlan, Inc. will likely pay more claims in 2027 for the following reasons:
Hospitals and doctors charging more for services.
More individuals seeking treatment.
Higher drug costs.
Changes in benefits:
Changes to deductibles, copayments, and out-of-pocket maximums for some products were implemented to limit the amount of the necessary rate change without sacrificing coverage.
Administrative costs and anticipated margins:
Administrative costs were set based on internal corporate estimates of normal operating costs. Federally required fees also apply. BlueChoice HealthPlan, Inc. is working hard to find ways to lower these costs through intensive review of current practices.
CELTIC INSURANCE (AMBETTER);
Celtic Insurance Company is filing rates for the individual block of business, effective January 1, 2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum.
This information is intended for use by the South Carolina Department of Insurance, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in South Carolina to assist in the review of Celtic Insurance Company’s individual rate filing. The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions.
In 2025, earned premium was $532.57 per member per month (PMPM). Incurred claims in 2025 were $542.76, or 101.91% of premium. Netting risk adjustment from the claims results in an estimated loss ratio (incurred claims net of estimated risk adjustment transfers, divided by earned premiums) of 114.36%. We expect unit costs to increase for 2027. Further, we have updated underlying experience for the single risk pool, expected administrative expense, and assumptions for federal risk adjustment. These factors, as well as changes to the assumed morbidity of the single risk pool and medical trend, result in a premium rate increase.
Medical trend, or the increase in health care costs over time, is composed of two components: the increase in the unit cost of services and the increase in the utilization of those services. Unit cost increases occur as care providers and their suppliers raise their prices. Utilization increases can occur as people seek more services than before. Additionally, simple services can be replaced with more complex services over time, which is known as service intensity trend. An example of service intensity trend would be the replacement of an X-ray with an MRI scan. Replacing the service with a more intense service causes the total cost of medical services to increase.
The proposed rate change of 23.2% applies to approximately 1,316 individuals. Celtic Insurance Company’s projected administrative expenses for 2027 are $109.42 PMPM. Administrative expense does not include $12.80 for taxes and fees. The historical administrative expenses for 2026 were $84.01 PMPM, which excludes taxes and fees. The projected loss ratio is 85.0% which satisfies the federal minimum loss ratio requirement of 80.0%.
INSTIL HEALTH INSURANCE:
Depending on the plan selected, approximately 2,500 members currently enrolled in an InStil Individual health plan will see an adjustment to premiums effective January 1st, 2027. The average premium increase across all plans is projected at 23.3%.
Financial experience of the product:
During 2025, premiums received have likely been insufficient to cover claims paid, administrative costs, commissions, taxes, risk adjustment transfers, and fees. The rate adjustment effective January 1, 2027, is needed to cover future changes in medical costs as well as impacts of regulatory policy change in the Individual market. If, in 2027, paid claims are significantly less than anticipated, rebates will be paid to Individual ACA members.
Changes in medical service costs:
InStil will likely pay more claims in 2027 for the following reasons:
Hospitals and doctors charging more for services.
More individuals seeking treatment.
Higher drug costs.
Changes in benefits:
Changes to deductibles, copayments, and out-of-pocket maximums for some products were implemented to limit the amount of the necessary rate change without sacrificing coverage.
Administrative costs and anticipated margins:
Administrative costs were set based on internal corporate estimates of normal operating costs. Federally required fees also apply. InStil Health Insurance Company is working hard to find ways to lower these costs through intensive review of current practices.
MOLINA HEALTHCARE OF SC:
Molina’s rate filing reflects the following rate changes by metal tier for Molina’s membership. Molina has [REDACTED] members enrolled effective March 2026 and reported as of April 2026. The rate change calculation below is consistent with Worksheet 2, Section II of the URRT, which only includes members on renewing plans.
The rate changes vary by metal tier due to changes in the Actuarial Value (AV) Pricing Values assigned to each metal plan that are applied to the Plan Adjusted Index Rate.
[REDACTED]
SELECT HEALTH OF SC:
[REDACTED]
UNITEDHEALTHCARE OF SC:
UHC is filing 2027 rates for individual products. The proposed rate change is [Redacted: TRADE SECRET] and will affect [Redacted: TRADE SECRET] individuals. The rate changes vary between [Redacted: TRADE SECRET] and [Redacted: TRADE SECRET]. Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes.
Unfortunately, as you can see above, the actuarial memos for Molina, SelectCare and UnitedHealthcare are all heavily redacted, meaning I don't know what their effectuated enrollment tallies are. I've made rough guesstimates based on each of their March 2025 enrollment numbers (42.6K, 6.2K and 26.4K respectively), knocking these down to 25K, 5K and 15K which brings the grand statewide total up to around 420,000 enrollees, which seems about right given the confirmed on-exchange enrollment of 387K as of February.
Marketwide (and assuming my estimates for Molina, Select Care and UnitedHealthcare are reasonably close), the weighted average increase being requested for 2027 is 17.2%. Being off significantly on Molina wouldn't move the needle much; being off on SelectHealth could lower the average slightly. If UHC's enrollment is significantly higher, that would raise the average.
As for South Carolina's small group market, the carriers there are seeking unweighted premium increases averaging around 8.6%.
UPDATE 10/19/26: The final/approved 2027 rate filings for SC's individual and small group markets have been published to the SERFF database, and I'm afraid the weighted average increases for the former are higher than originally requested: 22.1% overall vs. the 17.2% preliminary average. The approved filings also include an important correction to one of the enrollee figures for BlueChoice HealthPlan.
Meanwhile, the small group market carriers had their rate changes approved pretty much exactly as is, while also filling in some of the enrollment figures (and allowing for a rough estimate for the rest). In the end, small group enrollees are looking at 8.9% average rate hikes.
South Carolina
2027 Rate Changes

https://acasignups.net/rate_changes/2027/sc

#southcarolina #smallgroup #rate #absolutetotal #totalcare #ratechanges #final #ratereview #congressionalrepublicans #enrollment

#rss #feeds #linksharing #qwibbit

Mississippi: Want to see what the ACA looks like after a year of ...

2026-10-20T00:43:45Z

Mississippi: Want to see what the ACA looks like after a year of Trump & no mitigating factors in place?

Mon, 10/19/2026 - 3:56pm
When I last updated my "coverage loss" estimate a couple of weeks back, I noted that while I have hard effectuated enrollment data for Medicare and Medicaid as well as the CHIP and BHP programs, my estimates for ACA exchange enrollment have to rely on rough projections because:
...I could eliminate (or at least vastly narrow) the upper/lower bound estimates if CMS would actually update the actual Health Insurance Exchanges Monthly Effectuated Enrollment database, which is supposed to be updated monthly but which has been stuck at February 2026 for the past four months...
I think it's safe to say that this quote from Mississippi Insurance Commissioner Mike Chaney helps explain why the Centers for Medicare & Medicaid Services (CMS) have been a wee bit sluggish on updating their ACA exchange reporting:
...Federal subsidies that helped make marketplace coverage affordable for many people have expired. Around 200,000 Mississippians opted out of their Marketplace coverage this year. Mississippi dropped from about 335,000 people enrolled in 2025 to around 125,000 who are still making payments as of August. Additionally, insurers are requesting substantial premium increases. Enrollees in the ACA Marketplace can expect to see an average rate increase of around 20% next year, depending on their carrier and plan. And some companies are leaving altogether. Molina Healthcare intends to withdraw from Mississippi’s federally run marketplace after this year, while Cigna is leaving Mississippi and every other state’s ACA exchange.
Now, the 20% average rate hike for unsubsidized enrollees isn't shocking to me; I actually had Mississippi's preliminary 2027 rate hikes down as 21% back in August.
The 125,000 effectuated as of August figure, however, is new. When I fill out my effectuated enrollment spreadsheet it looks like this...
That's right: A stunning 55% drop in effectuated enrollment vs. the same month a year earlier. Here's what that looks like visually:
Mississippi is an important state to use here because, unlike most of the other states that I have more recent enrollment data for, the Magnolia State...
HASN'T expanded Medicaid under the ACA
DOESN'T operate their own ACA exchange
DOESN'T offer their own supplemental financial subsidies
DOESN'T have a Basic Health Plan (BHP) program in place for lower-income residents, and...
DOESN'T have Premium Alignment pricing in place to help mitigate the damage.
In other words, Mississippi is a lot more representative of most states than those other states in terms of what the real-world impact of Trump/GOP policy changes over the past year and a half have been on effectuated ACA exchange enrollment.
To be clear: I'm not saying that every state fitting the above description has seen enrollment plummet by more than half, I'm just saying that I wouldn't be surprised if many of them have and if the others are close to it.
The rest of Chaney's op-ed is primarily focused on a stop-gap proposal to help mitigate the carnage in his state. To his credit, he's not gleefully cheering the gutting of the ACA marketplace or enthusiastically pushing for junk plans, and he's putting the blame exactly where it belongs: On Congressional Republicans and the Trump Regime:
Over the past year, more than 200,000 Mississippians have left the Affordable Care Act marketplace as the cost of coverage has increased due to the expiration of the Enhanced Premium Tax Credits at the end of 2025. At the same time, insurers are requesting significant rate increases or leaving the market. Families who are already struggling are having to ask, “What can I afford?”
As insurance commissioner, my responsibility is to protect Mississippi consumers and help ensure they have access to insurance products that meet their needs. That means we need to look at every responsible option available to us. One option that deserves serious consideration is expanding access to short-term health insurance plans.
Short-term plans are not a replacement for comprehensive health insurance, and they are not the right choice for everyone. These plans may not be a good option for those with serious health conditions. They generally provide fewer benefits and protections than Affordable Care Act plans, and consumers need to understand those differences before purchasing a policy.
But a lower-cost plan may be a better option than having no insurance at all. Someone who has lost marketplace coverage, is between jobs, is waiting for employer-sponsored coverage to begin or simply cannot afford a traditional marketplace plan should have an opportunity to purchase affordable coverage that can help protect against unexpected medical expenses.
This is exactly the Sophie's Choice mindset that I've expressed myself in the past, at least up until 2021 when the enhanced ACA subsidies were first put into place: While #ShortAssPlans do generally suck, as long as the ACA subsidies aren't robust enough, they're a far-from-ideal but still at least somewhat reasonable alternative for some segments of the population.
...Mississippi needs to pursue practical solutions that expand access, encourage competition and give consumers more choices. Short-term health insurance is one piece of that conversation. It is not the entire answer to Mississippi’s health care affordability challenges, but it can be an important option for people who need affordable coverage now. My office is seeking approval from the Mississippi Legislature and its leadership so we can apply for 1332 waivers. Federal regulators have asked MID to try to get the waiver to lower high-cost claims and premiums.
Again: I'm not happy about the situation, but I understand Chaney's position here. Unlike states which operate their own ACA exchanges, Mississippi isn't in a position to offer supplemental subsidies to help mitigate the lost federal ones, and even if they were, their current political leadership sure as hell isn't likely to approve anything like that anyway, even if the state could afford to do so which they probably can't.
In addition, unlike most other states, Mississippi can't even count on a massive blue wave next month to sweep out their current government since they hold their state elections in odd-numbered years. This means that the absolute earliest that Mississippi could even theoretically take another course of action would be in 2028, which means they're still stuck with the current affordability crisis for a minimum of 2 more years.
Mississippi
2027 Rate Changes
eAPTC
Short-Term Plans
ShortAss Plans

https://acasignups.net/26/10/19/mississippi-want-see-what-aca-looks-after-year-trump-no-mitigating-factors-place

#rss #feeds #linksharing #qwibbit

2027 Rate Changes - Florida: +10.4% indy market (weighted); ...

2026-10-20T00:19:07Z

2027 Rate Changes - Florida: +10.4% indy market (weighted); +11.4% sm. group market (unweighted) (FINAL)

Mon, 10/19/2026 - 4:09pm
Originally posted 8/28/26
ACA exchange enrollment has dropped by more than 10% in Florida since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were only down 4% vs. OEP 2025...but effectuated enrollment was 7.7% lower year over year in January, rising to 10.3% lower as of February.
That's over 440,000 Floridians who already lost healthcare coverage in just the first two months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the federal Rate Review database.
UNFORTUNATELY, due to what seems to be Florida law having an absurdly wide legal definition of "Trade Secret Protection," every insurance carrier's actuarial memo is heavily redacted...meaning that I don't have any idea of how many people are actually enrolled via any of the specific carriers, which in turn means having no idea what the weighted average rate increase is in 2027 for the Florida individual (or small group) market.
In case you think I'm overstating things, this is what the Florida Office of Insurance Regulation filing database search results look like when I try searching for the 2027 rate filings...it literally includes a "TRADE SECRET!" graphic overlaying most of the forms (and the ones it doesn't aren't useful to me for this purpose anyway).
As a result, the best I can do is to run a simple unweighted average, which comes to 15.3% for the individual market, although it ranges from as low as 3.9% for Centene Venture Company to as high as a stunning 39.1% for AmeriHealth Caritas.
It's also important to note that four different insurance carriers participating in Florida's individual market this year are leaving in 2027:
Cigna Health & Life
Cigna HMO
Molina Healthcare of FL
Sunshine State Health Plan (Although it appears that they'll transition enrollees over to Ambetter if they don't choose another carrier; Sunshine is a subsidiary of Ambetter, which is also known as Centene and Celtic, if things weren't confusing enough...)
CORRECTION I previously had Community Care Network listed as one of the carriers leaving the Florida market; they've since contacted me to clarify that they are NOT exiting the Florida market next year, and will be offering policies under the 22 Health brand.
Unfortunately, they aren't listed under either name at the federal Rate Review database, and while they are listed at the Florida Office of Insurance Regulation database, the listing doesn't include either their preliminary or final 2027 average rate change, so I can't include that in the table below either.
My apologies for the error.
Not only don't I know what the enrollment is for any of the individual carriers, I also don't know what the total individual market size looks like in Florida either, although if I assume around 10% of it is off-exchange that would put it at roughly 4.28 million people as of early 2026.
Similarly, Florida's small group market is also losing two more carriers (Florida Health Care Plan and National Health Insurance Co), with the remaining eight carriers seeking an unweighted average rate increase of 11.4%, ranging from 8.4% to 15.5%.
UPDATE 10/19/26: The Florida Office of Insurance Regulation (FLOIR) has published the final, approved 2027 rate filings for the individual market. Unfortunately, they haven't included the actual enrollment numbers for any of the carriers (which are still protected under state "trade secret" privacy law), but they did include the overall weighted average, which is 10.4% marketwide. The unweighted average is 2.8 points lower than the preliminary requested increases, but more importantly, the weighted average is nearly 5 points lower.
Of course, even a 10.4% average increase is nothing to cheer about, but it's better than 15.3%, so...
Florida
2027 Rate Changes
<<

https://acasignups.net/rate_changes/2027/fl

#ratechanges #floridaoffice #market #ratereview #final #insuranceregulation #congressionalrepublicans #tradesecret #weighted #health

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Maryland Health Connect launches 2027 ACA window shopping, ...

2026-10-16T10:22:02Z

Maryland Health Connect launches 2027 ACA window shopping, partners w/Code for America to deal w/implementing H.R.1

Mon, 10/12/2026 - 3:52pm
via the Maryland Health Benefit Exchange:
COMPARE 2027 HEALTH PLANS AND PRICES ON MARYLANDHEALTHCONNECTION.GOV
Marylanders can now preview 2027 health plans and prices on MarylandHealthConnection.gov, the state’s official health insurance marketplace where Marylanders can shop and enroll in health insurance, as well as determine eligibility for Medicaid and other assistance programs. Use the Get an Estimate tool to compare health plans and savings.
Maryland Health Insurance Open Enrollment for 2027
Maryland’s 2027 health insurance open enrollment period runs from Nov. 1, 2026 through Jan. 15, 2027. During open enrollment, Marylanders can sign up for a plan from well-known insurance carriers like CareFirst, Kaiser Permanente, UnitedHealthcare, and Wellpoint Maryland, Inc. Vision and dental plans also are available.
“Maryland Health Connection is dedicated to providing quality health care for all Marylanders,” said Johanna Fabian-Marks, executive director of the Maryland Health Benefit Exchange.
“Even as health insurance costs rise across the country, the Maryland Premium Assistance Program is here to ease that burden and keep out-of-pocket costs down. We encourage everyone to explore their financial help options and preview 2027 plans on MarylandHealthConnection.gov.”
About the Maryland Premium Assistance Program
Maryland Premium Assistance Program provides state financial help to eligible Marylanders who buy health insurance through Maryland Health Connection. The program helps lower monthly health insurance premiums for people who qualify based on their household income.
Also via the Maryland Health Benefit Exchange:
Code for America and State of Maryland Partner to Streamline Medicaid Eligibility Amid H.R. 1 Implementation
Partnership brings together the civic technology ecosystem to protect access to healthcare benefits ahead of new federal redetermination and work reporting requirements
Code for America, the leading civic tech nonprofit making public services easier to navigate through technology, and the Maryland Health Benefit Exchange (MHBE), the agency that administers Maryland Health Connection, the state of Maryland’s health insurance marketplace, today announced a new partnership to streamline eligibility and enrollment processes for Maryland Medicaid members and caseworkers as the state prepares for new federal requirements under H.R. 1.
Beginning in January, all 50 states must implement new federal Medicaid rules, including twice-yearly redeterminations and expanded work-reporting verification for many adults. These requirements will significantly increase the administrative burden on Medicaid recipients, who will have to do more to prove eligibility, and on caseworkers, who will have to do more to verify eligibility. The challenge is heightened by short implementation timelines, unclear policy guidance, and outdated technology solutions.
In Maryland, approximately 1.47 million people receive Maryland Medicaid coverage and about 320,000 of those members will be affected by the new rules and are at risk of losing coverage.
Under the partnership, Code for America will work alongside the Maryland Health Benefit Exchange (MHBE) to upgrade government technology and workflows before the new Medicaid requirements take effect. The partnership will also draw on expertise from Maryland Medicaid and non-profit organizations focused on civic technology. Civilla will support a redesign of the mobile application, and Public Policy Lab (PPL) will help improve the notices Maryland Medicaid members receive so important information and required actions are clear and next steps are easy to navigate.
“Partnering with Code for America will accelerate our efforts to put human-centered design at the very heart of state government,” said MHBE Executive Director Johanna Fabian-Marks. “Our mission is to connect Marylanders with high-quality, affordable health coverage through innovative technology. Working alongside Code for America will help us move that mission forward with simple, intuitive technology. We are proud to lead the way in showing how public-private partnerships can serve the state.”
“At a moment when states are being asked to do more with fewer resources, we are mobilizing the civic technology ecosystem around a shared goal: helping protect Medicaid coverage for eligible members while giving caseworkers the tools and support they need,” said Rebecca Piazza, Executive Director of Safety Net Strategy at Code for America. “Maryland is showing what it means to lead by preparing early, bringing together expertise from all corners, and taking action on behalf of the people it serves.”
Code for America will work with Maryland to reduce Maryland Medicaid caseworker burden and improve the customer experience while measuring outcomes in real-time. This includes mapping caseworker workflows and co-designing tools that reduce manual work; redesigning confusing notices so members understand what they need to do and when; and simplifying the application experience so people can more easily access benefits while caseworkers spend less time resolving preventable issues.
This effort builds upon Code for America’s ongoing government partnerships to strengthen the social safety net by making it easier for eligible people to access and maintain benefits, including food assistance and health coverage, while reducing the administrative burden on caseworkers.
Code for America has also developed a work requirements implementation guide and a corresponding toolkit with a variety of resources government agencies can use to navigate changes under H.R. 1.
About Code for America
Code for America, the country’s leading civic tech nonprofit for over 15 years, believes that government can work for the people, and by the people, in the new digital age. We work with government at all levels across the country to make the delivery of public services better with technology. We partner with community organizations and governments to build digital tools and client-facing apps that help people navigate government, change policies, and improve programs. Our goal: a resilient government that works well for everyone. Learn more at codeforamerica.org.
To partner with Code for America, visit here.
About Maryland Health Benefit Exchange (MHBE)
Maryland Health Benefit Exchange (MHBE), a public corporation and independent unit of state government established in 2011, administers Maryland Health Connection, the state’s official health insurance marketplace.
About Maryland Health Connection (MHC)
Maryland Health Connection (MHC) is the official state-based marketplace for Marylanders to shop and enroll in health insurance, as well as determine eligibility for Medicaid and other assistance programs. It is the only place where Marylanders can access financial help such as tax credits to make health coverage more affordable.
About Maryland Medicaid
Maryland Medicaid provides comprehensive health coverage to approximately 1.5 million Marylanders, roughly one in five state residents, including children, pregnant women, older adults, people with disabilities, and low-income adults. The program supports more than 120,000 providers, making it a critical component of Maryland’s health care system and a major driver of access, health outcomes, and health care delivery across the state. Maryland Medicaid also plays a central role in supporting healthcare across the life span, including maternal and child health, behavioral health, long-term services and supports, and home- and community-based services.
Maryland
2027 Open Enrollment

https://acasignups.net/26/10/12/maryland-health-connect-launches-2027-aca-window-shopping-partners-wcode-america-deal

Connect for Health Colorado launches 2027 ACA window shopping ...

2026-10-16T09:44:54Z

Connect for Health Colorado launches 2027 ACA window shopping

Mon, 10/12/2026 - 4:08pm
via Connect for Health Colorado:
Colorado Health Insurance Shoppers Get an Early Look at 2027 Plans and Prices
Connect for Health Colorado’s Estimate & Explore tool is now available with new plan year information; customers can begin enrolling on Nov. 1.
COLORADO – Colorado’s official health insurance marketplace is giving customers an early look at 2027 health insurance plans, offering more time for people to compare coverage and costs before the annual open enrollment period begins.
Connect for Health Colorado’s Estimate & Explore tool offers personalized recommendations and side-by-side plan comparisons to help customers understand their coverage options. Customers can preview and compare 2027 plans now so they are prepared when open enrollment begins on Nov. 1.
Colorado has taken significant steps to keep coverage costs below what customers might otherwise face. Even so, affordability remains a real concern for many Coloradans, making it especially important to compare plans and understand the financial help that may be available.
The Colorado Division of Insurance announced last month health insurance premiums will rise on average 10% for customers on the individual market. The division’s release of final 2027 rates allowed Connect for Health Colorado to load updated plan and cost information into the Estimate & Explore tool earlier than usual. Connect for Health Colorado does not set health insurance rates.
Side note: A few weeks ago I was confused when the CO Dept. of Regulatory Agencies stated average 2027 premiums would be around 10% higher instead of the 12.8% I had calculated. I contacted CO DORA to clarify, and it was explained to me that the 10% is based on what they're projecting the average increase to be based on Cigna, which currently holds a significant share of the CO individual market, pulling out of the state; basically, they're modeling which other carriers they expect Cigna's current enrollees to transition to.
This is an unusual way to report a weighted average in my view, but at least it provides some context for the 10% estimate.
“Choosing health insurance is an important financial decision, and we want Coloradans to have as much time as possible to explore their options,” said Kevin Patterson, chief executive officer of Connect for Health Colorado. “By making 2027 plan information available now, customers have more time to look closely at their coverage and costs, ask questions and get help from an expert before it’s time to enroll.”
The extra time may be especially valuable this year. Connect for Health Colorado’s data shows that lower-cost 2027 plans are available to many customers who receive financial help. About 60% could find a plan for $10 or less per month, and 3 out of 4 could find a plan for $75 or less per month if they shop and compare.
Customers can use the Estimate & Explore tool to compare monthly premiums, deductibles, provider networks, prescription drug coverage and other costs, and consider whether their current plan still meets their needs and budget.
“Our message to Coloradans is simple: Take advantage of this time,” Patterson said. “Compare your options, consider how your health care needs may have changed, and get help from an expert if you need it. You don’t have to make a decision today but you can prepare and be ready on Nov. 1 when it’s time to enroll.”
Connect for Health Colorado’s free network of certified Assisters and health insurance Brokers can help customers make informed decisions about their health coverage. Experts are located throughout Colorado and speak more than 22 languages. They can help Coloradans apply for free, and there’s no obligation to buy a plan when contacting an expert.
Open enrollment for Plan Year 2027 runs from Nov. 1, 2026, through Jan. 15, 2027. Customers who enroll by Dec. 15 will have coverage beginning Jan. 1, 2027. Customers who enroll between Dec. 16 and Jan. 15 will have coverage beginning Feb. 1, 2027.
Coloradans can use the Estimate & Explore tool now, find free expert help on Connect for Health Colorado’s website, or call 855-752-6749 if they have questions.
Colorado
C4HCO
2027 Open Enrollment

https://acasignups.net/26/10/12/connect-health-colorado-launches-2027-aca-window-shopping

Washington HealthPlan Finder responds to federal ACA ...

2026-10-16T09:05:44Z

Washington HealthPlan Finder responds to federal ACA "fraud" announcement & issues statement on Gov. Ferguson's H.R.1 Executive Order

Mon, 10/12/2026 - 4:20pm
via the Washington Health Benefit Exchange:
Response to federal ACA fraud announcement
The Trump administration’s announcement earlier today around Affordable Care Act enrollees does not currently affect Washington state. The focus of this effort involves enrollees who are part of the federal marketplace, rather than state-based marketplaces like Washington Health Benefit Exchange.
Strong program integrity has been and remains a goal of the Exchange; where ongoing public trust and the responsible stewardship of taxpayer dollars are part of our success. We take these efforts very seriously and continue to act quickly if any issues arise. There is no evidence that there are issues with brokers or enrollees in Washington state, as highlighted in the federal marketplace. The Exchange has proven processes in place to identify broker conduct issues and continually seeks to strengthen safeguards around broker access and consumer authorization, effectively reducing risk for Washington consumers.
The Exchange has successfully implemented several tools to support program integrity and, specifically, address fraud risk. These include strategic use of federal and state data sources for eligibility and enrollment determinations and monitoring; strict and continuous monitoring of operational systems and the entities that interact with them; fostering strong local partnerships that bring “on-the-ground” knowledge of potential bad actors; adoption of technology that can quickly adapt to emerging threats or concerns; and ongoing collaboration with federal and state regulators on oversight and fraud response.
Reminder, Open enrollment for Washington Healthplanfinder begins Nov. 1 and runs through Jan. 15, 2027.
Also via the Washington Health Benefit Exchange:
Washington Health Benefit Exchange statement on Governor Ferguson’s Executive Order
Washington Health Benefit Exchange honored to join the H.R. 1 Continuous Medicaid Response Committee
Washington continues to take proactive efforts to reduce harm to Washington residents caused by federal changes that impact multiple health and social service programs.
“We are pleased to join the governor’s convening to ensure coordination on activities we are undertaking to implement federal changes in a way that minimizes harm and maximizes health coverage continuity. We welcome formalizing these partnerships and collaboration,” said Washington Health Benefit Exchange Board Chair, Monica McLemore.
The Exchange and its bipartisan Board remain committed to working with Gov. Ferguson, the Legislature, state agency partners and stakeholders to support efforts to preserve coverage and make health insurance more accessible and affordable to all Washingtonians.
Learn more in this bulletin from the Office of the Governor:
Governor Bob Ferguson signed an executive order today to help mitigate the impacts in Washington state from H.R. 1, federal legislation gutting health care and food assistance nationwide.
President Donald Trump signed H.R. 1 more than a year ago, cutting more than $1.3 trillion in health care and food assistance nationwide. Many health care coverage impacts are coming in the next several months.
Washington is required to implement H.R. 1, and has already been forced to spend nearly $100 million to do so. If Washington state were to pay for everything H.R. 1 cuts, it would cost an estimated $3.2 billion per biennium.
Two major impacts are coming in the next several months:
Starting Oct. 1, H.R. 1 drastically limits the Medicaid eligibility for lawfully present immigrants. Before the state took action, 14,000 lawful immigrants were set to lose their Apple Health coverage.
Starting Jan. 1, more than 600,000 Washingtonians will be subject to work requirements for the first time in order to keep their Apple Health coverage. These individuals will also be required to reapply twice as frequently.
“In the richest country in the world, Donald Trump is kicking the most vulnerable people off their health coverage,” Governor Ferguson said. “The Big Bad Betrayal Bill is devastating to our health care system. But we are not powerless. I asked my team to find ways to blunt the impact of H.R. 1 on Washingtonians, and they delivered. Their work has preserved health care coverage for hundreds of thousands of Washingtonians. The work continues, and my executive order lays out our next steps.”
At a press conference in Seattle today, Governor Ferguson highlighted two major achievements: Saving Apple Health coverage for 3,000 Washington immigrants, and implementing an automated verification hub to help 400,000 Washingtonians keep their Apple Health coverage.
He also highlighted that even with these accomplishments, at least 200,000 are projected to lose their Apple Health coverage by the end of 2027 as a direct result of H.R. 1.
Because of the long delay between passing the bill and many of the elements of the bill going into effect, too many people are unaware of what is coming, and what their options are.
The governor encouraged everyone with Apple Health to make sure their information is current, and to look out for communications from Apple Health. He asked Washingtonians to help spread the word, and help loved ones verify their information.
Protecting Apple Health coverage for lawfully present immigrants
Washington state is doing extensive outreach to immigrant communities with our health care navigators, the Office of Refugee and Immigrant Assistance and community partners, providers, and labor.
This team has helped people update their information and, in some cases, take steps to transition to an immigration status that will allow them to continue to qualify for Medicaid coverage.
Those efforts have helped 3,000 Washington immigrants keep their health care coverage.
Instead of 14,000 immigrants losing Apple Health on October 1, those efforts have brought that number down to 11,000.
Nation-leading verification hub protects Apple Health for 400,000 Washingtonians
Washington is leading the nation in building an automated verification hub.
Every additional form or documentation requirement creates another opportunity for someone to lose coverage, not because they are ineligible, but because the process is too difficult.
This hub will bring together data that is already available to automatically confirm eligibility, so people don’t have to submit new paperwork every six months.
Washington state expects this will help 400,000 people keep their Apple Health.
Executive order sets a path forward, impacts remain
Governor Ferguson signed an executive order laying out a path forward.
The order emphasizes Washington state will continue doing the work mentioned before, such as building our verification hub.
Next, it establishes a formal committee: The H.R. 1 Continuous Medicaid Response Committee.
The committee will be led by Washington’s health services agencies, in consultation with the Office of the Insurance Commissioner, Health Benefit Exchange and other agencies.
They will have a number of responsibilities, including:
monitoring for impacts on Washingtonians and our healthcare system;
coordinating responses to future changes;
develop a proposal to create a Healthcare Access and Affordability Council, which will develop short-term and long-term strategies to help people keep their health care coverage, and control health care costs;
and identifying barriers, coverage disruptions and opportunities for state action.
Governor Ferguson’s order also directs a coordinated statewide public awareness campaign, focused on getting the word out to all impacted Washingtonians.
The order directs the Department of Health to develop a data accountability system, to track who is losing coverage, and where there are gaps so the state can take additional action, and understand the true impact of H.R. 1 in our state.
Governor Ferguson’s order also directs DSHS to work with philanthropic organizations and other partners to expand the capacity and reach of the state.
Washington State
H.R.1
Big Ugly BIll
Medicaid
Medicaid Expansion
Work Reqruirements
Fraud

https://acasignups.net/26/10/12/washington-healthplan-finder-responds-federal-aca-fraud-announcement-issues-statement-gov

2027 Rate Changes - Iowa +5.7% for unsubsidized indy market ...

2026-10-16T08:27:00Z

2027 Rate Changes - Iowa +5.7% for unsubsidized indy market enrollees; Medica is out

Mon, 10/12/2026 - 4:35pm
Originally posted 07/13/2026
Via the Iowa Insurance Dept:
ACA Individual Market — 2027 filings subject to rate hearings:
Avera Health Plans — 14.82% average increase on 438 lives; range of 12.30% to 21.70%
Iowa Total Care, Inc. — 16.84% average increase on 6,982 lives; range of 9.39% to 21.75%
Oscar Insurance Company — 11.94% average increase on 11,971 lives; range of 4.63% to 28.17%
UnitedHealthcare Plan of the River Valley — 11.77% average increase on 546 lives; range of 9.66% to 12.53%
Wellmark Health Plan of Iowa — 4.98% average increase on approximately 80,000 lives; range of -2.27% to 10.73%; on-Exchange
As for Medica, which has around 4,000 Iowa enrollees this year...
Medica will no longer offer individual marketplace plans in Iowa, Kansas and Oklahoma, effective January 1, 2027.
The decision affects about 4,000 members in Iowa, 600 members in the Kansas City area in Kansas, and 8,400 members in Oklahoma, the company confirmed to Becker’s. The insurer will continue to offer marketplace coverage in Minnesota, Missouri, Nebraska, North Dakota and Wisconsin.
“Members currently enrolled in Medica individual products in these states will continue to receive benefits until their renewal date,” a Medica spokesperson said. “Medica’s strategic focus is to ensure we remain competitive in markets where we can deliver value by simplifying offerings, reducing overlap, and prioritizing high-value provider partnerships.”
This puts Iowa's total ACA-compliant individual market at around 104,000 people total as of spring 2026, with preliminary weighted average 2027 rate increases of around 6.7%...the second-lowest statewide average I've seen so far, after Vermont's 6.5% average:
Avera Health Plans:
1. SCOPE AND RANGE OF RATE INCREASE
Avera Health Plans, Inc. (Avera) is requesting a rate increase for the Avera MyPlan individual products for Iowa with an effective date of January 1, 2027. The requested overall rate increase impacts approximately 438 members. The rate increase being requested for the Avera MyPlan products is 14.8% averaged across all members. Rate changes vary by plan due to changes in cost sharing parameters (e.g., deductible, coinsurance, copays) relative to 2026 cost sharing parameters, ranging from 12.3% to 21.7% by plan.
2. FINANCIAL EXPERIENCE
There is no historical financial experience to report as Avera entered the Iowa individual market on January 1, 2026. The financial experience for Avera’s South Dakota individual ACA-compliant experience, which supports manual rate projections in Iowa, was unfavorable in 2025 relative to the 2024 experience used to develop 2026 rates.
3. CHANGES IN MEDICAL SERVICE COSTS AND TREND ASSUMPTIONS
To capture the increasing cost and utilization of medical services, projections from manual rate experience assume 6.7% annual trend. This assumption is based on analysis of regional and national trends and actuarial judgment.
4. CHANGES IN BENEFITS
Avera will make cost sharing modifications by plan to comply with the final 2027 Actuarial Value Calculator and based on 2027 strategic considerations. To the extent the plan changes lead to a higher or lower level of benefit richness, the premium rates would increase or decrease, respectively.
5. ADMINISTRATIVE COSTS AND ANTICIPATED PROFITS
Avera is targeting a loss ratio of 86.5% for its individual block of business in January 2027. This loss ratio allows 13.5% for total health plan administrative costs, taxes, fees, and anticipated profits.
6. EXPIRATION OF EXPANDED ADVANCE PREMIUM TAX CREDIT SUBSIDIES
Avera expects the expiration of expanded Advance Premium Tax Credit subsidies will result in higher market morbidity due to the anticipated mix of enrollees remaining in the market.
IOWA TOTAL CARE:
Iowa Total Care is filing rates for the individual block of business, effective January 1, 2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum.
This information is intended for use by the Iowa Insurance Division, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Iowa to assist in the review of Iowa Total Care’s individual rate filing.
The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions.
In 2025, earned premium was $517.11 per member per month (PMPM). Incurred claims in 2025 were $363.50, or 70.29% of premium. Netting risk adjustment from the claims results in an estimated loss ratio (incurred claims net of estimated risk adjustment transfers, divided by earned premiums) of 80.67%. We expect unit costs to increase for 2027. Further, we have updated underlying experience for the single risk pool, expected administrative expense, and assumptions for federal risk adjustment. These factors, as well as changes to the assumed morbidity of the single risk pool and medical trend, result in a premium rate increase.
Medical trend, or the increase in health care costs over time, is composed of two components: the increase in the unit cost of services and the increase in the utilization of those services. Unit cost increases occur as care providers and their suppliers raise their prices. Utilization increases can occur as people seek more services than before. Additionally, simple services can be replaced with more complex services over time, which is known as service intensity trend. An example of service intensity trend would be the replacement of an X-ray with an MRI scan. Replacing the service with a more intense service causes the total cost of medical services to increase.
The proposed rate change of 16.8% applies to approximately 6,982 individuals. Iowa Total Care’s projected administrative expenses for 2027 are $100.80 PMPM. Administrative expense does not include $19.87 for taxes and fees. The historical administrative expenses for 2026 were $81.57 PMPM, which excludes taxes and fees. The projected loss ratio is 81.0% which satisfies the federal minimum loss ratio requirement of 80.0%.
OSCAR INSURANCE CO:
1. Scope and Range of Rate Increase
The purpose of this document is to present rate change justification for Oscar Insurance Company, Inc (Oscar’s) Individual Affordable Care Act (ACA) products, with an effective date of January 1, 2027, and to comply with the requirements of Section 2794 of the Public Health Service Act as added by Section 1003 of the Patient Protection and Affordable Care Act (ACA).
Using in-force business as of March 2026, the proposed average rate increase for renewing plans is 11.9%. Rate increases vary by plan and range from 4.6% to 28.2% due to a combination of factors including shifts in benefit leveraging and cost-sharing modifications and network changes. This rate increase is absent of rate changes due to attained age. There are 11,971 current members impacted by this rate increase.
2. Reason for Rate Increase(s)
The significant factors driving the proposed rate change include the following:
Medical and Prescription Drug Infl ation and Utilization Trends
The projected premium rates reflect the most recent emerging experience which was trended for anticipated changes due to medical and prescription drug inflation and utilization.
Administrative Expenses, Taxes and Fees, and Risk Margin
Changes to the overall premium level are needed because of required changes in federal and state taxes and fees. In addition, there are anticipated changes in both administrative expenses and targeted risk margin.
Prospective Benefit Changes
Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value Calculator and state requirements, as well as for strategic product considerations.
Anticipated Changes in the Average Morbidity of the Covered Population
Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.
Anticipated Changes in the Network Configuration
Changes to the overall premium level are needed because of anticipated changes in the underlying network configuration and associated unit costs.
UNITEDHEALTHCARE OF THE RIVER VALLEY:
Scope and Range of the Rate Increase
UHCPRV is filing 2027 rates for individual products. The proposed rate change is 11.77% and will affect 546 individuals. The rate changes vary between 9.66% and 12.53%. Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes.
Financial Experience of the Product
The premium collected in plan year 2025 was $3,966,129. Incurred claims during this period were $3,070,089 and UHCPRV expects payments of $42,830 for risk adjustment. The loss ratio, or portion of premium required to pay medical claims, for plan year 2025 is 78.49%.
Changes in Medical Service Costs
There are many different healthcare cost trends that contribute to increases in the overall U.S. healthcare spending each year. These trend factors affect health insurance premiums, which can mean a premium rate increase to cover costs. Some of the key healthcare cost trends that have affected this year’s rate actions include:
Increasing cost of medical services: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies.
Increased utilization: The number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected using expensive procedures such as surgery versus simply monitoring or providing medications.
Higher costs from deductible leveraging: Healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year.
Impact of new technology: Improvements to medical technology and clinical practice often result in the use of more expensive services, leading to increased healthcare spending and utilization.
Legislative & regulatory changes: Premiums reflect an increase in projected average cost per member driven by adverse morbidity impacts associated with the expiration of enhanced APTCs and changes in federal premium subsidy eligibility.
WELLMARK HEALTH PLAN OF IA:
Scope and Range of Rate Increase
Wellmark Health Plan of Iowa, Inc. (Wellmark) has requested an average rate increase of 5.0% for ACA-compliant policies effective January 1, 2027. Rate increases vary by plan, ranging from -2.3% to 10.7%, and do not include rate changes due to age of the members on the policy. As of March 31st, 2026, there are approximately 80,000 individual members in the pool. Most of the members in the pool are eligible for a premium subsidy and may not experience a post-subsidy rate change within the range above.
Financial Experience of the Product
Wellmark anticipates 2026 experience will be worse than the target loss ratio. Applying the requested rate increases, Wellmark projects a loss ratio of 89% for this block of business in 2027. It should be noted that the projected Medical Loss Ratio (MLR) meets the minimum requirement of 80% defined in the ACA.
Changes in Medical Service Costs
Annual trend of 4.5% was used to project claims from the experience period into the rating period and drives rates up for 2027. This trend assumption includes changes in service costs and utilization.
Changes in Benefits
Plan design changes were made to Wellmark’s 2027 product offerings. These changes drive rates down for 2027. Rate changes provided above incorporate the impact of plan design changes.
Administrative Costs and Anticipated Profits
The main drivers of administrative expenses are employee salaries and benefits, broker and agent commissions, and various governmental taxes and fees. Wellmark strives to maintain a low administrative expense as a percent of premium, as well as the underlying cost of care, in order to provide the best value to our customers. With a decrease to the Exchange User Fee, smaller government fees in 2027 are driving rates down.
American Rescue Plan Enhanced Subsidy Expiration
The enhanced subsidies afforded in the American Rescue Plan expired in 2026. Wellmark anticipates this change will result in worse market risk, driving rates up.
UPDATE 10/12/26: The SERFF database has been updated with the final, approved rate changes for the 2027 individual market in Iowa. Overall, state regulators shaved a point or two off the top depending on the carrier, resulting in the weighted average increase dropping from 6.7% to 5.7%.
I still don't have access to the small group market filings, however.
Iowa
2027 Rate Changes
Medica

https://acasignups.net/rate_changes/2027/ia

2027 Rate Changes - North Dakota: +17.5% indy market; +17.9% sm. ...

2026-10-16T07:46:41Z

2027 Rate Changes - North Dakota: +17.5% indy market; +17.9% sm. group (FINAL)

Tue, 10/13/2026 - 9:08am
Originally posted 08/11/2026
ACA exchange enrollment has dropped by 7.8% in North Dakota since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of 2025.
Initial signups during Open Enrollment were down 4.4% vs. OEP 2025...but effectuated enrollment was 5.7% lower year over year in January and down 7.8% as of February.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the federal Rate Review database:
Blue Cross Blue Shield of ND
Beginning 1/1/2027, members currently enrolled in various BCBSND Individual QHP’s will receive an adjustment to premiums exceeding 15% annually and requiring consumer disclosure. The average increase across all plans is 21.4%, but specific premium adjustments will vary by age, tobacco usage status, and individual plan selections. This adjustment will affect approximately 32,000 members.
Financial Experience
For policy year 2025, premiums received were sufficient to cover claims paid, administrative costs, commissions, taxes, and fees. The rate adjustment effective January 1, 2027, is intended to cover future changes in medical/pharmacy expenses, state-based reinsurance pool modifications, population morbidity changes due to expiring enhanced premium tax credits, administrative costs, taxes and fees, and profit/risk margin.
Under Medical Loss Ratio (MLR) requirements, the ACA requires Individual products to pay at least 80 cents of every premium dollar (after taxes and fees) toward medical/pharmacy claims and other qualified expenses. BCBSND significantly exceeds this requirement, expecting to pay approximately 90% of net premium dollars for 2027 Individual QHP’s towards qualified MLR expenses. If, in 2027, paid claims are significantly less than anticipated, rebates will be paid to Individual QHP members. Changes in Medical/Pharmacy Costs, Benefits, and Administrative Expenses BCBSND is expecting notable increases in Medical/Pharmacy expenditures and other cost drivers in 2026/2027 due to the following factors:
Increased reimbursement rates for physicians & hospital systems that provide care to members • Surging utilization and intensity of outpatient medical procedures and services
Growing utilization and cost of pharmaceuticals, especially GLP/GIP-1 Weight-Loss drugs which have notably increased costs since their addition to North Dakotas Essential Health Benchmark
Changing cost-shares such as deductibles and copayments
Expected deterioration of the North Dakota Individual markets overall health status, due to population changes related to the expiration of enhanced premium tax credits (eAPTC’s)
Significant changes to North Dakota’s state-based reinsurance program parameters for 2027 reducing the level of premium subsidization it brings to the individual marketplace
Medica Health Plans
Medica Health Plans (MHP) is requesting a rate change for its Affordable Care Act (ACA) individual market business in North Dakota. The rate change will take effect on January 1, 2027 and will impact an estimated 2,363 members. The average rate change will be 13.64% and will result in rate changes that vary across plan designs. This includes changes to the costs of care.
MHP uses 2025 data from North Dakota to develop premium rates. This data includes estimates of changes to the below through 2027:
Population Medica expects to insure
Cost of medical services
Cost of pharmacy services
Taxes and fees
The significant factors that impact the rate change include those listed above. Claim costs per member per month are expected to change from $485.81 in 2025 to $603.75in 2027.
2) Financial Experience of the Product
In 2025, 93.35% of premium dollars went towards medical services. Under the ACA, individual products are required to pay at least 80% of premium dollars, after taxes and fees are removed, toward medical services. For 2027, MHP is expecting that 84.47% of premium dollars will be spent on medical services.
3) Changes in Medical Service Costs
Medical cost changes, in both number of services and costs of services, make up the largest increase to MHP’s premium rates. Additionally, impacts due to better rates with hospitals and doctors and reviewing recent experience also aid in determining premium changes. Finally, relationships with providers are helping to improve premium rates through a lower overall cost for care.
4) Changes in Benefits MHP updates the plan designs offered each year, which impacts each plan’s cost-sharing (e.g. deductibles, copayments, etc.). These updates follow federal rules for how much of costs the insurance company will cover under that plan. Because these updates will be different for each plan, the rate changes will also be different by plan.
5) Administrative Costs and Anticipated Margins: MHP expects the cost to administer coverage per member per month (PMPM) for 2027 to be $77.00, which is higher than the 2026 value of $68.20. The main drivers of MHP’s administrative expenses are employee salaries and benefits, agent commissions, claim processing/IT, and clinical/network services.
Sanford Health Plans
(unfortunately, Sanford's actuarial memo is heavily redacted which also means I don't have a hard enrollment number for them, but I'm estimating it to be around 3,600 people based on the official February on-exchange effectuated enrollment number from the Centers for Medicare & Medicaid Services (CMS), assuming a small number of off-exchange enrollees as well.
Assuming my estimate for Sanford is accurate, the weighted average rate hike being requested by North Dakota carriers is 19.6%.
As for the North Dakota small group market, there are four carriers asking for an unweighted average rate increase of 14.5% (filings for two of the four are redacted, preventing a weighted average from being run):
UPDATE 10/13/26: North Dakota Insurance Commissioner Jon Godfread has posted the final, approved 2027 rate changes for the individual & small group markets:
Insurance Commissioner Jon Godfread announced the health insurance premium rate changes for 2027 Affordable Care Act (ACA) plans. North Dakotans in ACA individual and small group plans can expect their rates to go up. Rising healthcare costs are the primary reasons why.
“Families and small businesses are right to be frustrated by another increase in their health insurance premiums,” Godfread said. “At the heart of this problem is the cost of receiving health care. When hospital care, medical services and prescription drugs become more expensive, the cost of insuring that care rises, too. We cannot deliver lasting relief on insurance premiums without addressing the bills those premiums pay.”
Insurance companies are required to submit filings that include their rates to the North Dakota Insurance & Securities Department. State law gives the commissioner the authority to approve or adjust rates requested by companies. The commissioner is tasked with balancing consumers' interests in keeping premiums affordable while also ensuring companies remain financially sound.
“Protecting consumers means scrutinizing what insurers charge and making sure they pay claims when people need care,” Godfread said. “We review the insurers’ financial condition, claims costs, administrative expenses and profit margins, and we reduced several of their requested increases for 2027. The unfortunate reality is that premiums must cover the expected cost of providing coverage. These approved rates reflect what our review determined is necessary to meet those obligations and maintain financially sound companies that North Dakotans can depend on.”
Overall there were some slight reductions in both markets, bringing the weighted average increases for unsubsidized enrollees down to 17.5% in the individual market and 17.9% for small group enrollees.
North Dakota
2027 Rate Changes

https://acasignups.net/rate_changes/2027/nd

Hobbling towards Enrollment: My 2027 ACA Open Enrollment Guide ...

2026-10-16T05:34:34Z

Hobbling towards Enrollment: My 2027 ACA Open Enrollment Guide (Part 1)

Wed, 10/14/2026 - 3:04pm
(sigh) Welp. Welcome to TrumpCare 2.0: The subsidies have been gutted, anyone earning more than 4x the federal poverty level is completely S.O.L., nearly anyone who isn't a U.S. citizen has been thrown under the bus, and there's more ugliness yet to come.
Even with all of this, however, the ACA isn't quite dead yet: It still offers affordable coverage to many people (if far less affordable than it was a year ago), it still offers a lot of vitally important patient protections, and it's still the only viable option for millions of Americans who are self-employed or who work for small businesses which don't offer decent health coverage on their behalf.
So, with that in mind, it's time once again to update my annual ACA Open Enrollment Period (OEP) Guide for 2027. As I noted last year, most of the Open Enrollment tips I give every year remain good advice, even if they kind of feel like slapping a Band-Aid® on a gaping gunshot wound this year.
Before I begin, it's extremely important to know what the Federal Poverty Level (FPL) will be in 2027. The FPL is a critical part of the formula used to determine eligibility for both premium tax credits as well as Cost Sharing Reduction (CSR) subsidies and Medicaid expansion eligibility in the states which have expanded the program. In addition, the FPL threshold goes up by a few percent each year due to inflation.
The table below breaks out the key annual income levels for different FPL thresholds based on the number of people in the household. Note that all of these levels are 15% higher in Hawaii and 25% higher in Alaska:
With all of that in mind, here's some important things to know when you go to #GetCovered.
1. DON'T MISS THE DEADLINE!
The 2027 Open Enrollment Period officially runs from November 1st, 2026 through January 15th, 2027 in most states, but there are some exceptions at both ends.
California doesn't launch their 2027 OEP until November 1st, but current enrollees have been able to actively re-enroll for 2027 since October 1st. California's OEP runs through January 31st, 2027.
Connecticut starts their 2027 OEP on October 23rd.
The District of Columbia's OEP runs through January 31st, 2027.
Idaho already started their 2027 OEP on October 15th, and it only runs through December 15th.
Massachusetts starts their 2027 OEP on October 23rd, and it runs through January 23rd, 2027.
New Jersey's OEP runs through January 31st, 2027.
New York's OEP runs through January 31st, 2027.
Rhode Island's OEP runs through January 31st.
Virginia's OEP runs through January 29th, 2026.
In most states you have to enroll by December 15th in order for your coverage to start on January 1st; otherwise it won't start until February 1st. However, there's a few exceptions:
Idaho: The December 15th deadline is the ONLY one (no February-start eligibility!)
Massachusetts: December 23rd for January 1st coverage
California, Maryland, Nevada, New Jersey, New Mexico and Rhode Island: December 31st for January 1st coverage
Here's the official deadlines for coverage starting February 1st for every state:
California: January 31st
District of Columbia: January 31st
Idaho: n/a (Special Enrollment only)
Massachusetts: January 23rd
New Jersey: January 31st
New York: January 31st
Rhode Island: January 31st
Virginia: January 29th
ALL OTHER STATES: January 15th
There are some important exceptions to the above deadlines, however: Some people are eligible to enroll in coverage year round:
Members of federally-recognized Native American tribes or Alaska Natives can enroll in ACA coverage year round.
There are several state-specific programs which allow eligible enrollees to do so year round, including:
Connecticut: Covered Connecticut
District of Columbia: Healthy DC (Basic Health Plan)
Massachusetts: ConnectorCare
Minnesota: MinnesotaCare (Basic Health Plan)
New York: Essential Plan (Basic Health Plan)
Oregon: Bridge Program (Basic Health Plan)
In addition, people who are eligible for Medicaid or the Children's Health Insurance Program (CHIP) are eligible to enroll in those programs year-round.
If you want to enroll outside of the dates above and aren't eligible for any of the exceptions listed, you'll likely have to qualify for a Special Enrollment Period (SEP).
Qualifying Life Experiences (QLEs) which make you eligible for a SEP include things like:
Losing employer-sponsored healthcare coverage
Getting married or divorced
Giving birth/adopting a child
Turning 26 and having to move to your own policy
Losing eligibility for Medicaid or CHIP
Moving out of your current rating area
2. ONLY ENROLL VIA AN OFFICIAL ACA HEALTH EXCHANGE OR AN AUTHORIZED ENROLLMENT PARTNER.
ACA financial subsidies are only availalble to eligible enrollees who sign up through an official ACA exchange or an authorized 3rd-party exchange entity, known as an Enhanced Direct Enrollment (EDE) entity.
There's a ton of junk plans and scam artists out there, especially these days. Fraudulent plans are being hawked endlessly via both robocalls, spam emails and fly-by-night websites.
IMPORTANT: Scams & Junk Plan pitches are an even worse problem these days due to both the expired tax credits as well as other Trump regime policy changes which have made it more difficult for people to enroll in legitimate ACA plans or to qualify for financial help.
If you're enrolling online, make sure to use one of the official ACA exchange websites:
CALIFORNIA: Covered California
COLORADO: Connect for Health Colorado
CONNECTICUT: Access Health CT
DISTRICT OF COLUMBIA: DC Health Link
GEORGIA: Georgia Access
IDAHO: Your Health Idaho
ILLINOIS: Get Covered Illinois
KENTUCKY: kynect
MAINE: CoverME.gov
MARYLAND: Maryland Health Connection
MASSACHUSETTS: MA Health Connector
MINNESOTA: MNsure
NEVADA: Nevada Health Link
NEW JERSEY: Get Covered NJ
NEW MEXICO: beWellnm
NEW YORK: NY State of Health
OREGON: ExplORe Health (new!)
PENNSYLVANIA: Pennie
RHODE ISLAND: HealthSource RI
VERMONT: VT Health Connect
VIRGINIA: VA's Insurance Marketplace
WASHINGTON STATE: WA Healthplan Finder
ALL OTHER STATES: HealthCare.Gov
As for EDEs, it's important to note that some of these may also sell non-ACA compliant plans. The largest EDE, HealthSherpa, only sells on-exchange ACA-compliant policies. Full disclosure: They advertise on this website.
Also note that while some insurance carrier websites are also hooked into the federal exchange via an EDE, they (understandably) only list their own plans. I still recommend only using one of the websites listed above. Remember, whether via an official exchange site or an EDE, you have to enroll on-exchange to be eligible for financial help!
3. DOUBLE-CHECK YOUR 2027 INCOME TO SEE IF YOU'RE ELIGIBLE FOR FINANCIAL HELP.
As i note in the table above, the household Federal Poverty Level (FPL) threshold is critical in determining whether or not you're eligible for Advanced Premium Tax Credits (APTC) as well as Cost Sharing Reduction (CSR) assistance...and while the enhanced tax credits expiring last year means that APTC levels are far less generous across the board, there's still at least some level of financial help available for most enrollees.
Here's the APTC income eligibility sliding scale for 2027 for households at various income brackets compared to the formulas in 2025. As you can see, the subsidy formula has become far less generous due to the expiration:
For example: $40,000/year for a single adult was 266% FPL in 2025 but will only be around 251% FPL in 2027.
A single adult who earns exactly $40,000 each year only had to pay around 4.6% of their income for the benchmark Silver plan in 2025 (~$153/month)...but in 2027, they'll have to pay about ~8.7%, or roughly $290/month. A family of four which only had to pay 2% of their income in premiums for the benchmark plan in 2025 will have to pay 3.4x as much next year, and so on.
Here's what this looks like visually (I'm using my own family of 3 people here in Oakland County, Michigan with 2026 pricing for this particular example; it will vary depending on where you live and your household makeup):
4. IF YOU EARN MORE THAN 400% FPL, THERE ARE WAYS TO LEGALLY GET YOUR 2026 MAGI INCOME BELOW THE SUBSIDY CLIFF THRESHOLD.
I'm neither an accountant nor a tax attorney, but there are several perfectly legal ways for people with incomes over the 400% FPL "subsidy cliff" threshold to push their household back below the cut-off level so that they'll remain eligible for ACA tax credits after all (you can use these to increase your subsidy even if you're already below 400% FPL, for that matter). From my friend & colleague Louise Norris:
A lower income and more adjustments to income will reduce MAGI. You should consult your tax advisor to consider the available deductions/adjustments on your tax return that are above the line that shows your AGI since reductions to your AGI will also reduce your ACA-specific MAGI.
Tax-deductible contributions to a traditional individual retirement account (IRA) will reduce your ACA-specific MAGI. Your tax advisor should be able to explain the details of this to you, including how to determine whether you’re eligible to make tax-deductible contributions to a traditional IRA.
In addition, your tax advisor can explain how contributing to an employer-sponsored pre-tax retirement plan like a 401(k) will lower your ACA-specific MAGI.
...If you’re self-employed, your tax advisor can advise whether it is in your best interest to set up a self-employed retirement plan such as a SEP IRA, SIMPLE IRA, or Solo 401(k). Talk with your tax advisor to see if one makes sense for you. Keep in mind that these retirement plans for self-employed people have contribution limits that are potentially higher than those of traditional IRAs allowing people to reduce their MAGI by a larger amount than a traditional IRA would allow.
If you have an HSA-eligible high-deductible health plan (HDHP), contributions to an HSA will reduce your ACA-specific MAGI. Your tax advisor should be able to answer any questions you have about this. It's important to note that starting with the 2026 plan year, all Bronze and catastrophic plans purchased in the health insurance Marketplace will be considered HDHPs. So if you enroll in one of these plans, you'll be eligible to contribute to an HSA, as long as you don't have any additional major medical coverage.
Self-employed people may also deduct their health insurance premiums, which may lower their MAGI, but it gets a bit complicated if that’s the factor that makes you eligible for a premium subsidy.
5. HOWEVER, BE CAREFUL, BECAUSE THERE'S NO LONGER A CAP ON HOW MUCH YOU HAVE TO PAY BACK IF YOU UNDERESTIMATE YOUR INCOME...
Until now (and up through the end of 2025), there's been a limit on how much of their federal tax credits ACA enrollees have to pay back to the federal government if they underestimated their annual household income...which is to say, if they overestimated the amount of tax credits they were technically eligible for.
For the 2025 tax year, enrollees whose household income ends up being less than 200% FPL only have to pay back a maximum of $375 if they're single or up to $750 for any other tax filing status.
If they earn between 200 - 300% FPL, they're limited to paying back no more than $975 if they're single or $1,950 for any other filing status.
And if they earn between 300 - 400% FPL, they're limited to paying back no more than $1,625 if single or $3,250 for other filing statuses.
If their MAGI income is over 400% FPL, however, they'll have to pay whatever the excess APTC ends up being.
HOWEVER, starting with the 2026 calendar year, there will no longer be ANY caps on what portion of excess APTC has to be repaid, regardless of what your income bracket is.
If you overestimate your tax credits by $1,000 next year, you'll have to pay back $1,000. If you overestimate by $5,000, you have to pay back all $5,000. And if you think you'll end up below that 400% FPL threshold but end up with a 2026 MAGI of 401% or higher...you'll have to pay back every dime, which could potentially be $10,000 or more.
So proceed with the HSA/IRA ideas laid out in #4 above with caution.
That's it for Part 1. Stay tuned for Part 2 of my 2027 ACA Open Enrollment Period Guide coming soon...

https://acasignups.net/26/10/14/hobbling-towards-enrollment-my-2027-aca-open-enrollment-guide-part-1

2027 Rate Changes - Ohio: +16.3% indy market; +22.0% sm. group ...

2026-10-16T04:50:58Z

2027 Rate Changes - Ohio: +16.3% indy market; +22.0% sm. group market (FINAL)

Thu, 10/15/2026 - 9:08am
Originally posted 08/27/2026
ACA exchange enrollment has dropped by 32% in Ohio since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were down nearly 20% vs. OEP 2025...but effectuated enrollment dropped further, by 23% year over year in January and by over 32% in February.
That's over 160,000 Ohioans who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the federal Rate Review database:
ANTIDOTE:
Antidote’s average proposed rate increase of 15.80%, effective January 1, 2027, is expected to impact 30,508 members based on May 2026 membership. The rate increase is the same for all adult members within a given plan, though it varies by plan, ranging between 11.05% and 26.60%. Rate changes vary by plan due to the impact of changes in benefits and changes to the Cost Sharing Reduction (CSR) shortfall load.
Financial Experience of the Product
Antidote’s 2025 experience is shown in the URRT included with the 2027 rate filing, with a reported loss ratio of 115.5% in URRT Worksheet 2, Section II. The requested rate increases are expected to result in a loss ratio of 93.0% in 2027 using the methodology prescribed by 45 CFR 158.
Changes in Medical Service Costs
Medical trend for these products is anticipated to be an average of 7.5% per year on allowed claims. Medical trends include a combination of utilization and costs of services. This is an increase in annual trend from the 2026 rate development and is included in the calculation of the rate increase.
Morbidity
We include a morbidity increase to claims relative to Antidote’s experience to account for the expiration of enhanced subsidies at the end of the 2025 plan year, consistent with current regulations. This adjustment results in a net 6.1% increase to the experience rate.
Risk Adjustment
We include a risk adjustment transfer payment based on Antidote’s anticipated competitive position in 2027. We expect new enrollees to have a health status similar to the Ohio statewide average, but given Antidote has no prior experience with these new members, we anticipate Antidote will have less ability to fully capture all applicable diagnoses information. We expect this will ultimately lead to a payable into the risk adjustment program for 2027.
Retention
We include retention as provided by Antidote for 2027, including a federal exchange fee decrease relative to 2026.
BUCKEYE COMMUNITY/AMBETTER:
Estimated Average Annual Premium
The estimated average annual premium per policy in calendar year 2027 is x x x .
(Unfortuantely, Buckeye has redacted both their average premium increase as well as their effectuated enrollment number, although the former is at least available at the federal rate review database).
Distribution of Business
See Appendix 1.2 for the expected age and geographic distributions for these products.
Rate Tables
See Appendix 1.3 for allowable rating factors and Appendices 1.3b and 1.3c for clarification on service area definitions. Appendix 1.4 also includes an example of how rating factors will be applied. Note that for family coverage, rates for children are charged to no more than the three oldest covered children under age 21 consistent with the Family Structure rules of the Patient Protection and Affordable Care Act (ACA).
Impact of eAPTC Expiration
To account for eAPTC expiration prior to the 2027 benefit year, we have assumed rates will increase due to anticipated reductions in enrollment, both at the issuer and single risk pool level. As eAPTCs expire and enrollees subsequently face increased out-of-pocket premiums, we assume healthier individuals who tend to be more price sensitive will leave the market, worsening the average morbidity of the individual risk pool.
BUCKEYE HEALTH PLAN:
Estimated Average Annual Premium
The estimated average annual premium per policy in calendar year 2027 is XXXXX
(Unfortuantely, Buckeye has redacted both their average premium increase as well as their effectuated enrollment number, although the former is at least available at the federal rate review database).
Distribution of Business
See Appendix 1.2 for the expected age and geographic distributions for these products.
Rate Tables
See Appendix 1.3 for allowable rating factors and Appendices 1.3b and 1.3c for clarification on service area definitions. Appendix 1.4 also includes an example of how rating factors will be applied. Note that for family coverage, rates for children are charged to no more than the three oldest covered children under age 21 consistent with the Family Structure rules of the Patient Protection and Affordable Care Act (ACA).
Impact of eAPTC Expiration
To account for eAPTC expiration prior to the 2027 benefit year, we have assumed rates will increase due to anticipated reductions in enrollment, both at the issuer and single risk pool level. As eAPTCs expire and enrollees subsequently face increased out-of-pocket premiums, we assume healthier individuals who tend to be more price sensitive will leave the market, worsening the average morbidity of the individual risk pool.
CARESOURCE OHIO:
Individual Market Withdrawal Notification
1. Description of Withdrawal Plan and Scope
CareSource will discontinue its Individual Market health insurance products in the State of Ohio.
a. Products Affected
CareSource will withdraw all Individual Market products, including both On-Exchange and Off-Exchange ACA-compliant plans offered in Ohio. This withdrawal does not apply to other lines of business, including Medicaid, Medicare, or other non-Individual market offerings.
b. Reason for Withdrawal
CareSource has undertaken a comprehensive evaluation of its Individual Market business and broader organizational strategy. Based on this review, CareSource has made the decision to exit the Ohio Individual Market to align resources with long-term strategic priorities and ensure continued focus on sustainable lines of business.
c. Timeline and Effective Dates
• Withdrawal effective date: January 1, 2027
• Coverage termination date: December 31, 2026
d. Replacement Coverage
CareSource will not offer replacement Individual Market coverage to affected members in Ohio. Members will be directed to HealthCare.gov to evaluate available coverage options from other issuers during the applicable Open Enrollment Period.
e. Other Jurisdictions
This withdrawal applies specifically to the Ohio Individual Market. CareSource’s participation in other states and lines of business is evaluated independently and may differ.2. Product Form Identification All forms associated with the products being discontinued, including policy forms, evidences of coverage, and schedules of benefits, are provided in Exhibit A.
3. Affected Enrollment
As of 05/26/26: 28,319 (27,095 on exchange, 1,224 off-exchange)
4. Efforts to Market Book of Business
CareSource evaluated the feasibility of marketing the affected Individual Market block of business to other insurers. Based on this assessment, CareSource has determined that, due to the size, composition, and strategic considerations associated with the block, it is not pursuing efforts to market the book of business to affiliated or non-affiliated insurers.
COMMUNITY INSURANCE (ANTHEM):
Community Insurance Company (also referred to as Anthem) has made an application to the Ohio Department of Insurance for premium rate changes for its fully ACA-compliant individual health plan products. This increase will impact approximately 73,000 Ohio insured members renewing in 2027 with Anthem. At the individual plan level, rate increases range from 12.05% to 23.62%. An individual’s actual rate could be higher or lower depending on the geographic location, age characteristics, dependent coverage and other factors.
Financial Experience
Anthem expects the proposed rate increase will cover projected medical trends and yield a medical loss ratio of 87.21%, meaning more than eighty-seven cents of each premium dollar are expected to go to covering our members’ medical expenses and improving health care quality. This projected MLR of 87.21% exceeds the minimum MLR requirement of 80% as defined in the Affordable Care Act (ACA). In the event Anthem’s MLR is less than the Federal required minimum for a three year period, Anthem will refund the difference to policyholders, consistent with federal regulations.
Drivers of Rate Increase
The primary drivers of premium increases are associated with increased cost of benefit expense for this ACA compliant block. Increased cost of benefit expense is driven by increases in the price of services primarily from hospitals, physicians and pharmacies, coupled with members increasing their use of health care services, also called “utilization”. Increases in the price of services are driven by technological advances, new specialty medications, and a variety of other factors. Increased utilization is driven by member level utilization and selection patterns in the Guaranteed Issue, Community Rated ACA market.
Efforts to Control Costs
Anthem is committed to working to hold down the cost of insurance and price the Individual ACA market for long term sustainability. We continue to explore innovative collaboration with providers and negotiate deeper discounts at our hospitals. We provide members with tools to make informed decisions about where and how to receive treatment. Despite these efforts to moderate the cost of insurance, the cost of benefit expense in the Individual ACA market has continued to rise. In light of emerging costs, 2027 premium increases are needed to price Anthem’s ACA-compliant Individual health plan products for long term sustainability.
MEDICAL HEALTH INSURING CORP:
For Individual ACA plans effective January 1, 2027, MMO is proposing an overall average increase of 21.6% for existing plans, potentially impacting up to 3,113 current MMO members. This rate increase is based on actuarial projections, and results may differ from these projections as actual experience deviates from the rating assumptions.
Items impacting the proposed rate increase include:
Increase in medical and drug costs are projected at 7.0% annually
Changes in demographics and morbidity of the risk pool
An increase in MMO’s projected risk adjustment transfer payment
The profit and risk is projected to increase $21.03 PMPM. The taxes and fees are projected to increase $13.38 PMPM due to MMO marketing On-Exchange plans in 2027.
The projected loss ratio is 80.11%, which satisfies the federal minimum loss ratio requirement of 80.0%.
MOLINA:
Molina Healthcare of Ohio, Inc. is a managed care organization that provides healthcare services to individuals eligible for Medicaid, Medicare, and Marketplace throughout the State of Ohio. Molina Healthcare of Ohio, Inc. 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 19.5% for the 32 Molina members enrolled in continuing plans effective May 2026.
2. Financial experience of the product: The proposed premium rates yield a medical loss ratio of 89.8%. The medical loss ratio represents the percentage of every premium dollar that Molina expects to spend on medical expenses and improving health care quality for our members. The projected medical loss ratio of 89.8% exceeds the Affordable Care Act minimum required loss ratio of 80.0%.
3. Changes in Medical Service Costs: Medical inflation related to the utilization and cost of covered services increased claims by 8.5%. Trend is one of the primary contributors to an increase in rates. Changes in provider contracting rates also contributes to rate change.
4. Changes in Benefits: In 2027, the impact on rates from benefit design changes for all renewal plans is minimal.
5. Administrative Costs and Anticipated Margins: Total administrative expenses are expected to contribute toward -2.2% of premium change. The targeted profit margin remains 3.0% of premium.
OSCAR BUCKEYE STATE:
The purpose of this document is to present rate change justification for Oscar Buckeye State Insurance Corporation (Oscar’s) Individual Affordable Care Act (ACA) products, with an effective date of January 1, 2027, and to comply with therequirements of Section 2794 of the Public Health Service Act as added by Section 1003 of the Patient Protection and Affordable Care Act (ACA).
Using in-force business as of May 2026, the proposed average rate increase for renewing plans is 18.0%. Rate changes vary by plan due to a combination of factors including shifts in benefit leveraging and cost-sharing modifications. This rate decrease is absent of rate changes due to attained age. The rate increase impacts an estimated 77,548 members.
2. Reason for Rate Increase(s)
The significant factors driving the proposed rate change include the following:
Medical and Prescription Drug Inflation and Utilization Trends
The projected premium rates reflect the most recent emerging experience which was trended for anticipated changes due to medical and prescription drug inflation and utilization.
Administrative Expenses, Taxes and Fees, and Risk Margin
Changes to the overall premium level are needed because of required changes in federal and state taxes and fees. In addition, there are anticipated changes in both administrative expenses and targeted risk margin.
Prospective Benefit Changes
Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value Calculator and state requirements, as well as for strategic product considerations.
Anticipated Changes in the Average Morbidity of the Covered Population
Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.
Anticipated Changes in the Network Configuration
Changes to the overall premium level are needed because of anticipated changes in the underlying network configuration and associated unit costs.
OSCAR INSURANCE CORP:
Exhibit A summarizes the proposed rate increases by plan effective January 1, 2027. Rate increases vary by plan due to a combination of factors including shifts in benefit leveraging, cost-sharing modifications, and geographic rating factors.
Using in-force business as of May 2026, the proposed average rate change for renewing plans is XXXXX . This rate change is absent of rate changes due to attained age.
(Unfortunately, Oscar Insurance Corp. has redacted both their average premium increase as well as their effectuated enrollment number, although the former is at least available at the federal rate review database).
The significant factors driving the proposed rate change include the following:
Medical and Prescription Drug Infl ation and Utilization Trends
The projected premium rates reflect the most recent emerging experience which was trended for anticipated changes due to medical and prescription drug inflation and utilization.
Administrative Expenses, Taxes and Fees, and Risk Margin
Changes to the overall premium level are needed because of required changes in federal and state taxes and fees. In addition, there are anticipated changes in both administrative expenses and targeted risk margin.
Prospective Benefi t Changes
Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value Calculator and state requirements, as well as for strategic product considerations.
Anticipated Changes in the Average Morbidity of the Covered Population
Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.
PARAMOUNT INSURANCE CO:
Paramount Insurance Co. was acquired by Medical Mutual of Ohio in 2024 but still had around 2,200 ACA exchange enrollees as of spring 2025. I'm operating on the assumption that these have been either phased

https://acasignups.net/rate_changes/2027/oh

2027 Rate Changes - New Jersey: +19.8% indy mkt; +18.8% sm. group ...

2026-10-16T04:01:08Z

2027 Rate Changes - New Jersey: +19.8% indy mkt; +18.8% sm. group mkt (FINAL)

Thu, 10/15/2026 - 10:41am
Originally posted 08/13/2026
ACA exchange enrollment has dropped by 11.4% in New Jersey since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year...despite NJ offering state-based subsidies to help mitigate the lost federal assistance.
Initial signups during Open Enrollment were only down 0.8% vs. OEP 2025...but effectuated enrollment was 4.4% lower year over year in January, gradually rising to 11.4% lower as of April, according to Get Covered NJ, the state ACA exchange.
That's over 56,000 Kansans who already lost coverage in just the first four months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the federal Rate Review database:
AmeriHealth HMO, Inc:
AmeriHealth HMO, Inc. ("AHNJ”) is revising premium rates for the New Jersey Individual Health ACA compliant products, effective from January 1, 2027. Rate increases average 18.2%, ranging from 18.2% to 18.2%. The proposed revisions to each plan are shown on the last page of this exhibit. About 17 members will be affected.
Proposed rate increases of 10% or higher:
IHC Gold HMO Regional Preferred $20/$50 18.2%
There were no changes to the rating structure affecting premium rates.
Financial Experience of the Product:
The premium collected, risk adjustment transfer, and incurred claims for these products during the period January 1, 2025 to December 31, 2025 were $591,836.74, $1,187,168.69, and $2,492,999.89, respectively. The resulting “loss ratio” is 140%. This ratio is the portion of premium that is needed to pay medical claims. The complement of the loss ratio is the portion of premium needed for taxes and fees, administrative expenses, and margin. The projected loss ratio, using New Jersey’s requirements and taking into account the rate increase noted above, is 35%.
Changes in Taxes and Fees:
The Federal government discontinued the Health Insurance Providers Fee beginning for premiums due in 2021.
Changes in Medical Service Costs:
Increasing cost of medical services: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies. We estimate cost increases to be 4.5%. Increased utilization: The number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected by the use of expensive procedures such as surgery versus simply monitoring or providing medications. We estimate utilization increases to be 4.7%.
Higher costs from deductible leveraging: Healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year. We estimate deductible leveraging increases to be roughly 1%.
Changes in Benefits:
Some plan benefits are mandated by federal and state law. All changes in benefits are in compliance with the uniform modifications rules stipulated by the Federal government.
Administrative Costs:
Administrative Costs and anticipated margins make up approximately the same percentage of premium in 2027 that they do in 2026. The premium rates presented in this filing include a contribution to reserves.
AmeriHealth Insurance Co. of NJ:
AmeriHealth Insurance Company of New Jersey ("AHIC”) is revising premium rates for the New Jersey Individual Health ACA compliant products, effective from January 1, 2027. Rate increases average 17.0%, The proposed revisions to each plan are shown on the last page of this exhibit. About 131,000 members will be affected.
There were no changes to the rating structure affecting premium rates.
Financial Experience of the Product:
The premium collected, risk adjustment transfer, and incurred claims for these products during the period January 1, 2025 to December 31, 2025 were $985,710,024, -$131,451,940, and $740,632,945, respectively. The resulting “loss ratio” is 104%. This ratio is the portion of premium that is needed to pay medical claims. The complement of the loss ratio is the portion of premium needed for taxes and fees, administrative expenses, and margin. The projected loss ratio, using New Jersey’s requirements and taking into account the rate increase noted above, is 80%.
Changes in Taxes and Fees:
The Federal government discontinued the Health Insurance Providers Fee beginning for premiums due in 2021.
Changes in Medical Service Costs:
Increasing cost of medical services: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies. We estimate cost increases to be 4.6%.
Increased utilization: The number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected by the use of expensive procedures such as surgery versus simply monitoring or providing medications. We estimate utilization increases to be 5.9%.
Higher costs from deductible leveraging: Healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year. We estimate deductible leveraging increases to be roughly 1%.
Changes in Benefits:
Some benefits have been revised in some plans to moderate the impact of rising health care costs. The overall impact on rates of these changes is small.
Some plan benefits are mandated by federal and state law. Benefit changes for some plans were also made. All changes in benefits are in compliance with the uniform modifications rules stipulated by the Federal government.
Administrative Costs:
Administrative Costs and anticipated margins make up approximately the same percentage of premium in 2027 that they do in 2026. The premium rates presented in this filing include a contribution to reserves.
Horizon Healthcare Services Inc:
Horizon Blue Cross Blue Shield of New Jersey (Horizon-BCBSNJ) is increasing premium rates for the NJ Individual ACA-compliant products by an average of 15.4% for 2027 enrollments. Rate increases by product are displayed in the table below. Additionally, the final premium will depend on the member’s age and family composition.
Approximately 191K members are estimated to be impacted by rate actions exceeding 10%. Historical average yearly premium increases for Individual ACA-compliant products by Horizon-BCBSNJ:
2024: 4.2%
2025: 6.1%
2026: 18.1%
Horizon-BCBSNJ is subject to the State and Federal Minimum Loss Ratio requirements. This means that at least 80% of premium dollars – after risk adjustment and ACA-imposed fees and taxes - has to be spent on medical costs. The rate actions for 2027 are projected to meet this requirement.
Reasons contributing to the increase in premium rates include the following:
Medical and prescription drug costs inflation. Service costs increase each year. The contributing factors include: health care providers increasing their fees, members utilizing more services and supplies, advances in prescription drug development and medical technology (such as gene therapies), and heavy marketing of Specialty drugs, among other factors.
In 2026, the State Reinsurance parameters were revised, which resulted in carriers receiving about 40% less in reinsurance receivables for high-cost claimants. Rates had to increase in order to make up for this shortfall in funding.
Financial Experience of the Individual Block
The premium collected and incurred claims for these products during the January 2025 – December 2025 period were $2,182M and $1,998M, respectively. Reinsurance and Risk Adjustment receivables are anticipated to be $461M and $268M respectively. After accounting for ACA-imposed taxes and fees, this results in an anticipated NJ State one-year Medical Loss Ratio (MLR) of 86.2% for 2025. This ratio is the portion of premium that is needed to pay medical claims. The complement of the loss ratio is the portion of revenue needed for taxes and fees, administrative expenses, and margin.
The projected 2027 loss ratio on a one-year basis, using New Jersey’s requirements and taking into account the rate increase noted above, is 86.2%. The projected 2027 NJ loss ratio on a three-year basis, is 84.7%.
Changes in Benefits
Benefit coverage and cost sharing levels are two important components in determining premium levels and may be changed periodically. Cost Sharing changes, such as copay, coinsurance, deductible, maximum out pocket levels, may be made to any number of benefits, including but not limited to:
Primary Care and Specialist visits, Urgent Care visits, Inpatient Hospital stays, Outpatient Surgery procedures, Emergency Room visits, Prescriptions, Radiology Imaging, and Laboratory Testing, among others. Some benefit changes are also required by legislation or regulation.
Oscar Garden State Insurance Corp:
The purpose of this document, which is submitted in conjunction with the Part I Unified Rate Review Template (URRT), is to present rate change justification for Oscar Garden State Insurance Corporation (Oscar’s) individual Affordable Care Act (ACA) products, with an effective date of January 1, 2027, and to comply with the requirements of the Part II Justification.
Using in-force business as of March 2026, the proposed average rate increase for renewing plans is 29.3% and impacts an estimated 144,367 members. The minimum and maximum rate change percentages are 25.8% and 30.6%, respectively. Rate increases vary by plan due to a combination of factors including shifts in benefit leveraging and cost-sharing modifications. This rate increase is absent of rate changes due to attained age. Rate increases will not vary by member within a plan since the age factors and geographic factors will not change for the 2027 plan year.
2. Financial Experience
The total net premiums and medical expenses (claims costs +/- risk adjustment transfers) for these products during the January 1, 2025 to December 31, 2025 experience period were $230M and $193M, respectively. The resulting “loss ratio”, expressed as medical expenses over premiums, is 83.8%. This ratio represents the portion of premium that is needed to pay medical claims costs. The complement of the loss ratio is the portion of premium needed for taxes and fees, administrative expenses, and risk margin.
Oscar’s projected loss ratio for the 2027 plan year based on the federally-prescribed MLR methodology is 88.5%. Oscar’s projected loss ratio for 2027 based on the New Jersey methodology is 84.7%.
Changes in Medical Service Costs
The significant healthcare cost trends driving the proposed rate change include the following:
Increased cost of medical services and prescription drug inflation: annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies. The estimated annual cost increase is 3.0%.
Increased utilization: the number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected by the use of expensive procedures such as surgery versus simply monitoring or providing medications. The estimated annual utilization increase is 1.8%.
Higher costs from deductible leveraging: healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year. The estimated deductible leveraging increase is about 0.4%.
4. Changes in Benefits
Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value requirements, as well as for strategic product considerations.
5. Administrative Costs and Anticipated Margins
Oscar anticipates changes in both administrative expenses and targeted risk margin from what was included in the current premium rates. Overall administrative expense load increased from 14.9% to 16.4%. Targeted risk margin after federal income taxes is 4.3%, which is aligned with last year’s target of 3.4%.
UnitedHealthcare:
The following memorandum describes the key drivers of the rate increase effective January 1st, 2027, for UnitedHealthcare Insurance Company (“UHIC”). UHIC policies are individual medical plans offered in New Jersey and are fully compliant with the Patient Protection and Affordable Care Act.
Rate Change
The overall average rate change is 35.7%. The rate change by plan varies from 28.3% to 39.6%.
Number of Individuals Impacted
There are 7,820 individuals impacted as of April 30th, 2026.
Financial Experience of Product
The premium collected between January 1st, 2025 and December 31st, 2025 was $108,434,989. Incurred claims net of reinsurance during this period were $78,222,799 and UHIC is estimated to receive $1,332,786 from the risk adjustment program. The loss ratio, or portion of premium required to pay medical claims, for this time period is 70.9%.
Key Drivers of Change in Medical Service Costs
Increasing Cost of Medical Services: Annual increases in reimbursement rates to health care providers – such as hospitals, doctors, and pharmaceutical companies.
Increased Utilization: The number of office visits and other services continues to grow. In addition, total health care spending will vary by the intensity of care and use of different types of health services. The price of care can be affected by the use of expensive procedures such as surgery versus simply monitoring or providing medications.
Higher Costs from Deductible Leveraging: While health care costs continue to rise every year, if deductibles and copayments remain the same, a greater percentage of health care costs need to be covered by health insurance premiums each year.
Impact of New Technology: Improvements to medical technology and clinical practice require use of more expensive services - leading to increased health care spending and utilization.
Demographics: Change in the projected age, gender, and metal mix of the underlying population can change the medical claims expected to be incurred.
Morbidity: Change in the projected health status of both the New Jersey individual market and UHIC’s population lead to increased healthcare spending and a decrease in the offsetting impact of the risk adjustment program.
Regulatory Changes: The changes to federal premium subsidy eligibility for consumers are expected to lead to higher costs as healthier enrollees exit the market.
Changes in Benefits
Changes in covered benefits or benefit plan designs impact costs and therefore affect premium changes. Benefit plans are typically changed for one of three reasons: to comply with the requirements of the Affordable Care Act, to respond to consumer feedback, or to address a particular medical cost issue to provide for greater long-term affordability of the product. The Affordable Care Act implemented requirements for the “value” that must be offered by plan designs in the Individual and Small Group markets. These are called “metal levels”. For a benefit plan to remain classified within a particular metal level from year to year, adjustments to deductibles, copayments or coinsurance are sometimes required. These adjustments impact the cost and therefore the premium increases for the plan.
Administrative Costs and Anticipated Margins
UHIC works to directly control administrative expenses by adopting better processes and technology, and through the development of programs and innovations that make health care more affordable. UHIC has led the marketplace by introducing key innovations that make health care services more accessible and affordable for customers, improve the quality and coordination of health care services, and help individuals and their physicians make more informed health care decisio

https://acasignups.net/rate_changes/2027/nj

2027 Rate Changes - Illinois: +14.0% indy, +17.1% sm. group ...

2026-10-16T02:37:24Z

2027 Rate Changes - Illinois: +14.0% indy, +17.1% sm. group (FINAL)

Thu, 10/15/2026 - 2:28pm
Originally posted 06/11/2026
via the Illinois Dept. of Insurance:
Affordable Care Act (ACA) - Illinois Rate Filings
The chart below contains proposed rates for Plan Year 2027, which will be reviewed for compliance with federal and state requirements. Please submit any comments to DOI.HealthRateReview@illinois.gov by Friday, July 10, 2026.
2026 Illinois On- and Off-Exchange Plan Analyses can be found here.
The Health Rate Review Consumer Guide can be found here.
How are rates developed?
Each year, health insurance companies determine future premiums based on a number of past factors.
These factors include, but are not limited to, hospital and prescription drug costs, enrollment figures, utilization trends, and inflation. Companies use these factors to project future consumer premium costs and ensure they can pay claims and remain financially stable. The ACA establishes an MLR which requires insurers to spend at least 80% of premiums collected in the individual and small group markets and requires insurers to spend at least 85% of premiums collected in the large group market.
Other factors that can impact consumer premium costs include age, location, the number of employees in an employer plan, and the type of plan a consumer chooses.
Under the ACA, a health insurance company may not use a consumer’s pre-existing conditions to deny coverage or determine a consumer’s premium rates.
What is the rate review process?
All individual and small group insurers are required to submit their rates to the Department annually by a deadline set by the Director of Insurance. Deadlines may change from year-to-year. After the rates are submitted, the Department is required to post the rates on its website within five (5) business days and then accept public comments for a period of 30 days. The Department must post all public comments within five (5) business days after the comment period ends.
The Director must then issue a decision approve, disapprove, or modify an insurer’s rates within 60 days. The Director must take public comments into account. If the Director does not issue a decision, the plan rates are automatically approved. The Department is required to notify the insurer of its decision and post the final rates on its website.
The Department uses credentialed actuaries and experts to determine whether rates are reasonable and adequate.
Where do I find the rate tables?
Individual and small group rates filed with the Department can be found here: Rate Filings. The Department posts an insurer’s initial average, maximum and minimum plan rate increases or decreases on the left-hand side of the table, and the Department posts an insurer’s final average, maximum and minimum plan rate increases or decreases on the right-hand side of the table. Links to the carrier’s rate filing or filings and the Department’s final decisions are posted on the far-right side of the table.
The initial rates filed by an insurer may vary from the final rates. The initial rates may also remain the same. After an insurer files their initial rates, the Director will determine whether the insurer’s rates are reasonable or adequate. If the insurer’s rates are found to be unreasonable or inadequate, the Director will adjust the final rates. If the insurer’s rates are found to be both reasonable and adequate, the Director will approve the rates without making any changes.
Oscar Health Plan:
The significant factors driving the proposed rate change include the following:
Medical & Prescription Drug Inflation & Utiliziation Trends
The projected premium rates reflect the most recent emerging experience which was trended for anticipated changes due to medical and prescription drug inflation and utilization.
Administrative Expenses, Taxes & Fees, and Risk Margin
Changes to the overall premium level are needed because of required changes in federal and state taxes and fees. In addition, there are anticipated changes in both administrative expenses and targeted risk margin.
Prospective Benefit Changes
Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value Calculator and state requirements, as well as for strategic product considerations.
Anticipated Changes in the Average Morbidity of the Covered Population
Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.
UnitedHealthcare of Illinois:
Some of the key healthcare cost trends that have affected this year’s rate actions include:
Increasing cost of medical services: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies.
Increased utilization: The number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected using expensive procedures such as surgery versus simply monitoring or providing medications.
Higher costs from deductible leveraging: Healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year.
Impact of new technology: Improvements to medical technology and clinical practice often result in the use of more expensive services, leading to increased healthcare spending and utilization.
Changes in market morbidity: Premiums reflect a modest increase in expected claims costs due to federal changes to premium subsidy eligibility for certain immigrant populations in 2027. These changes are expected to lead to some healthier members exiting coverage, resulting in a slightly higher average risk level and a small upward impact on premiums.
MercyCare HMO: (unfortunately, most of their actuarial memo is redacted)
Rate changes reflect changes in medical and pharmacy benefit cost, both price changes and changes in utilization. They also reflect the cost of CMS risk adjustment transfer payments borne by the plan, along with changes in administrative expenses.
Celtic Insurance Co: (again, much of the memo is redacted)
Impact of eAPTC Expiration
To account for eAPTC expiration prior to the 2027 benefit year, we have assumed rates will increase due to anticipated reductions in enrollment, both at the issuer and single risk pool level. As eAPTCs expire and enrollees subsequently face increased out-of-pocket premiums, we assume healthier individuals who tend to be more price sensitive will leave the market, worsening the average morbidity of the individual risk pool.
Health Care Service Corporation (BCBS IL): Welp.
It's also worth noting that Cigna, which is dropping out of the ACA market entirely, has around 2,900 effectuated enrollees in Illinois who will have to find other coverage this fall for 2027.
Letter of Intent to Discontinue Participation in the Illinois Individual Medical Market
Dear Ann Gillespie:
Cigna Healthcare (“Cigna”) submits this letter to formally notify the Illinois Department of Insurance (the “Department”) of its intent to discontinue participation in the Illinois Individual Medical Market, effective January 1, 2027.
This notice is provided pursuant to 50 Ill. Adm. Code § 2025.70 (Discontinuance of a Market) and 50 Ill. Adm. Code § 2025.40 (Notice Requirements), as well as applicable federal requirements governing guaranteed renewability and market withdrawals under 45 CFR §§ 146.152, 147.106, and 148.122.
After careful consideration, Cigna has determined that continued participation in the Illinois Individual Medical Market is not viable over the long term due to scale limitations and the operational demands of competing in a highly dynamic regulatory and market environment. This decision applies only to Individual Medical products and does not affect Cigna’s Individual Market dental offerings, which will continue without interruption.
The details of our Individual medical market exit include the following:
Number of Lives Impacted: 2,885 (including both on and off exchange)
Affected Illinois Counties: Cook, DuPage, Grundy, Kane, Kankakee, Kendall, Lake, McHenry and Will
Product Forms Impacted: On Exchange CCGH-134525701 and Off Exchange CCGH-134602242
Effective Date of Non-renewal: January 1, 2027.
Line of Business Impacted: Individual HMO
In any event, this works out to a 14% average requested rate hike for the Illinois individual market next year, and a 15.4% average increase for small group enrollees.
It's also worth noting that the Illinois ACA exchange individual market as of March 2026 is a whopping 17% lower than the number who selected policies during Open Enrollment, which I'll discuss in more detail in a separate blog post soon...
For what it's worth, here's how effectuated on-exchange enrollment in Illinois has changed by month for every year up through May 2026...
...and here's what that looks like visually, with 2026 compared to 2025 and 2019 (the last pre-COVID/pre-enhanced subsidy year):
UPDATE 10/15/26: The Illinois Insurance Dept. has published the final, approved 2027 rate changes for both the individual and small group markets.
There were virtually no changes to the individual market rate change requests, resulting in a weighted average increase of 14.0% for unsubsidized enrollees. Small group plans, meanwhile, are actually set to increase more than the initial requested rate hikes, going from 15.4% to 17.1% on average.
Illinois
2027 Rate Changes
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https://acasignups.net/rate_changes/2027/il