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<title>One more thing about that Kansas Senate campaign ad...</title>
<link>https://acasignup.net/26/10/01/one-more-thing-about-kansas-senate-campaign-ad</link>
<description><span class="submitted-by">Thu, 10/01/2026 - 6:11pm</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/thumb_roger_marshall.jpg?itok=wqs5gzNM" width="300" height="158" alt="" /></div></div></div><div class="field field-name-field-video field-type-video-embed-field field-label-hidden"><div class="field-items"><div class="field-item even">
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<iframe class="" width="480" height="270" src="//www.youtube.com/embed/9ng2gFYGh3U?width%3D480%26amp%3Bheight%3D270%26amp%3Btheme%3Ddark%26amp%3Bautoplay%3D0%26amp%3Bvq%3Dlarge%26amp%3Brel%3D0%26amp%3Bshowinfo%3D1%26amp%3Bmodestbranding%3D0%26amp%3Biv_load_policy%3D1%26amp%3Bcontrols%3D1%26amp%3Bautohide%3D2%26amp%3Bwmode%3Dopaque" frameborder="0" allowfullscreen></iframe> </div>
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<p>I don’t write about specific political campaign ads very often, but this one happens to be directly related to the healthcare field (namely, medical debt), so it seemed to merit a few words.</p>
<p>About a week ago, Adam Hamilton, the Democratic nominee for U.S. Senate in Kansas, came out with a new TV ad featuring one of the <a href="https://www.nytimes.com/2026/09/08/us/politics/roger-marshall-obgyn-doctor-debts.html">former patients who was once sued by his Republican opponent</a>, incumbent Senator (and former OB/GYN) Roger Marshall (the ad starts at 2:26 in the clip posted above).</p>
<p>In the ad, the woman, Meischa Zimmerman, says:</p>
<blockquote><p>“One evening I see lights. I open the door, and it’s a police officer. They arrested me because I didn’t make a $50 payment to Roger Marshall. I was 8 months pregnant and I said please, do not handcuff me in front of my 2-yr old daughter.</p>
<p>“Roger Marshall preyed on the low-income families of Kansas. The healthcare system is broken…but not for Roger Marshall. He’s absolutely profiting from it.”</p>
</blockquote>
<p>In response to this ad, a few days later, Sen. Marshall <a href="https://www.kcur.org/politics-elections-and-government/2026-09-29/roger-marshall-defamation-patient-arrested-adam-hamilton">claimed that the ad was “defamatory,</a>” demanded that the Hamilton campaign cease &amp; desist running it, and threatened legal action:</p>
<blockquote><p>Lawyers for a Kansas Republican U.S. senator running for reelection sent his opponent a cease-and-desist letter demanding the Democrat stop airing an ad featuring one of the senator’s former patients.</p>
<p>The lawyers for U.S. Sen. Roger Marshall, R-Kansas, said in a Monday letter that the Rev. Adam Hamilton’s campaign had published and distributed ads about Marshall’s medical debt collection practices that were “defamatory.”</p>
<p>The ad begins with Meischa Zimmerman, who said she was arrested while eight months pregnant for missing a $50 payment to Marshall. She was paying roughly $50 a month to account for 18% interest on nearly $3,600 in total debt, according to court records.</p>
<p>The woman was one of more than 700 patients who Marshall sued while a practicing physician in Great Bend, according to reporting by the New York Times.</p>
</blockquote>
<p>In response to <strong>that</strong>, today the Hamilton campaign’s attorneys responded to Marshall’s demands, <a href="https://bsky.app/profile/hamilton4kansas.bsky.social/post/3mwtod26dtk2g">going through the claims, the facts, the ad and the law point by point.</a></p>
<p>A bunch of other outlets have been writing about this story, so I’ll try not to be redundant…but there’s one factor which I haven’t seen anyone else mention which I feel needs some attention, and it’s this:</p>
<blockquote><p><strong><span style="background-color:#ffff00">“…She was paying roughly $50 a month to account for 18% interest on nearly $3,600 in total debt, according to court records.”</span></strong></p>
</blockquote>
<p>18% interest sounds pretty excessive to me, so out of curiosity I decided to <a href="http://www.bankrate.com/credit-cards/tools/credit-card-payoff-calculator/">plug that into a debt calculator</a> to see just how long it would take to pay off $3,600 at $50/month.</p>
<p><strong>At 0% interest</strong>, of course, it would take <strong>exactly 6 years</strong>, since you’re just paying off the principal. The child who Marshall delivered for Ms. Zimmerman via c-section (ie, the procedure which incurred the debt to begin with) would be in the first grade before it was paid off.</p>
<ul>
<li><strong>At 1% interest</strong> it would take 75 months.</li>
</ul>
<ul>
<li><strong>At 5%</strong> it would take 86 months, or over 7 years.</li>
</ul>
<ul>
<li><strong>At 10%</strong> it would take 111 months, or over 9 years.</li>
</ul>
<ul>
<li><strong>At 12% interest</strong> it would take 128 months.</li>
</ul>
<ul>
<li><strong>At 15% interest</strong> it would take 15 1/2 years. Her kid would be in driver’s ed.</li>
</ul>
<ul>
<li><strong>At 16% interest</strong> it would take 244 months…or over 20 years. The child whose birth initiated the $3,600 debt in the first place would be nearly old enough to drive.</li>
</ul>
<ul>
<li><strong>At 16.66% interest</strong>, it would take 568 monthly payments of $50 apiece to pay off…or more than 47 years. Ms. Zimmerman would presumably be on Medicare at this point, and her child would be a middle-aged man.</li>
</ul>
<p>Why did I go with such a specific percent for this last example?</p>
<p><strong>Because at anything above 16.66% interest</strong>, I get the following error message:</p>
<blockquote><p><strong>Your payments are not enough to cover the accumulated interest. Try increasing the payments.</strong></p>
</blockquote>
<p>That’s right: At 18% interest, the rate Marshall was charging this woman, <strong><span style="background-color:#ffff00">there was literally no way she could possibly have paid off a $3,600 bill at $50/month.</span></strong></p>
<p>It wouldn’t matter if she never missed a payment—the interest in the first month alone would have been more than $50, meaning <strong><span style="background-color:#ffff00">the balance would grow higher every month…for eternity.</span></strong></p>
<p> </p>
<p>If you’re not great at math, I’ll explain why this is:</p>
<ul>
<li>$3,600 x 18% = $648/year</li>
<li>$648 / 12 = $54/month in interest</li>
</ul>
<p>In other words, <strong>paying anything less than $54.01 per month</strong> means that <strong>the interest would be racking up faster than the payments</strong>…which is clearly what was happening here, since according to the NY Times article, <em>“it had ballooned to over $7,000 with interest</em>” several years ago.</p>
<p><a href="https://www.bankrate.com/credit-cards/tools/credit-card-payoff-calculator/">Try it for yourself here.</a></p>
<p>I'll leave it at that.</p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/kansas">Kansas</a></div><div class="field-item odd"><a href="/roger-marshall">Roger Marshall</a></div><div class="field-item even"><a href="/medical-debt">Medical Debt</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1">
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<pubDate>Thu, 01 Oct 2026 22:11:44 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
<guid isPermaLink="false">9981 at https://acasignup.net</guid>
<comments>https://acasignup.net/26/10/01/one-more-thing-about-kansas-senate-campaign-ad#comments</comments>
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<title>2027 Rate Changes - Idaho: +11.6% indy mkt, +11.5% sm. group mkt (FINAL)</title>
<link>https://acasignup.net/rate_changes/2027/id</link>
<description><span class="submitted-by">Thu, 10/01/2026 - 3:16pm</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/thumb_idaho_15.jpg?itok=xqJe3bPF" width="300" height="158" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><span style="color:#0000ff"><em><strong>Originally posted 08/03/2026</strong></em></span></p>
<p>Idaho is one of a handful of states where plan selections during the 2026 Open Enrollment Period actually <strong>increased</strong> year over year, by around 2.6%, in spite of the enhanced federal subsidies expiring back in December.</p>
<p>Two months into the year, however,<strong> effectuated enrollment</strong> is actually down slightly (by around 2.2%, or roughly 2,500 enrollees).</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/idaho_effectuated_month_year_table.jpg?itok=ZkQQQuz3"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/idaho_effectuated_month_year_table.jpg?itok=ZkQQQuz3" /> </a></p>
<p>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:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/idaho_effectuated_month_year_graph.jpg?itok=Be_fXQWv"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/idaho_effectuated_month_year_graph.jpg?itok=Be_fXQWv" /> </a></p>
<p>Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the <a href="https://apps.doi.idaho.gov/main/publicforms/RateReview?Indiv=Yes&amp;Group=&amp;Year=2027">Idaho Insurance Dept. website</a>. For <a href="https://pacificsource.com/update">PacificSource</a>, which is pulling out of the <strong>entire</strong> individual market nationally, I had to make an educated guess as to their current effectuated enrollment; it was <a href="https://acasignups.net/rate_changes/2026/id">around 4,300 people a year earlier.</a></p>
<p>Overall, individual market carriers are seeking a weighted average <strong>13.1% premium increase</strong> next year in Idaho, which <a href="https://acasignups.net/rate_changes/2026">currently has the lowest average ACA premiums in the country:</a></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/idaho_2027_indy_prelim.jpg?itok=mv6mc1nk"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/idaho_2027_indy_prelim.jpg?itok=mv6mc1nk" /> </a></p>
<blockquote><p><strong>Blue Cross of Idaho Health Services, Inc.</strong></p>
<p>The filed overall average rate change for January 1, 2027, is 14.01%. This average rate change does not indicate that every individual’s rate will change by this amount, as rates are affected by the ages of those covered, family coverage, the date of policy renewal and benefits chosen. We have estimated that rate changes by member, prior to the impact of aging, for the 30,382 members enrolled as of March 2026 will range between 0.5% and 26.1% including the impact of benefit and cost sharing changes.</p>
<p>Rate changes will vary by metal level:</p>
<p>Metal Level Average Rate Increase</p>
<ul>
<li>Gold 14.1%</li>
<li>Silver 15.0%</li>
<li>Bronze 13.7%</li>
<li>Catastrophic 8.0%</li>
</ul>
<p>Average increases also vary by rating area.</p>
<p>Rating Area Average Rate Increase</p>
<ul>
<li>1 12.9%</li>
<li>2 20.4%</li>
<li>3 6.6%</li>
<li>4 20.3%</li>
<li>5 16.0%</li>
<li>6 12.3%</li>
</ul>
<p>Most Significant Factors</p>
<p>The rate change described above is driven by the following factors:</p>
<ul>
<li>Paid Claims Expense: 9.31%</li>
<li>Administrative Expenses -0.47%</li>
<li>State Based Reinsurance 2.68%</li>
<li>Risk Adjustment 2.99%</li>
<li>Margin 2.72%</li>
<li>Other: -3.22%</li>
</ul>
</blockquote>
<blockquote><p><strong>Moda Health Plan, Inc.</strong></p>
<p>Individual Health Benefit Plans</p>
<p>Rate Change</p>
<p>The average rate change is 26.82%. The maximum is 30.97%, and the minimum is 24.80%. The number of individuals impacted by this rate change is 4,801.</p>
<p>Most Significant Factors</p>
<p>Moda Health Plan’s 2025 Idaho Individual experience was used to develop 2027 rates. This experience was determined to be 93.97% credible based on having 57,398 member months in the experience period and needing 65,000 members to be fully credible.</p>
<p>The most significant factor contributing to the increase is Moda Health Plan’s emerging Idaho Individual experience and an 9.2% annual trend. The other significant factor contributing to the increase is the manual rate component. Moda Health Plan’s 2025 Oregon Individual experience trended forward to the 2027 rating period and adjusted to an Idaho cost basis was used to develop the manual rate.</p>
<p>Other factors impacting the overall rate change are changes in reinsurance, risk adjustment, and silver loading assumptions.</p>
</blockquote>
<blockquote><p><strong>MOLINA Healthcare:</strong></p>
<p>In accordance with the 2027 Idaho Standards document, the following rate increase justification has been provided.</p>
<p>RATE CHANGE</p>
<p>Molina’s rate filing reflects the following rate changes by metal tier, averaging 12.9% Molina has 670 members in plans that are renewing enrolled effective March 2026 and reported as of March 2026. The rate change calculation below is consistent with Worksheet 2, Section II of the URRT, which only includes members on renewing plans.</p>
</blockquote>
<blockquote><p><strong>Mountain Health Cooperative (MHC)</strong> has 6,689 insureds enrolled who will be affected by 2027 Individual Market rate changes if they continue their coverage. Before federal subsidies, the average change in premium for these individuals will be 19.4%. The requested rate change varies by product with the smallest average change of 15.1% for Link Platinum and the largest average change of 50.3% for Access Catastrophic .</p>
</blockquote>
<blockquote><p><strong>Regence BlueShield of Idaho</strong> Preliminary Rate Increase Justification for 2027</p>
<p>The projected average rate change for plans effective January 1, 2027 is 8.4% which is an average rate change of about $40 per member per month (pmpm). Because 8.4% (or about $40) is an average, it is possible to have a different rate change. Factors affecting a member's premium are age, tobacco use, family composition, plan, and geographic area. Expected cost differences by product are updated every year to ensure premium differences are appropriate. Regence has approximately 23,000 members enrolled in this line of business as of March 2026.</p>
</blockquote>
<blockquote><p><strong>SelectHealth</strong></p>
<p>Rate Change</p>
<p>The Individual plan rates are increasing by 11.30 percent on average. The actual rate change varies by selected benefit plan and area. The number of individuals impacted is 31,709.</p>
<p>Contributing Factors</p>
<p>The rate change described above is driven by the following factors:</p>
<ul>
<li>The composition of the single risk pool</li>
<li>Medical and pharmacy cost increases</li>
<li>Expiration of Enhanced Subsidies</li>
<li>Changes to the Idaho High Risk Pool Reinsurance program</li>
</ul>
<p>1) The claims experience and health risk for the ACA risk pool continue to be high. Inflation and deductible leveraging are also increasing costs. 2) The utilization and costs for these plans are projected to increase for facility, provider, and pharmacy claims. 3) The enhanced subsidies expired at the end of 2025. 4) The Idaho High Risk Pool Reinsurance program is covering less of the total claims for 2027 compared to the prior year.</p>
</blockquote>
<blockquote><p><strong>St. Luke’s Health Plan, Inc.</strong></p>
<p>RATE CHANGE</p>
<p>We estimate an overall average premium rate change of 14.4% for the 20,385 individual members enrolled with St. Luke’s Health Plan, Inc. (SLHP) as of March 2026.</p>
<p>Rate changes are:</p>
<ul>
<li>+15.2% for the Expanded Bronze plan</li>
<li>+19.1% for the Expanded Bronze HDHP plan</li>
<li>+9.7% for the Silver 5800 plan</li>
<li>+13.0% for the Gold plan</li>
<li>+13.6% in Rating Areas 3 and 4</li>
<li>+16.0% in Rating Area 5</li>
</ul>
<p>MOST SIGNIFICANT FACTORS</p>
<p>The rate change described above is driven by the following factors:</p>
<ul>
<li>Changes in experience and demographics, based on SLHP’s fully credible claims experience: +1.8%</li>
<li>Changes due to Idaho’s 1332 waiver program: +2.6%</li>
<li>Medical and pharmacy cost trend: +5.3%</li>
<li>Changes in projected risk adjustment: +1.7%</li>
<li>Changes in retention: +1.7%</li>
<li>Changes in plan designs: +2.4%</li>
<li>Changes in morbidity due to the expiration of enhanced premium subsidies at the end of 2025: -1.8%</li>
</ul>
</blockquote>
<p>Meanwhile, Idaho's small group market carriers are asking for <strong>10.6% rate hikes on average:</strong></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/idaho_2027_sm_group_prelim.jpg?itok=d_X3fRh_"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/idaho_2027_sm_group_prelim.jpg?itok=d_X3fRh_" /> </a></p>
<p><strong><span style="background-color:#ffff00">UPDATE 10/1/26</span></strong>: The Idaho Insurance Dept. has posted the <a href="https://doi.idaho.gov/consumers/health-insurance/idaho-rate-review/">final, approved rates for the 2027 individual &amp; small group markets</a>. Several carriers had their rates tweaked either higher or lower; the overall impact is that unsubsidized <strong>individual market enrollees will be paying an average of 11.6%</strong> more while <strong>small group enrollees are facing 11.5% average premium increases.</strong></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/idaho_2027_indy_final.jpg?itok=kEWWuNpL"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/idaho_2027_indy_final.jpg?itok=kEWWuNpL" /> </a></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/idaho_2027_sm_group_final.jpg?itok=gCikS72F"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/idaho_2027_sm_group_final.jpg?itok=gCikS72F" /> </a></p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/idaho">Idaho</a></div><div class="field-item odd"><a href="/2027-rate-changes">2027 Rate Changes</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2">
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<pubDate>Thu, 01 Oct 2026 19:16:42 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
<guid isPermaLink="false">9943 at https://acasignup.net</guid>
<comments>https://acasignup.net/rate_changes/2027/id#comments</comments>
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<title> 2027 Rate Changes - Minnesota: +17.7% indy, +14.7% sm. group (FINAL)</title>
<link>https://acasignup.net/rate_changes/2027/mn</link>
<description><span class="submitted-by">Thu, 10/01/2026 - 2:59pm</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/thumb_minnesota_15.jpg?itok=nnBBTG6A" width="300" height="158" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><span style="color:#0000ff"><em><strong>Originally posted 06/17/2026</strong></em></span></p>
<p><a href="https://mn.gov/commerce/insurance/health/consumer-protections/rates/proposed/2027/">via the Minnesota Commerce Dept:</a></p>
<blockquote><p><strong>Individual Market Proposed Average Rate Changes for Plan Year 2027 </strong></p>
<p>The summary table below provides an overview of the proposed average rate changes from 2026 in the individual health insurance market, as reported by the insurers. </p>
<p>It is important to note these are the <strong>initial rates proposed by the insurers</strong> and filed with the Departments. Rates are <strong>subject to review and approval by the Departments,</strong> and the<strong> final approved rates may vary</strong> from these proposed rates for many reasons. </p>
<p>Additionally, the actual rate change a consumer will experience in 2027 can vary from the average – with factors such as specific plan, geographic rating area, and age playing a major role. </p>
<p><strong>...Aspirus Health Plan will be new to the exchange for Plan Year 2027.</strong> While <strong>UCare individual plans were supported throughout Plan Year 2026</strong> to ensure a smooth transition for Minnesotans after <strong>the company was acquired by Medica,</strong> UCare plans will no longer be available in Plan Year 2027.</p>
</blockquote>
<p>Thanks to my friend Louise Norris for calling my attention to this last point: While Ucare plans will no longer be available, it's not because they're pulling out of the state...<a href="https://www.medica.com/newsroom/news-releases/2026/01/medica-completes-acquisition-of-certain-ucare-contracts-and-assets">the company was bought out by Medica</a>, which presumably means that Ucare's ~28,000 exchange enrollees in Minnesota will be shifted to Medica plans instead and should still be counted as part of the annual weighted rate change calculation.</p>
<blockquote><p>Minnetonka, MN. – <strong>Medica</strong>, a Minnesota-based nonprofit health company serving more than 1.4 million members across eight states, announced the<strong> successful completion of its acquisition of certain contracts and assets from UCare, effective January 1, 2026.</strong></p>
<p>The closing of the transaction marks a significant milestone in strengthening access, stability and service for individuals, families and healthcare providers throughout Minnesota.</p>
<p>“This agreement reflects our commitment to ensuring stability and continuity for the communities we’re proud to serve,” said Lisa Erickson, CEO of Medica. “We look forward to serving our new members as we work toward our long-term strategies to advance affordability, quality and community-based care in Minnesota.”</p>
<p>The transaction was completed in accordance with state and federal requirements. Medica had announced a definitive agreement to acquire certain UCare assets and contracts in November.</p>
<p>As part of the agreement, <strong>individuals enrolled in UCare’s 2026 Medicaid and Individual and Family Plans will continue to receive services without interruption. All 2026 plans will be administered by Medica</strong>, but<strong> the plans themselves will be UCare Community Health Plan (UCHP) plans for 2026.</strong> Providers or members with questions are encouraged to visit Medica.com or for more information.</p>
</blockquote>
<p>Unfortunately the actual rate filing forms aren't available for Minnesota carriers yet, so I've had to estimate the weighted market share based on ON-EXCHANGE enrollment only (see table below) via the <a href="https://www.mnsure.org/assets/bd-2026-03-18-deck_tcm34-733367.pdf">MNsure March 2026 board of directors meeting presentation.</a></p>
<p>Assuming off-exchange enrollment is similar proportionately between the carriers, they're asking for <strong><span style="background-color:#ffff00">weighted average rate increases of 11.9%</span></strong></p>
<p><em><span style="background-color:#ffff00"><strong>IMPORTANT:</strong> Remember that these are for <strong>unsubsidized</strong> enrollees only.</span></em></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/minnesota_2027_indy_prelim.jpg?itok=Kg52Jxed"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/minnesota_2027_indy_prelim.jpg?itok=Kg52Jxed" /> </a></p>
<blockquote><p><strong>Small Group Market Proposed Average Rate Changes for Plan Year 2027</strong></p>
<p>The summary table below provides an overview of the proposed average rate changes from 2026 in the small group health insurance market, as reported by the insurers. </p>
<p>It is important to note these are the initial rates proposed by the insurers and filed with the Departments. Rates are subject to review and approval by the Departments, and the final approved rates may vary from these proposed rates for many reasons. </p>
<p>Additionally, the actual rate change a consumer will experience in 2027 can vary from the average – with factors such as specific plan, geographic rating area, age, and renewal date playing a major role.</p>
</blockquote>
<p>Again, without the actual rate filing documents I have no idea what the actual effectuated enrollment numbers are for MN's small group carriers, but the <strong>unweighted</strong> average increase being requested is 15.1%:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/minnesota_2027_sm_group_prelim.jpg?itok=zBsCfi82"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/minnesota_2027_sm_group_prelim.jpg?itok=zBsCfi82" /> </a></p>
<p><strong><span style="background-color:#ffff00">UPDATE:</span></strong> The Minnesota Commerce Dept. has published the <a href="https://mn.gov/commerce/insurance/health/consumer-protections/rates/approved/2027/">final, approved 2027 rate filings for both the individual and small group markets</a>. In addition, the <a href="https://serff-sfa.naic.org/serff/sfa/home/MN">SERFF database</a> has been updated with the actual filing forms, which means I've been able to fill in the <strong>total</strong> market enrollment figures (both on &amp; off exchange) for both markets.</p>
<p>Combined, this updated data means that the final weighted average rate increase for unsubsidized enrollees on Minnesota's <strong><span style="background-color:#ffff00">individual market policies will be around 17.7%</span></strong>, while small group enrollees are looking at <strong>14.7% average rate hikes.</strong></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/minnesota_2027_indy_final.jpg?itok=HfPo1jHz"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/minnesota_2027_indy_final.jpg?itok=HfPo1jHz" /> </a></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/minnesota_2027_sm_group_final.jpg?itok=_2UbMd2Y"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/minnesota_2027_sm_group_final.jpg?itok=_2UbMd2Y" /> </a></p>
<p>Meanwhile, on-exchange enrollment has plummeted in Minnesota (as it has in most states), with Open Enrollment plan selections down over 8% year over year and <strong>effectuated</strong> enrollment plunging by 28% in the first 2 months of 2026. <strong>Over 41,000 Minnesotans have lost ACA healthcare coverage</strong> in the North Star State:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/minnesota_effectuated_month_year_table.jpg?itok=Wq-F_9Yf"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/minnesota_effectuated_month_year_table.jpg?itok=Wq-F_9Yf" /> </a> <a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/minnesota_effectuated_month_year_graph.jpg?itok=jEA_86dX"> <img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/minnesota_effectuated_month_year_graph.jpg?itok=jEA_86dX" /> </a></p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/2027-rate-changes">2027 Rate Changes</a></div><div class="field-item odd"><a href="/tags/minnesota">Minnesota</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3">
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<pubDate>Thu, 01 Oct 2026 18:59:06 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
<guid isPermaLink="false">9891 at https://acasignup.net</guid>
<comments>https://acasignup.net/rate_changes/2027/mn#comments</comments>
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<title>2027 Rate Changes - Michigan: +14.5% indy market; +10.0% sm. group market (FINAL)</title>
<link>https://acasignup.net/rate_changes/2027/mi</link>
<description><span class="submitted-by">Wed, 09/30/2026 - 5:01pm</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/thumb_michigan_11.jpg?itok=hfr_ZBDk" width="300" height="158" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><span style="color:#0000ff"><em><strong>Originally posted 07/17/2026</strong></em></span></p>
<p>Before I begin, it's important to note that as in most states, ACA exchange enrollment has plummeted in Michigan since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year: Effectuated enrollment was <strong>down 27% year over year as of February</strong>, and has almost certainly continued to drop further since then. That's <strong>at least 131,000 fewer Michiganders enrolled in ACA healthcare coverage this year.</strong></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/michigan_effectuated_month_year.jpg?itok=9jSkbyo4"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/michigan_effectuated_month_year.jpg?itok=9jSkbyo4" /> </a></p>
<p>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:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/michigan_effectuated_graph.jpg?itok=kCXyr8tX"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/michigan_effectuated_graph.jpg?itok=kCXyr8tX" /> </a></p>
<p>With that in mind, here's the key points from the 2027 actuarial filings from the various insurance carriers participating in the Michigan individual market next. year (note that Molina is newly entering the Michigan market):</p>
<p><strong><span style="background-color:#ffff00">via Alliance Health &amp; Life Insurance Co:</span></strong></p>
<blockquote><p>4.3 PROPOSED RATE CHANGES</p>
<p>This filing reflects proposed rates for effective dates of January 1, 2027 through December 31, 2027. We develop premium rates for these Individual plans using AHL’s January 1, 2025 – December 31, 2025 Individual experience, in conjunction with internal research proprietary to AHL and other industry studies and surveys. We consider a number of items in developing the premium rates, including but not necessarily limited to:</p>
<ul>
<li>Projected morbidity level of the population anticipated to purchase the products</li>
<li>Proposed benefit plan designs</li>
<li>Anticipated medical trend, both utilization and cost of services</li>
<li>Applicable taxes and fees, including those newly applicable since 2014 under ACA</li>
<li>Anticipated risk adjustment payments (receipts)</li>
</ul>
<p>This memorandum addresses the rate increase requested for AHL’s Individual PPO product, which impacts 2027 renewals. AHL’s total single risk pool has 1,480 members as of February 2026. The rate increase being requested, weighted by current enrollment for AHL’s products, is an aggregate 14.05%. The requested rate increase varies by plan and area with a minimum change of 13.9% and a maximum change of 14.1%. These rates are effective for 12 months beginning January 1, 2027.</p>
<p>Reason for Rate Change</p>
<p>The following are the key drivers of the requested rate change.</p>
<ul>
<li>Base Experience – AHL’s Individual ACA experience is the basis for AHL’s 2027 premium rates. AHL’s claims experience is driving rate deficiency of 8.3%.</li>
<li>Trend – AHL’s 2027 annual claims trend is approximately 10.2%.</li>
<li>Risk Adjustment – The projected risk adjustment receivable is increasing relative to the filing approved effective January 1, 2026. This impacts the rate change by 1.7%.</li>
<li>Retention Charges – The load for retention is increasing relative to the filing approved effective January 1, 2026. This impacts the rate change by -6.1%.</li>
</ul>
</blockquote>
<p><strong><span style="background-color:#ffff00">via Blue Care Network of Michigan:</span></strong></p>
<blockquote><p>BCN is filing a year-over-year average rate increase for 2027 for all individual products that were offered in 2026 of 12.45%. Significant contributors to rate change are outlined in the table below:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/michigan_bcn.jpg?itok=MPsDrbta"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/michigan_bcn.jpg?itok=MPsDrbta" /> </a></p>
<p>Note this is a revised filing and takes into account only information learned subsequent to the original filing, in compliance with DIFS Bulletin 2026-14-INS. Drivers of rate change relative to the initial filing include:</p>
<ul>
<li>The 2025 experience period used as a starting point for claims projection has been revised according to an additional two months of claims runout relative to the initial filing:
<ul>
<li>Initial Filing: Incurred January 1st, 2025 to December 31st, 2025, paid through March 31st, 2026</li>
<li>Current Filing: Incurred January 1st, 2025 to December 31st, 2025, paid through May 31st, 2026</li>
</ul>
</li>
<li>Trend in 2026 has been revised to incorporate year-to-date 2026 experience, which has emerged considerably higher than previously projected.</li>
<li>Risk Adjustment has been revised to incorporate new information regarding actual 2025 risk adjustment results, and emerging 2026 morbidity and premium information.</li>
<li>Assumed relative risk levels between BCN and other carriers has been revised based on emerging yearto-date 2026 experience, which has been incorporated into the above mentioned 2026 trend and risk adjustment estimate.</li>
<li>Revisions to incorporate an updated Insurance Provider Assessment of $8.29 PMPM.</li>
</ul>
<p>The above-mentioned changes encompass only new information that could not have been reasonably known when the rates were originally filed.</p>
<p>Additional detail around the assumptions utilized in the rate development process is included in the following sections of this memorandum.</p>
<p>Although the rates for each product were based on the projected experience for the single risk pool as noted in Section 12 of this memorandum, the rate changes vary by product and plan. While the primary drivers of rate change variation by plan are changes in cost sharing provisions and updates to the Paid to Allowed Ratios as described in Section 8 of this memorandum, changes in network discount and other model changes can also contribute to variations by plan. <strong>Rating impacts of ARPA Subsidy expiration are detailed in Section 22.</strong></p>
<p><strong>...BCN’s individual book of business is projected to decrease by 11.5% from experience period enrollment of approximately 95,000 members in 2025 to approximately 84,000 members in 2027</strong>. BCN used 2026 enrollment as the starting point for the 2027 membership projection. <strong><span style="background-color:#ffff00">The key driver of the membership decrease is the ARPA subsidy expiration</span></strong>, though additional adjustments were made based on marketplace and historical trends as well as actions anticipated by competitor plans.</p>
<p>...Section 22: ARPA Impact</p>
<p><strong>Impact of enhanced subsidy expiration</strong>: We are projecting <strong>an approximate 5% increase in rates driven by market morbidity</strong>, of which 4% is already realized in 2026.</p>
<p><strong>Impact if enhanced subsidies are restored</strong>: We are projecting <strong>an approximate 2.5% rate reduction, driven by a decrease in rates due to improved market morbidity.</strong> However, we are not projecting a full reversal of the 5% noted above, as members that left the market may not return and there may be other market drivers that we will evaluate at that time. Thus we believe a range of impacts to be between 0% and 5.0%.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">via Blue Cross Blue Shield of Michigan:</span></strong></p>
<blockquote><p>BCBSM is filing a year-over-year average rate increase for 2027 for all individual products that were offered in 2026 of 12.93%. Significant drivers of the rate change include:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/michigan_bcbsmi.jpg?itok=-Auf6taP"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/michigan_bcbsmi.jpg?itok=-Auf6taP" /> </a></p>
<p>*The geographic coverage impact line represents the impact of discontinuing certain renewing plans within certain rating areas.</p>
<p>Note this is a revised filing and takes into account information learned subsequent to the original filing, in compliance with DIFS Bulletin 2026-14-INS. Drivers of rate change relative to the initial filing include:</p>
<ul>
<li>The 2025 experience period used as a starting point for claims projection has been revised according to an additional two months of claims runout relative to the initial filing:
<ul>
<li>Initial Filing: Incurred January 1st, 2025 to December 31st, 2025, paid through March 31st, 2026</li>
<li>Current Filing: Incurred January 1st, 2025 to December 31st, 2025, paid through May 31st, 2026</li>
</ul>
</li>
<li>Trend in 2026 has been revised to incorporate year-to-date 2026 experience, which has emerged considerably higher than previously projected</li>
<li>Risk Adjustment has been revised to incorporate new information regarding actual 2025 risk adjustment results, and emerging 2026 morbidity and premium information.</li>
<li>Assumed relative risk levels between BCBSM and other carriers has been revised based on emerging year-to-date 2026 experience, which has been incorporated into the above-mentioned 2026 trend and risk adjustment estimate.</li>
<li>Revisions to incorporate an updated Insurance Provider Assessment of $8.29 PMPM.</li>
</ul>
<p>The above-mentioned changes encompass only new information that could not have been reasonably known when the rates were originally filed.</p>
<p>Additional detail around the assumptions utilized in the rate development process is included in the following sections of this memorandum.</p>
<p>Although the rates for each product were based on the projected experience for the single risk pool as noted in Section 12 of this memorandum, the rate changes vary by product and plan. While the primary drivers of rate change variation by plan are changes in cost sharing provisions and updates to the Paid to Allowed Ratios as described in Section 8 of this memorandum, changes in network discount and other model changes can also contribute to variations by plan. Rating impacts of ARPA Subsidy expiration are detailed in Section 22.</p>
<p>...BCBSM’s individual book of business is projected to decrease by 30.3%, from experience period enrollment of approximately 58,000 members in 2025 to approximately 40,000 members in 2027. BCBSM used 2026 enrollment as the starting point for the 2027 membership projection. The key driver of the membership decrease is the ARPA subsidy expiration, though additional adjustments were made based on marketplace and historical trends.</p>
<p><strong>...Impact of enhanced subsidy expiration</strong>: We are projecting an <strong>approximate 5% increase in rates driven by market morbidity</strong>, of which 4% is already realized in 2026.</p>
<p><strong>Impact if enhanced subsidies are restored</strong>: We are projecting <strong>an approximate 2.5% rate reduction,</strong> driven by a decrease in rates due to improved market morbidity. However, we are not projecting a full reversal of the 5% noted above, as members that left the market may not return and there may be other market drivers that we will evaluate at that time. Thus we believe a range of impacts to be between 0% and 5.0%.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">via Health Alliance Plan:</span></strong></p>
<blockquote><p><strong>4.3 PROPOSED RATE CHANGES</strong></p>
<p>This filing reflects proposed rates for effective dates of January 1, 2027 through December 31, 2027.</p>
<p>We develop premium rates for these Individual plans using HAP’s January 1, 2025 – December 31, 2025 Individual experience, in conjunction with internal research proprietary to HAP and other industry studies and surveys. We consider several items in developing the premium rates, including but not necessarily limited to:</p>
<ul>
<li>Projected morbidity level of the population anticipated to purchase the products</li>
<li>Proposed benefit plan designs</li>
<li>Anticipated medical trend, both utilization and cost of services</li>
<li>Applicable taxes and fees, including those newly applicable since 2014 under ACA</li>
<li>Anticipated risk adjustment payments (receipts)</li>
</ul>
<p>This memorandum addresses the rate increase requested for HAP’s Individual HMO product, which impacts 2027 renewals. HAP’s total single risk pool has 2,256 members as of February 2026. The rate change being requested, weighted by current enrollment for HAP’s products, is an aggregate 12.60%. The requested rate change varies by plan and area with a minimum change of 12.6% and a maximum change of 12.6%. These rates are effective for 12 months beginning January 1, 2027.</p>
<p><strong>Reason for Rate Change</strong></p>
<p>The following are the key drivers of the requested rate change.</p>
<ul>
<li>Base Experience – HAP’s Individual ACA experience is the basis for HAP’s 2027 premium rates. HAP’s claims experience is driving rate deficiency of 3.8%.</li>
<li>Trend – HAP’s 2027 annual claims trend is approximately 10.0%.</li>
<li>Risk Adjustment – The projected risk adjustment payable is increasing relative to the filing approved effective January 1, 2026. This impacts the rate change by 4.9%.</li>
<li>Retention Charges – The load for retention is increasing relative to the filing approved effective January 1, 2026. This impacts the rate change by -6.2%.</li>
</ul>
</blockquote>
<p><strong><span style="background-color:#ffff00">via McLaren Health Plan:</span></strong></p>
<blockquote><p>McLaren will sell individual policies with effective date of January 1 st , 2027.</p>
<p>...The average annual premium for 2027 is $10,328.89, which is $860.74 PMPM (4.21 of URRT WK2 x 12). The average annual premium for 2026 is $8,646.07, which is $720.51 PMPM (2.13 of URRT WK2 x 12). As of March 2026, there are 3,191 policy holders and 4,701 covered lives affected by this proposed rate change. The average overall rate increase is 16.25% (1.12 of URRT WK2).</p>
<p><strong><span style="background-color:#ffff00">We have applied an explicit 1.032 morbidity adjustment due to expected market changes based on the expiration of the enhanced Premium Tax Credits (ePTC)</span></strong> made available under the American Rescue Plan Act, as well as additional policy considerations.</p>
<p>...A morbidity adjustment was applied to 2024 McLaren experience to translate base morbidity to 2027 projected morbidity. We estimated expected differences in the morbidity defined as plan liability risk score (2024 HHS model) normalized by the average induced demand, the average actuarial value, and demographic factor between the base period and the projection period. Because this ratio includes components of age and area, we back out the Step 6 manual demographic adjustment to arrive at a WACA morbidity adjustment shown in Step 7 of Appendix A. An additional morbidity adjustment was made due to reflect the policy adjustment described above. We applied the same adjustment as described in the experience portion of the memorandum.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">via Meridian Health Plan of MI:</span></strong></p>
<blockquote><p>Reasons for Rate Increase(s):</p>
<p>The rate projections for 2027 have been updated from the previous year’s projections to reflect the most recent assumptions and information available.</p>
<p>The following provides a narrative description of the significant factors driving the proposed rate increase for 2027.</p>
<ul>
<li>Single Risk Pool Experience and Morbidity (10.8% of premium impact versus 2026 filed rates)</li>
</ul>
<p>The individual single risk pool experience underlying the rate projections has been updated. The current model reflects the projected utilization trend applied to adjusted experience (from 2025 to 2027), including anticipated changes in the average morbidity of the single risk pool. There is a full description of utilization trend and other projection factors applied to experience in Section 6, ’Trend Factors’.</p>
<p>Risk adjustment transfer experience for 2027 includes consideration of changes to the statewide average premium, the Risk Adjustment program, and Meridian Health Plan of Michigan enrollee population morbidity relative to the Michigan single risk pool.</p>
<ul>
<li>Unit Cost trend ( 6.5% of premium impact versus 2026 filed rates) Unit costs and provider reimbursement agreements have been updated to reflect changes in the rating year.</li>
</ul>
<ul>
<li>Utilization trend ( 3.3% of premium impact versus 2026 filed rates)</li>
</ul>
<p>The projected utilization trends are consistent with observed historical trends based on internal analysis of our marketplace experience, supplemented by the Milliman Health Cost Guidelines. There is a description of the Health Cost Guidelines in Section 8, "Manual Rate Adjustments".</p>
<ul>
<li>Changes in Administrative Expenses and Profit ( 2.1% of premium impact versus 2026 filed rates)</li>
</ul>
<p>Changes in general administrative expenses incorporated into 2027 rates are resulting in a rate change due to differences from prior year expense assumptions. See Section 12, "Plan Adjusted Index Rate", for details on projected non-benefit expenses. Note that the requested rate change may not be the same across all plans within a product due to changes to the member cost sharing amounts by plan. Additionally, the defunding of CSR subsidies has contributed to the rate levels being higher than if the subsidies were to be funded.</p>
<p><strong>...Impact of eAPTC Expiration</strong></p>
<p>To account for eAPTC expiration prior to the 2027 benefit year, <strong>we have assumed rates will increase due to anticipated reductions in enrollment, both at the issuer and single risk pool level</strong>. <strong><span style="background-color:#ffff00">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</span></strong>, worsening the average morbidity of the individual risk pool.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">via Molina Healthcare of MI:</span></strong></p>
<p>(newly entering the Michigan market)</p>
<blockquote><p>This filing assumes CSRs remain unfunded throughout 2027. Rates and assumptions contained herein are no longer actuarially sound if this changes for plan year 2027. If the regulatory environment changes, Molina will work with the state to incorporate changes in an actuarially sound manner.</p>
<p>Molina’s rate filing reflects the following rate changes by metal tier for Molina’s membership. <strong>Molina has 0 members in plans that are renewing and 0 members in plans that are terminating for a total of 0 members enrolled effective March 2026 and reported as of April 2026. Similarly, Molina has 0 policyholders in plans that are renewing and 0 policyholders in plans that are terminating for a total of 0 policyholders. </strong>The rate change calculation below is consistent with Worksheet 2, Section II of the URRT, which only includes members and policyholders on renewing plans.<strong><span style="background-color:#ffff00"> Since Molina does not have any members for 2026, the rate change result is zero.</span></strong></p>
<p>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.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">via Oscar Insurance Co:</span></strong></p>
<blockquote><p>3. Proposed Rate Increases Reason for Rate Increase(s)</p>
<p>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 March 2026, the proposed average rate change for renewing plans is 11.9%. This rate change is absent of rate changes due to attained age.</p>
<p>The significant factors driving the proposed rate change are described in the following attribution summary and are displayed quantitatively in Table 1.</p>
<ul>
<li>Description / Value</li>
<li>Claim Experience in 2025 8.7%</li>
<li>Market Morbidity 3.1%</li>
<li>Medical and Prescription Drug Trend -1.0%</li>
<li>Prospective Benefit Changes -0.1%</li>
<li>Admin, Taxes and Fees, and Risk Margin 1.2%</li>
<li><strong>Total 11.9%</strong></li>
</ul>
<p>Anticipated Changes in the Average Morbidity of the Covered Population</p>
<p>Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.</p>
<p>Medical and Prescription Drug Inflation and Utilization Trends</p>
<p>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. Average cost trends were developed based on Oscar’s anticipated reimbursement levels. Utilization trends were developed at the broad service category level: inpatient facility, outpatient facility, professional, other, and prescription drugs.</p>
<p>Prospective Benefit Changes</p>
<p>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.</p>
<p>Administrative Expenses, Taxes and Fees, and Risk Margin</p>
<p>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.</p>
<p><strong>...Morbidity Adjustment</strong></p>
<p>An adjustment was included to reflect changes in the anticipated market morbidity in response to the uncertainty inherent in the marketplace. Specifically, Oscar anticipated changes to the market morbidity associated with the change in Michigan’s enrollment for the projection period relative to the experience period, d<strong><span style="background-color:#ffff00">ue to the ending of the enhanced subsidies introduced by the American Rescue Plan Act,</span></strong> as well as the several new enrollment and eligibility procedures and requirements introduced by regulations including, but not limited to, the 2025 Marketplace Integrity and Affordability Proposed Rule and the HHS Notice of Benefit and Payment Parameters for 2027 Proposed Rule.</p>
<p>This adjustment reflects the projected change in claim costs outside of the underlying demographics of the covered population and is also assumed when estimating the risk adjustment transfer for the projection period.</p>
<p>A factor of 1.078 is included in the “Morbidity Adjustment” entry on Worksheet 1, Section II of the URRT</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">via Priority Health:</span></strong></p>
<blockquote><p>The reasons for the rate change include:</p>
<ul>
<li>Updated experience upon which the rates are based.</li>
<li>Updated medical and prescription Rx cost and utilization trends.</li>
<li>Updated benefit relative values, which may cause variation in rate changes by plan.</li>
<li>Prospective benefit adjustments to existing products; the benefit relative values have been updated, which may cause variation in rate changes by plan.</li>
<li><strong><span style="background-color:#ffff00">Anticipated morbidity impact from the continued impacts of EPTC subsidy expiration in 2026.</span></strong></li>
<li>Anticipated changes in the payments to the Federal Risk Adjustment program incorporating the estimated 2025 Risk Adjustment Transfer Payment.</li>
<li>Updated factors for administrative expenses and margin. With this filing, the margin varies by plan.</li>
<li>Updated taxes and fees.</li>
<li>Updated Silver CSR Load.</li>
</ul>
<p>The overall average annual increase which will be experienced by members over January 1, 2026 filed rates is an 11.08% increase.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">via UnitedHealthcare Community Plan:</span></strong></p>
<blockquote><p>UHC will sell Individual policies with an effective date of January 1, 2027. The 2027 aggregate rate change as shown on the Unified Rate Review Template (URRT) is 25.54%. Rate changes by plan are found in Worksheet 2, row 1.11 of the URRT. The quantitative impact for all significant factors driving the proposed rate change is shown in the table below.</p>
<ul>
<li>Components of Rate Change / % Change</li>
<li>Base Experience 6.9%</li>
<li>Trend 11.4%</li>
<li>Regulatory Morbidity 2.5%</li>
<li>Benefit Design and CSR Load 4.6%</li>
<li>Non-Benefit Expenses -1.4%</li>
<li>Other -0.3%</li>
<li><strong>Total 25.54%</strong></li>
</ul>
<p><strong>EXPIRATION OF ENHANCED SUBSIDIES</strong></p>
<p><strong><span style="background-color:#ffff00">A 1.173 adjustment was applied to account for the expiration of enhanced premium subsidies passed under the American Rescue Plan Act (ARP</span></strong>) and extended by the Inflation Reduction Act (IRA). Due to the expiration of the enhanced premium subsidies effective 1/1/2026, <strong>UHC observed a decline in enrollment due to higher post-subsidy premiums</strong>. <strong><span style="background-color:#ffff00">Healthier members are expected to leave at a disproportionately higher rate than those with significant healthcare needs</span></strong>, increasing market morbidity in 2026. This estimate is based on internal modeling using historical Wakely National Risk Adjustment Reporting (WNRAR) data, Marketplace Open Enrollment Period Public Use Files, and Wakely Early Enrollment Reporting for 2026</p>
</blockquote>
<p>Put them all together and you get the following, although according to the <a href="https://www.michigan.gov/difs/-/media/Project/Websites/difs/OIRF/EHB/PDFs/2027_Proposed_Rate_Changes.pdf?rev=87d2b8fa3b6640c8a793034479bb3ee0&amp;hash=6DA0F3AC9BC2375ACEAF49307F4FEC9F">official Michigan Dept. of Insurance &amp; Financial Services summary page</a> the weighted averages are slightly lower for both the Individual and Small Group markets for some reason:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/2027_michigan_indy_prelim_0.jpg?itok=ucaMeOOM"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/2027_michigan_indy_prelim_0.jpg?itok=ucaMeOOM" /> </a></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/2027_michigan_sm_group_prelim.jpg?itok=MDhMgLzM"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/2027_michigan_sm_group_prelim.jpg?itok=MDhMgLzM" /> </a></p>
<p><strong><span style="background-color:#ffff00">UPDATE 9/30/26</span></strong>: There's still no official press release from the <a href="https://www.michigan.gov/difs/industry/insurance/affordable-care-act/marketplace-plan-rate-information">Michigan Dept. of Financial Services</a>, but the <a href="https://serff-sfa.naic.org/serff/sfa/home/MI">SERFF database</a> has been updated with what appear to be the <strong>final/approved rate filings</strong> for both the individual and small group market.</p>
<p>There's been only minor tweaks to a few of the filings, but most of them have been approved pretty much exactly as is across both markets. A few of the <strong>effectuated enrollment figures</strong> have been revised, however, which did cause very slight shifts in the weighted averages.</p>
<p>Overall, the average increase for the <strong>individual market will be around 14.5%</strong> while <strong>small group plans are going up 10.0% on average.</strong></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/michigan_2027_indy_final.jpg?itok=1GUL3xEm"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/michigan_2027_indy_final.jpg?itok=1GUL3xEm" /> </a></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/michigan_2027_sm_group_final.jpg?itok=wIG8gh2_"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/michigan_2027_sm_group_final.jpg?itok=wIG8gh2_" /> </a></p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/michigan">Michigan</a></div><div class="field-item odd"><a href="/2027-rate-changes">2027 Rate Changes</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4">
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<pubDate>Wed, 30 Sep 2026 21:01:23 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
<guid isPermaLink="false">9931 at https://acasignup.net</guid>
<comments>https://acasignup.net/rate_changes/2027/mi#comments</comments>
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<title>2027 Rate Changes - Rhode Island: +12.4% indy, +3.8% sm. group, +9.5% lg. group (FINAL)</title>
<link>https://acasignup.net/rate_changes/2027/ri</link>
<description><span class="submitted-by">Wed, 09/30/2026 - 4:26pm</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/thumb_rhode_island_7.jpg?itok=rLzebB-m" width="300" height="158" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><span style="color:#0000ff"><em><strong>Originally posted 06/20/2026</strong></em></span></p>
<p><a href="https://ohic.ri.gov/sites/g/files/xkgbur736/files/2026-06/Rate%20Review%20Process%20Press%20Release%20-%20Requested%20Rates%20June%202026.pdf">via the Rhode Island Insurance Commissioner:</a></p>
<blockquote><p><strong>2027 Requested Commercial Health Insurance Rates Have Been Submitted to OHIC for Review</strong></p>
<p>The Office of Health Insurance Commissioner (OHIC) today released the individual, small group, and large group market premium rates requested by Rhode Island’s insurers. The requests were filed as part of OHIC’s rate review process (for coverage effective on or after January 1, 2027).</p>
<p>“Health insurers are once again seeking rate increases to cover the rising cost of health care and other expenses,” said Health Insurance Commissioner Cory King. He continued: “OHIC will thoroughly review these requests to determine whether they are justified.”</p>
<p>Two insurers, Blue Cross Blue Shield of Rhode Island (BCBSRI) and Neighborhood Health Plan of Rhode Island (NHPRI), filed rates for plans to be sold on the individual market to people and families who do not receive insurance through their employer.</p>
<p><strong>In the individual market </strong>requested average rate increases for 2027 coverage range from 9.8% for BCBSRI to 24.9% for NHPRI. <strong>The weighted average increase of individual market requests for 2027 is 20.1%</strong>, compared to requested increase of 23.8% for 2026 coverage. Last year, OHIC approved an average individual market rate increase of 21.0% for 2026 coverage.</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/rhode_island_2027_indy_prelim.jpg?itok=1rHAArfG"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/rhode_island_2027_indy_prelim.jpg?itok=1rHAArfG" /> </a></p>
<p><strong>In the small group market</strong>, insurers requested average increases for 2027 ranging from 7.7% to 19.0%. <strong>The weighted average increase of small group market requests for 2027 is 8.7%</strong>, compared to the average requested increase of 22.0% for 2026 coverage. Last year, OHIC approved an average small group market rate increase of 17.6% for 2026 coverage.</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/rhode_island_2027_small_group_prelim.jpg?itok=nW7GkGC6"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/rhode_island_2027_small_group_prelim.jpg?itok=nW7GkGC6" /> </a></p>
<p>Five insurers – BCBSRI, UnitedHealthcare, Harvard Pilgrim Health Care of New England, Inc (HPHC)/HPHC Insurance Company (HPIC), Aetna, and Cigna – filed large group rates. Large group market requested average rate increases for 2027 range from 12.2% to 34.9%. The weighted average increase of large group market requests in 2027 is 15.5%, compared to the average requested increase of 24.1% for 2026 coverage. Last year, OHIC approved an average large group market rate increase of 19.3% for 2026 coverage.</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/rhode_island_2027_large_group_prelim.jpg?itok=uWijcuIJ"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/rhode_island_2027_large_group_prelim.jpg?itok=uWijcuIJ" /> </a></p>
<p>OHIC will review all data, pricing assumptions, administrative charges, and other information to assess the reasonability of the premium requests by each insurer. The Commissioner may approve as filed, modify, or reject an insurer’s rate filing in accordance with powers vested in the Office by the Rhode Island General Laws. Approval decisions on rates are based on data, actuarial analysis, and the requirements of Rhode Island law.</p>
<p>The proposed rate increases <strong>do not apply to self-funded employer groups that account for approximately 65% of Rhode Islanders with employer-sponsored coverage</strong>. Self-funded employers pay the health care expenses of their employees and dependents directly, commonly relying on health insurance companies for administrative services, such as member enrollment, provider contracting, and claims processing.</p>
<p>OHIC will also review each health insurer’s coverage and benefit contracts with consumers to ensure that plans sold in Rhode Island meet all benefit, access, and member cost sharing standards required by state and federal law. OHIC’s final decision to approve, modify, or reject the proposed rates is expected in mid-September.</p>
<p>This year the individual market rates filed by NHPRI will be considered as part of an administrative hearing process. The hearing is scheduled for the following dates:</p>
<ul>
<li>NHPRI Hearing: July 14th and July 15th.</li>
</ul>
<p>Additional details on the rate hearing can be found in the Public Comment Solicitation. OHIC will accept written public comments on the proposed rates through Friday July 24, 2026. Comments may be submitted in writing via email to <a href="mailto:OHIC.HealthInsInq@ohic.ri.gov">OHIC.HealthInsInq@ohic.ri.gov</a>.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">Blue Cross Blue Shield of RI:</span></strong></p>
<blockquote><p>Blue Cross &amp; Blue Shield of Rhode Island (“BCBSRI”) has submitted its annual rate filing for the individual market. This document gives an overview of that filing.</p>
<p>Scope and Range of the Rate Increase:</p>
<p>BCBSRI has calculated the weighted average rate increase for BCBSRI plans, before reflecting changes due to age, as 9.8%.</p>
<p>The range of rate increases for BCBSRI plans, before reflecting changes due to age, which consumers will experience is: 6.9% to 31.0%.</p>
<p>The actual increase for an individual now enrolled will vary based upon:</p>
<ul>
<li>the age of each person enrolled;</li>
<li>the plan chosen; and</li>
<li>if the person is eligible for federal subsidies.</li>
</ul>
<p>This filing impacts about 16,138 individuals now enrolled with BCBSRI and new customers joining after January 1, 2027. These individuals are enrolled either:</p>
<ul>
<li>directly with BCBSRI; or</li>
<li>through Rhode Island’s health insurance marketplace (HealthSource RI).</li>
</ul>
<p>The rate increase will take effect January 1, 2027. Rates will stay in effect until December 31, 2027.</p>
<p><strong>Key Drivers for this Filing:</strong></p>
<p>The rate increase for 2027 is due in large part to the continuing increase in the total cost of health care in Rhode Island.</p>
<p><strong>Significant inflation in the cost of goods and services in all sectors of the economy has had a profound impact on the cost of medical services</strong>, and BCBSRI expects to see <strong>substantial increases in provider unit costs for 2027</strong>. <strong>Specialty drug treatments also account for a large part</strong> of the increase in medical costs. Additionally, <strong>increases in how often and how much health care is received</strong> are driving an increase in rates for 2027. <strong>Required increases in primary care provider payments</strong> are also contributing to the rate increase.</p>
<p>Administrative costs factor into this filing as well. These include state and federal taxes, such as the state premium tax, and a state fee used to fund HealthSource RI. The state fee used to fund HealthSource RI adds 1.6% to the rate.</p>
<p><strong>This filing reflects a projected medical loss ratio (“MLR”) of 86.0% using the federal formula</strong>. The MLR is the percent of each premium dollar that we spend to pay for healthcare services and activities that improve the quality of care of our members. The federal government requires an MLR of 80% or higher in the individual market.</p>
<p><strong>Changes in Benefits:</strong></p>
<p>At the same time as this filing, BCBSRI submitted our 2027 health plans to the Office of the Health Insurance Commissioner for approval. The plan filing includes benefit changes consistent with state and federal regulations, including changes to:</p>
<ul>
<li>cost sharing amounts; and</li>
<li>annual out of pocket maximums.</li>
</ul>
<p>These benefit changes will take effect on January 1, 2027.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">Neighborhood Health Plan:</span></strong></p>
<blockquote><p>Neighborhood Health Plan of Rhode Island’s (Neighborhood) mission is to be an innovative health insurance company that, in partnership with Rhode Island’s Community Health Centers, secures access to high quality, cost-effective health care for Rhode Island’s at-risk populations. In service of this mission, Neighborhood has submitted its annual rate filing for the individual market. An overview of the filing is described below.</p>
<p><strong>Scope and range of increase:</strong></p>
<p>Weighted Average Rate Increase: 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 24.9%.</p>
<p>The range of rate changes, before reflecting changes in age, which consumers will experience, is approximately 17.9% to 29.3%.</p>
<p>The key drivers of this rate change, further described below, are an<strong> increase in medical services costs</strong> driven by <strong>required hospital rate increases tied to inflation and pharmacy costs</strong>, as well as an <strong>increase from anticipated growth in risk adjustment transfers.</strong> There is uncertainty in impacts of <strong>inflation</strong> beyond the hospital rate increase (particularly due to expanded primary care coverage mandates), <strong>uncertainty in market size due to Medicaid eligibility requirements</strong>, and <strong>significant high costs for new drugs coming on the market</strong>. Neighborhood’s financial health is a key component in being able to continue to offer the lowest priced products in the Marketplace.</p>
<p><strong>Financial experience of product:</strong></p>
<p>In January 2014, Neighborhood for the first time offered individual insurance coverage through HealthSource RI (HSRI). Stable membership from 2015 through 2025 has allowed Neighborhood to develop rates based on actual experience. Neighborhood retained actuarial expertise who utilized models along with Neighborhood’s commercial market experience to prepare the premium rates for individual market plans to be offered on HSRI and directly with Neighborhood in 2027.</p>
<p>Reserves have been established that allow Neighborhood to continue serving our members and maintain financial stability. Since Neighborhood first started offering products on HSRI in calendar year 2014,</p>
<p>Neighborhood’s commercial reserves have contributed to total reserves on average by 7% annually. Neighborhood will continue to grow our reserves by including a 7.0% contribution in this filing.</p>
<p><strong>Changes in Benefits:</strong></p>
<p>Neighborhood has updated the benefit packages in 2027 to comply with federal Actuarial Value (AV) requirements. These benefit changes impacted the rate change by approximately -2.0%, which reduced the overall rate increase.</p>
<p><strong>Changes in Medical Service costs:</strong></p>
<p><strong>A main driver of premium increases includes a higher percentage of members electing bronze level plans in 2026 that is anticipated to be sustained in 2027, increasing medical costs on paid claims for our members</strong> resulting in an approximate 8.9% medical/prescription drug annual trend assumption. Components of this trend also include increases in unit costs of medical services due to inflation, increased medical utilization, primary care coverage mandates, increases in specialty drug expenses, technology advances in medicine, equipment and drugs, changes in network provider contracts, and other factors. To ensure members are getting the best high quality, cost-effective health care, Neighborhood regularly reviews medical expenses to find innovative ways to decrease medical costs for our members.</p>
<p><strong>Administrative costs and anticipated profits:</strong></p>
<p>Neighborhood is committed to high quality, cost-effective health care which involves managing administrative costs by increasing operating efficiencies and reducing unnecessary expenditures.</p>
<p>Administrative cost changes resulted in a negligible increase to average premium. This does not include taxes and fees.</p>
<p><strong>Neighborhood anticipates that 87.3% of premium dollars (net of taxes and fees) will go towards medical expenses.</strong> This is an estimate that will be subject to change based on medical trends and other adjustments under federal regulations as well as emerging experience. Federal requirements under the ACA state at least 80% of premium dollars need to be utilized for medical expenses. If less than 80% of premium dollars go towards medical expenses under the federal requirement, members will receive a premium rebate based on the difference. Neighborhood is in compliance with ACA regulations.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">UPDATE 9/30/26:</span></strong> The Rhode Island Insurance Commissioner has published the <a href="https://ohic.ri.gov/sites/g/files/xkgbur736/files/2026-09/Rate%20Review%20Process%20Press%20Release%20-%20Approved%20Rates%20September%202026%20final.pdf">final, approved rate changes for the 2027 individual, small and large group carriers</a>, along with information about their <strong>new state-based subsidy program</strong> which is launching next year:</p>
<blockquote><p><strong>2027 Commercial Health Insurance Rates Approved with Modifications</strong></p>
<ul>
<li><strong>Approved average rate increases for each market are lower than 2026. Implementation of new state programs underway to make health care more affordable and lower cost trends.</strong></li>
</ul>
<p>CRANSTON, R.I. (September 29, 2026) – Commercial health insurance premiums for 2027 newly approved by the State of Rhode Island’s Office of the Health Insurance Commissioner (OHIC) will save Rhode Islanders $86.7 million in 2027 compared to what the commercial health insurers initially requested. Rates are going up overall primarily due to rising health care costs.</p>
<p><strong>The average approved rate increase for the 2027 individual market is 12.4%</strong>, 7.7 percentage points lower than the average requested increase. For the 2027 <strong>small group market, the average approved rate increase is 3.8%</strong>, 4.9 percentage points lower than the average requested increase. <strong>At 9.5%, the approved average large group market rate increase</strong> is 6 percentage points lower than the average requested increase.</p>
<p>“Rising health care costs continue to present a financial burden and barrier to care for too many Rhode Islanders,” said Health Insurance Commissioner Cory King. “The Office of the Health Insurance Commissioner is committed to working in collaboration with all stakeholders to make health care more affordable.”</p>
<p>In the months since the rate filings were submitted in May, OHIC has reviewed the medical and pharmacy expense trend assumptions, administrative charges, and margin requests for each insurer. Additionally, OHIC staff reviewed the benefit coverage documents for each health plan to ensure compliance with state and federal laws.</p>
<p>OHIC’s rate review produced several changes to the rates requested by insurers in May. Key changes include:</p>
<ul>
<li><strong>Medical utilization and severity trend assumptions</strong>: OHIC performed its own trend analysis and identified changes to insurers’ medical utilization and severity trend assumptions. OHIC adopted these changes to lower rates.</li>
<li><strong>Insurer administrative costs</strong>: OHIC’s decision caps administrative cost increases at the rate of general inflation, excluding food and energy commodities.</li>
<li><strong>State health insurance fee</strong>: The General Assembly repealed the approximately $4 per person per month fee established in the FY 2026 budget, as requested by Governor McKee. This was removed from the 2027 premiums.</li>
</ul>
<p><strong>Easing Consumer Cost Burden</strong></p>
<p>In a program proposed by Governor McKee in the FY 2027 budget and funded by the General Assembly, Rhode Islanders who purchase their own coverage through HealthSource RI may qualify for new state premium subsidies in 2027 under the <a href="https://healthsourceri.com/stayconnected/">Rhode Island Marketplace Affordability Program</a>. The program, created in response to the expiration of enhanced federal premium tax credits, <strong>provides financial assistance to about 20,000 income-eligible customers to help make health insurance more affordable.</strong></p>
<p>To address rising health care costs, Governor McKee included in his FY 2027 budget recommendation a legislative proposal drafted by OHIC to increase accountability for health care cost growth by insurers and large provider entities, while emphasizing increased investment in primary care. The General Assembly approved this recommendation in June. The law provides OHIC new authorities to set health care cost growth targets and all-payer primary care investment targets, collect and publicly report data, hold an annual public hearing, and require performance improvement plans for health care entities that exceed the cost growth targets. The new law is informed by OHIC’s analysis of approaches taken in California, Connecticut, Delaware, Massachusetts, Oregon, and Washington.</p>
<p>Overview of Approved Rates</p>
<p>Tables 1 – 3, below, summarize the approved rates for 2027 and the enrollment with each insurer, by market, as of March 2026. The rate change approved by OHIC is shown along with the rate change requested by the insurers in the May filings. <strong>Overall, the OHIC approved weighted average rate changes are 12.4% for the individual market, 3.8% for the small group market, and 9.5% for the large group market.</strong></p>
</blockquote>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/rhode_island_2027_indy_final.jpg?itok=APov8lf3"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/rhode_island_2027_indy_final.jpg?itok=APov8lf3" /></a></p>
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<pubDate>Wed, 30 Sep 2026 20:26:12 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
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<title>Addressing the 35% "Phantom Enrollee" Zombie Lie...again</title>
<link>https://acasignup.net/26/09/29/addressing-35-phantom-enrollee-zombie-lieagain</link>
<description><span class="submitted-by">Tue, 09/29/2026 - 1:20pm</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/thumb_zombie.jpg?itok=LOp61hWU" width="300" height="158" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><blockquote><p>"In other words, Republicans’ insistence that they have a superior alternative to Obamacare is <strong><span style="background-color:#ffff00">a zombie lie — a claim that should be dead after having been proved false again and again, but it is still shambling along, eating people’s brains</span></strong>."</p>
<p><a href="https://www.nytimes.com/2020/06/29/opinion/obamacare-coronavirus-republicans.html">--Paul Krugman, NY Times, 6/29/20</a></p>
</blockquote>
<p>This is perhaps the 3rd or even 4th time that I've written a post debunking this particular Republican zombie lie, but usually I've included it as part of <a href="https://acasignups.net/25/09/28/how-full-shit-hill-op-ed-let-me-count-ways">a larger post debunking other silly claims</a> as well. Since it's making the rounds again I figured I should write something up which addresses it standalone.</p>
<p>Over the weekend, Assistant U.S. Attorney General for Fraud Colin McDonald went on FOX News and, while discussing &amp; defending the Trump Regime's <a href="https://acasignups.net/26/09/22/breaking-vanceoz-kick-760000-aca-coverage-andor-subsidies-based-fraud-claims-predicted-ai">announcement last week that they've kicked ~760,000 ACA enrollees off of their coverage</a> due to suspected (not proven, mind you) fraud, he made the following claim:</p>
<blockquote><p>"<strong>Apparently 35% of people have never even used their Obamacare account</strong> for any health services. <strong><span style="background-color:#ffff00">That is a statistical impossibility</span></strong> and it's because <strong><span style="background-color:#ffff00">these are not real people</span></strong> seeking real care. <strong><span style="background-color:#ffff00">These are fraudsters</span></strong> who have exploited their names to put them on the Obamacare roles."</p>
</blockquote>
<p>The "35% have never used their policy" claim is based on <a href="https://paragoninstitute.org/paragon-prognosis/the-rise-of-phantom-obamacare-enrollees-biden-covid-credits-drive-massive-increase-in-individual-market-enrollees-with-no-medical-claims/">an analysis done by Brian Blase of the Paragon Institute</a>. However, there's some <strong><span style="background-color:#ffff00">major problems</span></strong> with the <a href="https://www.cms.gov/files/document/enrolleeswithoutclaims-2019-24.xlsx">underlying data released from the Centers for Medicare &amp; Medicaid Services</a> (CMS).</p>
<p><strong><span style="background-color:#ffff00">First up: Is this really a "statistical impossibility?"</span></strong></p>
<p>Many others besides me have made the obvious points that <a href="https://yougov.com/en-us/articles/50576-who-are-the-most-accident-prone-drivers-in-america">around half of car owners say they've never actually utilized their auto insurance</a>, and the vast majority of people with mortgages never file a claim on their homeowner's insurance in a given year (only <a href="https://www.rubyhome.com/blog/house-fire-stats/">1 out of 413 houses in the U.S. catch on fire per year</a>...obviously there are other types of damage like flooding or a tree falling through the roof which might cause a claim, but you get my point).</p>
<p>Perhaps health insurance is a different story, however?</p>
<p>Let's listen to <a href="https://x.com/MattAFiedler">Matt Fiedler</a>, Senior Fellow at the Center on Health Policy at the Brookings Institute. <a href="https://x.com/MattAFiedler/status/1958581096439824693">He addressed this very issue last August</a> in a brilliant Twitter thread which I'm reposting below (reformatted for easier readability in a blog format); I hope he's OK with my doing so:</p>
<blockquote><p><strong>To start, it’s common for insured people to have no claims in a year;</strong> not everyone needs care. Is the 35% figure for individual market enrollees unreasonably high, as claimed?</p>
<p>Using the MEPS [<a href="https://meps.ahrq.gov/mepsweb/">Medical Expenditure Panel Survey</a>], I estimate that about <strong><span style="background-color:#ffff00">15%</span> of non-elderly people with 12 months of group* coverage in 2022 had no medical spending,</strong> even though no one thinks phantom enrollees exist in the group market.</p>
</blockquote>
<p><em>*<strong>Group coverage</strong> = <strong>Employer-sponsored</strong> insurance, as opposed to <strong>individual market </strong>(ACA exchange) insurance.</em></p>
<p>So, right off the bat we've already accounted for over 40% of the so-called "phantom enrollees." Moving on...</p>
<blockquote><p>And, as others have noted, <strong>there’s good reason to expect the individual market rate to be *much* higher</strong>: individual market enrollees are <strong>typically enrolled for <span style="background-color:#ffff00">only part of the plan year</span></strong>. <strong>Fewer months enrolled mechanically means <span style="background-color:#ffff00">fewer chances to incur claims</span>.</strong></p>
<p>Concretely, other CMS* data show <strong><span style="background-color:#ffff00">Marketplace enrollment spells averaged only ~8 months in the FFM states in 2024</span></strong>. That’s enough to <strong>explain much of the difference between CMS’ estimate </strong>of the individual market no-claims rate and my 15% group market estimate.</p>
</blockquote>
<p><em>*CMS = The Centers for Medicare &amp; Medicaid Services...aka the very division of the Health &amp; Human Services Dept. which Dr. Oz is in charge of.</em></p>
<p>In other words, the average person with employer-sponsored insurance is far more likely to be enrolled in that policy for the full 12 months than the average person with ACA coverage, who is generally someone who's either self-employed or who works for a small employer which doesn't provide coverage for them...both of whom tend to be less pinned down to a specific home address, have much more variable incomes from one month to the next, etc.</p>
<p>Also, as another health insurance industry colleague (who prefers to remain nameless...they work for a large insurer &amp; are an expert on health insurance risk adjustment) put it after reviewing the Paragon analysis:</p>
<blockquote><p>The short version is that the EWOC [Enrolled Without Claims] “total enrollees” <strong><span style="background-color:#ffff00">counts enrollees multiple times if they change plans</span></strong>. It is impossible to say how many EWOCs there are in a state, but <strong>Paragon/WSJ’s numbers are inaccurate</strong> and really a measure of <strong>enrollee/plan combinations that double-counts anyone who changed plans during the year</strong>.</p>
<p>Of course there are plenty of other problems with Paragon’s analysis, but this one basically means<strong> the numbers they’re publishing are wrong</strong> and the phenomena driving the trends they identify <strong>may have very little to do with fraud.</strong></p>
</blockquote>
<p>In other words, if you enroll in a <strong>Blue Cross</strong> plan for 6 months but then <strong>move out of state</strong> and switch to, say, a <strong>Molina</strong> plan for the other 6 months of the year and don't happen to visit the doctor once the entire year, guess what? They're counting that as <strong>2</strong> enrollees "not filing a claim all year" instead of one.</p>
<p>Getting back to Fiedler's thread:</p>
<blockquote><p>Here’s the math. <strong>Suppose enrollees have a 14.6% chance of generating a claim each month</strong>. I’ve chosen this percentage so that if a person was enrolled for 12 months, they’d have a 15% (= [1-0.146]^12) chance of having no claims, matching my group market estimate.</p>
<p><strong>Now suppose that the exact same enrollees were enrolled for only 8 months</strong> (the FFM average). <strong><span style="background-color:#ffff00">In that case, we’d expect 28%</span> (= [1-0.146]^8]) to incur no claims.</strong></p>
<p>There are lots of ways one could refine this calculation, but refinements could actually make the effect of enrollment duration differences larger. What’s clear is that duration matters *a lot*. Plus<strong> there could be other big differences between the individual &amp; group markets.</strong></p>
</blockquote>
<p>We've already accounted for at least 80% of the supposedly "statistically impossible" 35% "phantom enrollee" figure, and this is just the low-hanging fruit.</p>
<blockquote><p><strong>Bottom line: it’s unsurprising that the individual market has a sizeable no-claims rate</strong>, especially given its relatively short enrollment durations. Given that, <strong>these data do not provide persuasive evidence that “phantom” enrollments are widespread.</strong></p>
<p>Some have also highlighted the fact that the share of enrollees without claims rose substantially from 2020 to 2024. <strong>But that’s exactly what we’d expect in a period where enhanced subsidies attracted many (real) new enrollees into the market.</strong></p>
<p>Prior research has found that subsidy expansions tend to pull in enrollees who use less care—and are thus less likely to incur claims—than those already in the market. For particularly high-quality evidence on this point, <a href="https://www.aeaweb.org/articles?id=10.1257/aer.20171455">see here</a></p>
</blockquote>
<p>In the next portion of his thread, Fiedler addresses another fascinating, if ironic, flaw in the argument being used by the Trump Regime: That insurance carriers are supposedly pocketing billions of dollars thanks to all of this alleged "fraud" via "phantom enrollees:"</p>
<blockquote><p><strong>There’s also another serious flaw...</strong><strong><span style="background-color:#ffff00">even if there were lots of phantom enrollees</span>, health insurers wouldn’t “get the benefit,” and it wouldn’t impose the claimed large costs on the federal government.</strong></p>
<p>In particular, the “tens of billions” cost estimate they both cite appears to be derived by <strong>assuming that the presence of phantom enrollees would result in additional federal subsidy payments and no other changes.</strong> That assumption is indefensible.</p>
<p>To see why, suppose there were a surge of phantom enrollees into the market. <strong>Total claims spending in the market would remain the same, but *per enrollee* claims spending would fall</strong>. Premiums would follow, and, by design, Marketplace subsidies follow premiums.</p>
<p><strong>So the gov’t would pay for more enrollees but pay less for each one</strong>. On net, federal costs would likely rise only slightly, and mainly because there would be a modest cost shift from unsubsidized enrollees (whose premiums fall) to the gov’t, not because insurers got a windfall.</p>
</blockquote>
<p>For the math on this, I'm going to flip Fiedler's example around:</p>
<p>Let's suppose you have an insurance carrier with <strong>exactly 100,000 enrollees</strong> whose policies cost <strong>an average of $750/mo apiece</strong> at full price and who receive <strong>an average of $570/mo in federal tax credits</strong>, leaving them <strong>paying an average of $180/mo apiece</strong> (the actual national averages for 2025 were <a href="https://acasignups.net/2026_oep/final/03">$741, $563 &amp; $178</a>, but I'm using round numbers for illustrative purposes). Let's say that 35% of them (35,000) were indeed Phantom Enrollees.</p>
<p>To simplify it even further, let's assume that 100% of these enrollees remain enrolled for all 12 months, and none of the Phantom Enrollees were being double-counted.</p>
<p>If so, this means:</p>
<ul>
<li>Premiums for all 100,000 enrollees would total $750 x 12 x 100,000 = <strong><span style="background-color:#ffff00">$900 million </span></strong>for the year</li>
<li>Federal tax credits would total $570 x 12 x 100,000 = $684 million</li>
<li>Net premiums for the enrollees would total $180 x 12 x 100,000 = $216 million</li>
</ul>
<p>The first adjustment we have to make is that these are averages only--the actual full price premiums vary widely depending on the enrollee, plan, carrier etc. Again, to keep things simple, I'm going to assume that all of them are enrolled in the same policy, are the same age, and so forth.</p>
<p>The actual tax credits per enrollee <strong>also</strong> vary widely, however, and I can't ignore that, since the <strong>entire premise</strong> of the "phantom enrollee" theory is that they're among those who pay <strong>nothing</strong> in net premiums after tax credits are applied...because if they received an invoice for even $1/month and failed to pay it, they'd eventually be kicked off of their policies.</p>
<p>In other words, in this example, all 35,000 of these (alleged) Phantom Enrollees are getting a full ride: Mr. &amp; Mrs. U.S. Taxpayer are shelling out <strong>the full ~$9,000/year</strong> to insurance carriers for policies which no one is actually enrolled in!</p>
<p>The Trump Regime is arguing that these "phantom enrollees" mean that insurance carriers are <strong>pocketing a stunning $315 million per year</strong> in taxpayer money for enrollees who don't exist. If so, it stands to reason that <strong>terminating all 35,000 policies would save taxpayers that amount, right?</strong></p>
<p><strong><span style="background-color:#ffff00">Well...no, actually.</span></strong></p>
<p>What you have to remember is that under the <a href="https://acasignups.net/19/08/07/important-updates-my-half-assed-mlr-explainer-or-how-much-will-be-rebated-2019-2020">Affordable Care Act's Medical Loss Ratio (MLR) rule</a>, insurance <strong>carriers are legally required to spend at least 80% of gross premium dollars on actual medical claims</strong> (it's actually 85% for large group plans, but we're sticking with the individual market here).</p>
<p>If they spend <strong>less</strong> than 80% on claims (on a 3-year rolling average), they have to <strong>pay back the balance to the policyholders</strong> in the form of a rebate check. This is a real thing which I've written about many times before: Every year, up to several million ACA enrollees r<strong>eceive rebate checks </strong>which can range from just a few dollars to several thousand dollars! <a href="https://www.cms.gov/files/document/2024-rebates-state.pdf">In 2025 alone</a>, <strong>over 5 million enrollees received nearly $1.2 billion in rebates averaging $233 per enrollee!</strong></p>
<p>Why is this relevant? Because it means that a <strong><span style="background-color:#ffff00">minimum of $720 million </span></strong>of that $900 million total has to go to pay for <strong><span style="background-color:#ffff00">actual medical claims</span></strong>, leaving just $180 million for the insurance carrier's <strong>gross</strong> (not net) margin.</p>
<p><strong>Do you see where I'm going with this?</strong></p>
<p>If 35,000 of the enrollees don't actually exist, that means that <strong>the 65,000 who do exist <em>really did rack up $720 million in medical claims</em></strong> that year (give or take). I mean, from the insurance carrier's perspective, those 35,000 "phantoms" are the equivalent of a healthy 20-yr old college kid who never does anything dangerous and who blows off his mother whenever she nags him to "at least go in for a checkup!"</p>
<p>How does removing them from the risk pool change the math? Well, before, you had $720M / 100,000 = average medical claims of ~$7,200 apiece. Now you have the same $720M divided across just 65,000 people...or <strong>average medical claims of over $11,000 apiece!</strong></p>
<p><em>The risk pool has instantly become 54% more expensive on a per-enrollee basis.</em></p>
<p>What does this mean for the insurance carrier? Well, for starters, it means that <strong>they're gonna have to jack up their premiums the following year.</strong></p>
<p>Remember, this year they're only charging an average of $750/month at full price. They'll have to charge <strong>at least</strong> $923/mo next year...and that's just to cover the actual medical claims (note that in this example I'm not even considering inflation or other factors). In order to make a 10% <strong>gross</strong> margin, they'll have to charge $1,026/mo on average, and in order to make the highest margin they're legally allowed to <strong><span style="background-color:#ffff00">they'll have to charge each enrollee $1,154/mo on average...again, a 54% rate hike.</span></strong></p>
<p>OK, so the unsubsidized enrollees are screwed, but what about the taxpayers? Certainly <strong>they'd</strong> save money by doing this, right?</p>
<p>Well, no...because <strong><span style="background-color:#ffff00">the federal subsidies would also have to increase by a similar amount in order to keep the net premiums for subsidies enrollees at roughly the same thresholds they're at this year.</span></strong></p>
<p>Remember, ACA subsidies are structured on <strong>a sliding scale based on your household income.</strong> Even without the enhanced subsidies, the <a href="https://acasignups.net/25/09/30/114-new-75-i-warned-net-aca-rate-hikes-will-increase-even-more-if-improved-tax-credits">standard ACA subsidy formula</a> states that if your household income is up to 150% of the federal poverty level, you only have to pay around 4.2% of it in premiums for the "benchmark" Silver plan; if it's ~200% FPL you only have to pay around 6.6% in premiums, and so on.</p>
<p>Under this formula, a single adult who earns $30,000/year (192% FPL) <strong>only has to pay $155/month for the benchmark plan regardless of how much that plan costs at full price</strong>.</p>
<p>If it costs $750/mo this year, they receive $595/mo in tax credits</p>
<p>If the premium jumps to $1,154/mo next year, <strong>they'll still only have to pay (roughly) $155/mo</strong>...which means <strong>they'll receive around $999/mo in subsidies.</strong></p>
<p>The exact dollar amounts and percentages would vary a bit for a variety of reasons, but the point is that from a strict federal budgetary POV, the federal government would likely end up paying--and the insurance carriers would receive, in aggregate--<strong><span style="background-color:#ffff00">roughly the same amount in tax credits as it does now</span></strong>...just <strong><span style="background-color:#ffff00">spread out across fewer enrollees.</span></strong></p>
<p>Now, does this mean that <strong>actual</strong> cases of fraud should be shrugged off? Not at all: If any of these "zero-claim" enrollees really do turn out to be nonexistent, then yes, their policies should indeed be terminated and those involved in the fraudulent enrollment should absolute be held accountable.</p>
<p>For one thing, the <strong>reason</strong> why this type of fraud exists in the first place is because of <a href="https://acasignups.net/24/04/02/ugh-kff-reports-important-security-flaw-healthcaregov">unscrupulous insurance brokers who do it in order to pocket the commission</a>. That really <strong>is</strong> fraud which really <strong>does</strong> cost both taxpayers <strong>and the insurance carriers real money</strong>, since brokers can typically earn around $15 - $20 per member per month...which is paid by the insurance carrier, which of course bakes that cost into their premiums as well.</p>
<p>If you assume $18 PMPM on average, that amounts to around $216/year per enrollee, so in my hypothetical example, giving all 35,000 "phantoms" the boot would theoretically save the insurance carrier (and, thus, the U.S. federal government) around...<strong>$7.6 million</strong>, or <strong>roughly 1.1%</strong> of the total federal tax credits.</p>
<p>And again, remember that <strong>all of this assumes that all 35% really don't exist to begin with</strong>, which, as Fiedler explains above, is <strong>extremely</strong> unlikely. My personal guess is that actual "phantom" enrollees only make up perhaps a tenth of this estimate at most, although the <strong>other</strong> fraud problem (brokers <a href="https://acasignups.net/24/04/02/ugh-kff-reports-important-security-flaw-healthcaregov">signing real people up without their knowledge or permission</a>) may very well make up a decent number of cases as well.</p>
<p>THAT type of fraud (by a subsection of insurance <strong>brokers/agents</strong>, NOT by any actual <strong>enrollees themselves</strong>) really <strong>does</strong> cause real harm to people, in two ways:</p>
<ul>
<li><strong>First</strong>, if someone has been enrolled in a $0-premium plan for months without knowing it and <strong>their actual income</strong> turns out to be <strong>higher </strong>than the income <strong>projected</strong> by the asshole broker who illegally enrolled them, the enrollee may be on the hook to pay a chunk (or even all) of the subsidies back when they file their taxes the following year even though they never touched the insurance they didn't even know they had.</li>
</ul>
<ul>
<li><strong>Second</strong>, in some cases brokers were apparently <strong>switching enrollees from one insurance carrier to another</strong> without their knowledge/permission. This can be absolutely devastating to the enrollee when they try <strong>filing</strong> a claim with the carrier they're supposed to be enrolled with only to discover that they're no longer enrolled in that policy...and that the doctor/hospital/etc that they're filing the claim with isn't in network with the carrier they've been illegally switched to.</li>
</ul>
<p>BOTH of <strong>THESE</strong> scenarios, to the extent that they've actually been happening <strong>absolutely are serious fraud </strong>and the brokers/agents responsible should not only lose their certifications, but should be prosecuted if possible. At a bare minimum they should be required to be the ones to either repay any subsidies owed or the uninsured medical bills for their victims.</p>
<p>It's also worth noting that even if all 760,000 enrollees who were flagged really were "improperly enrolled" (regardless of whether they "don't exist," were enrolled w/out their knowledge/permission, or for some other reason), that would still only be around 3 - 4% of the total ACA enrollment population. As a colleague of mine noted, <strong><span style="background-color:#ffff00">"</span><em><span style="background-color:#ffff00">a 4% fuzzy rate under very generous standards means program integrity is high."</span></em></strong></p>
<p>For comparison, there are <a href="https://bipartisanpolicy.org/explainer/what-is-program-integrity/">18 other federal programs across other departments which had "improper payment rates" exceeding 10%</a> in 2024 totaling ~$58 billion (and before you start pinning the blame on the Biden Administration, the GAO found that there were <a href="https://www.gao.gov/products/gao-20-344">$175 billion in improper federal payments in fiscal year 2019 during the first Trump Administration</a>).</p>
<p>In short, I'm all for cracking down on <strong>actual</strong> fraud, but <em>"1.1% in savings at the outside assuming 100% of all of those accused really are guilty"</em> is a far cry from the <strong>35%</strong> savings implied by this talking point...and yes, Mr. McDonald, plenty of real, flesh &amp; blood people have been known to go many months or even several years without ever seeing a doctor once.</p>
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<pubDate>Tue, 29 Sep 2026 17:20:00 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
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<title>CMS posts enrollment report: ANOTHER 800,000 Americans lost Medicaid/CHIP coverage in June 2026</title>
<link>https://acasignup.net/26/09/28/cms-posts-enrollment-report-another-800000-americans-lost-medicaidchip-coverage-june-2026</link>
<description><span class="submitted-by">Mon, 09/28/2026 - 11:23am</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/twitter_cms_logo_3.jpg?itok=2Sn7xuD3" width="300" height="158" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>The Trump Regime has <a href="https://www.medicaid.gov/resources-for-states/downloads/eligib-oper-and-enrol-snap-jun2026.pdf">published an update to the official Medicaid/CHIP enrollment data:</a></p>
<blockquote><p><strong>April 2026 Key Findings</strong></p>
<p><strong>Medicaid and CHIP Enrollment</strong></p>
<ul>
<li><strong>In June 2026</strong>, <strong>73.2 million individuals </strong>were enrolled in Medicaid and CHIP.</li>
<li><strong>66.0 million individuals </strong>were enrolled in Medicaid, and<strong> 7.2 million individuals </strong>were enrolled in CHIP.</li>
<li><strong>38.1 million adults were enrolled in Medicaid</strong>, and there were <strong>35.0 million Medicaid child and CHIP enrollees.</strong></li>
</ul>
</blockquote>
<p>Total Medicaid/CHIP enrollment in June 2026 <strong><span style="background-color:#ffff00">dropped about 1.1% from May 2026</span></strong>, or <strong><span style="background-color:#ffff00">another </span><strong><span style="background-color:#ffff00">~808,0</span></strong><span style="background-color:#ffff00">00</span><span style="background-color:#ffff00"> people.</span></strong></p>
<p>The all-time high enrollment watermark for Medicaid/CHIP was in <a href="http://acasignups.net/23/07/31/cms-releases-april-2023-enrollment-data-medicaidchip-enrollment-peaked-941m-actually-more">April 2023</a>, when it officially hit <strong>94.1 million Americans</strong> (<strong>95.7 million when you include the U.S. territories</strong>).</p>
<p>It's important to note that CMS actually has two different reports on Medicaid enrollment: The monthly <a href="https://www.medicaid.gov/medicaid/program-information/medicaid-chip-enrollment-data/medicaid-and-chip-enrollment-trend-snapshot/index.html">Medicaid &amp; CHIP Enrollment Trend Snapshot</a> (referenced above) and the <a href="https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/medicaid-enrollment-data-collected-through-mbes/index.html">Medicaid Budget &amp; Expenditure System (MBES)</a>.</p>
<p>Each type of report measures Medicaid enrollment a bit differently:</p>
<blockquote><ul>
<li><strong>The MBES report is a year out of date</strong> (through <a href="https://acasignups.net/26/02/06/cms-posts-medicaid-expansion-enrollment-june-2025-204-million-nationally">June 2025</a>) while the <strong>Trend Snapshot is only 4 months out of date</strong> (through March 2026).</li>
<li><strong>MBES</strong> includes <strong>individuals enrolled in limited benefit plans</strong>.</li>
<li>MBES data represents the count of unduplicated individuals enrolled at <strong>any time during each month</strong>, while the Performance Indicator data captures individuals enrolled on <strong>the last day of the month.</strong></li>
<li>MBES only includes individuals whose coverage is funded through Medicaid while the published <strong>Performance Indicator also includes individuals funded through CHIP.</strong></li>
<li>MBES and Performance Indicator data may be <strong>derived from different state systems.</strong></li>
<li><strong>Retroactive state adjustments to MBES or Performance Indicator data</strong> may be in progress.</li>
<li>States have likely generated MBES data and Performance Indicator data from <strong>state systems on different dates.</strong></li>
<li>MBES includes the U.S. territories: <strong>American Samoa, Guam, N. Mariana Islands, Puerto Rico </strong>and the <strong>U.S. Virgin Islands</strong>.</li>
</ul>
</blockquote>
<p>The MBES numbers for <strong><span style="background-color:#ffff00">U.S. territories</span></strong> stood at <strong>1.44 million Medicaid enrollees as of June 2025.</strong><strong> </strong>If you add those to the Trend Snapshot total for the 50 states +DC, it comes in at <strong><span style="background-color:#ffff00">74.6 million as of June 2026.</span></strong></p>
<p>It's also worth noting that ACA Medicaid <strong>Expansion</strong> enrollment specifically was <a href="https://acasignups.net/26/02/06/cms-posts-medicaid-expansion-enrollment-june-2025-204-million-nationally">20.4 million as of June 2025 according to the MBES report</a>, down around 3.6 million from the all-time high it reached in May 2023.</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/medicaid_chip_enrollment_202606.jpg?itok=clb5CBA1"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/medicaid_chip_enrollment_202606.jpg?itok=clb5CBA1" /> </a></p>
<p>Between <strong>January 2025</strong> (when Trump took office again) and <strong>June 2026</strong>, <strong><span style="background-color:#ffff00">net Medicaid/CHIP enrollment has dropped by over 6.2 million people, or 7.8%.</span></strong></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/medicaid_chip_enrollment_202606_vs_202605.jpg?itok=O738GVRA"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/medicaid_chip_enrollment_202606_vs_202605.jpg?itok=O738GVRA" /> </a></p>
<p>This ranges from virtually <strong>no net enrollment change at all in Oklahoma</strong> to as much as a <strong><span style="background-color:#ffff00">23.7% drop in Medicaid/CHIP enrollment in Indiana</span></strong>, where there are 421,000 fewer Hoosiers enrolled in either program than at the beginning of Trump 2.0.</p>
<p>In terms of raw numbers, the largest decline in enrollment is <strong>California</strong>, as you'd expect, where <strong><span style="background-color:#ffff00">over 1.8 MILLION residents have been removed from the Medicaid/CHIP rolls</span></strong> since January 2025 (a 13.7% drop).</p>
<p>Of course, Medicaid/CHIP enrollment dropping isn't <strong>necessarily</strong> a bad thing<strong> if</strong> the reason is because those folks instead moved to other types of comprehensive healthcare coverage instead such as individual coverage (ACA marketplace), Medicare or employer-sponsored coverage. However, given <a href="https://acasignups.net/26/07/09/small-enough-drown-bathtub-how-trump-congressional-republicans-are-shrinking-aca-enrollment">what's happening with the ACA marketplace</a> this year and that <strong>200,000 more Americans were unemployed</strong> in <a href="https://www.bls.gov/news.release/pdf/empsit.pdf">June 2026</a> vs. <a href="https://www.bls.gov/opub/ted/2025/number-of-unemployed-at-6-9-million-in-december-2024.htm">December 2024</a>, that's not terribly comforting.</p>
<p>Medicare enrollment, on the other hand, <a href="https://acasignups.net/26/09/01/cms-posts-may-2026-medicare-data-705-million-total">has gone up by over 1.74 million</a> since January 2025, which does cancel out some of the Medicaid/CHIP losses...except that most of those additional Medicare enrollees didn't shift from Medicaid/CHIP. Most of them aged out from employer coverage, while some turned 65 and transitioned from ACA policies or other types of healthcare coverage.</p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/cms">CMS</a></div><div class="field-item odd"><a href="/tags/medicare">Medicare</a></div><div class="field-item even"><a href="/tags/medicaid">Medicaid</a></div><div class="field-item odd"><a href="/tags/chip">CHIP</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_7">
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<pubDate>Mon, 28 Sep 2026 15:23:24 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
<guid isPermaLink="false">9979 at https://acasignup.net</guid>
<comments>https://acasignup.net/26/09/28/cms-posts-enrollment-report-another-800000-americans-lost-medicaidchip-coverage-june-2026#comments</comments>
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<title>2027 Rate Changes - Tennessee: +15.6% indy market; +14.7% sm. group market (FINAL)</title>
<link>https://acasignup.net/rate_changes/2027/tn</link>
<description><span class="submitted-by">Mon, 09/28/2026 - 9:15am</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/thumb_tennessee_4.jpg?itok=S-dxa5LH" width="300" height="158" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><span style="color:#0000ff"><em><strong>Originally posted 08/11/2026</strong></em></span></p>
<p>ACA exchange<strong> enrollment has dropped by over 14% in Tennessee</strong> since <strong>Congressional Republicans allowed the enhanced federal subsidies to expire</strong> at the end of last year.</p>
<p>Initial <strong>signups</strong> during Open Enrollment were down<strong> 11.4%</strong> vs. OEP 2025...but <strong>effectuated enrollment</strong> dropped by 14% year over year as of February.</p>
<p>That's <strong><span style="background-color:#ffff00">over 72,000 Tennesseans who already lost coverage in just the first two months of the year</span></strong>...a number which has likely continued to climb since then.</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/tennessee_effectuated_month_year_table_0.jpg?itok=x5HYIN_F"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/tennessee_effectuated_month_year_table_0.jpg?itok=x5HYIN_F" /> </a></p>
<p>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:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/tennessee_effectuated_month_year_graph.jpg?itok=wS4nQnb1"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/tennessee_effectuated_month_year_graph.jpg?itok=wS4nQnb1" /> </a></p>
<p>Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the <a href="https://ratereview.healthcare.gov/">federal Rate Review database:</a></p>
<p><strong><span style="background-color:#ffff00">ALLIANT HEALTH PLANS:</span></strong></p>
<blockquote><p>The purpose of this justification is to explain the rate increases for the following Alliant Health Plans (Alliant) individual comprehensive medical plans in Tennessee with effective dates of January 1, 2027 through December 31, 2027. This justification is intended 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). This justification may not be appropriate for purposes or scopes beyond those described above and, therefore, should not be used for other purposes.</p>
<p><strong>This justification specifically addresses the rate increase requested for the SoloCare products, which impacts 4,373 members. The average rate increase across all plans from the most recently approved rates effective January 1, 2026 is 23.3%. The minimum and maximum rate changes are 16.1% and 27.5%, respectively, and vary bybene fit plan.</strong></p>
<p>2. CHANGES IN EXPERIENCE BASIS</p>
<p>Alliant’s 2025 claims experience, both direct Tennessee experience as well as the Georgia experience underlying the manual rate, was unfavorable relative to the 2024 claims experience used in developing 2026 rates.</p>
<p>3. CHANGES IN MEDICAL SERVICE COSTS AND TREND ASSUMPTIONS</p>
<p>The projection of claims from Alliant’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.</p>
<p>4. CHANGES IN BENEFITS</p>
<p>Alliant will make cost sharing modifications by plan to comply with the final 2027 Actuarial Value Calculator and to align with Alliant’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.</p>
<p>5. CHANGES IN RISK ADJUSTMENT</p>
<p>Alliant’s projected 2027 risk adjustment payable increased relative to the payable assumed in the 2026 rates.</p>
<p>6. EXPIRATION OF EXPANDED ADVANCE PREMIUM TAX CREDIT SUBSIDIES</p>
<p><strong><span style="background-color:#ffff00">It is expected the expiration of expanded Advance Premium Tax Credit subsidies will result in higher market morbidity due to the expected mix of enrollees remaining in the market.</span></strong></p>
</blockquote>
<p><strong><span style="background-color:#ffff00">BANKERS RESERVE LIFE INSURANCE:</span></strong></p>
<blockquote><p>Bankers Reserve Life Insurance Company of Wisconsin 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 Tennessee Department of Commerce and Insurance, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Tennessee to assist in the review of Bankers Reserve Life Insurance Company of Wisconsin’s individual rate filing.</p>
<p>The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions.</p>
<p>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.</p>
<p><strong>The proposed rate change of 18.1% applies to approximately 882 individuals. </strong>Bankers Reserve Life Insurance Company of Wisconsin’s projected administrative expenses for 2027 are $95.83 PMPM. Administrative expense does not include $12.54 for taxes and fees. The historical administrative expenses for 2026 were $78.95 PMPM, which excludes taxes and fees. The projected loss ratio is 88.9% which satisfies the federal minimum loss ratio requirement of 80.0%.</p>
<p> </p>
</blockquote>
<p><strong><span style="background-color:#ffff00">BLUE CROSS BLUE SHIELD OF TN:</span></strong></p>
<blockquote><p>BlueCross BlueShield of Tennessee is requesting approval for rate changes that average 10.4% across our ACA-compliant individual health plans. Our proposed rates factor in expected changes in our medical costs and retention.</p>
<p>Our requested rate changes are necessary to cover what we expect to pay out for the medical care our members need and cover operating expenses for on- and off-Marketplace individual plans in 2027 based on previous experience.</p>
<p><strong>As of April 2026, we have around 92,000 members who will be affected by our proposed changes if they elect to renew their plans for 2027.</strong> While the average rate increase is 10.4%, the amount each member would actually pay in 2027 will vary based on which plan they select, along with other factors like their income level, network selection, location, and age.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">CELTIC/CENTENE:</span></strong></p>
<p><em>(Unfortunately, Celtic Insurance Co's actuarial memo is heavily redacted, so I had to come up with a rough guesstimate as to their spring 2026 enrollment based on the <strong>total</strong> on-exchange enrollment as of February and the other carrier enrollment data).</em></p>
<p><strong><span style="background-color:#ffff00">CIGNA:</span></strong></p>
<p><em>(<a href="https://acasignups.net/26/04/30/cigna-sez-sayonara-another-major-carrier-bailing-aca-exchanges-next-year">Cigna announced last spring that they are pulling out of the individual market nationally</a>. I don't know their spring 2026 enrollment in Tennessee specifically, so I've guesstimated it to be perhaps 70,000 based on their spring 2025 enrollment.)</em></p>
<p><strong><span style="background-color:#ffff00">OSCAR INSURANCE CO:</span></strong></p>
<blockquote><p>The purpose of this document is to present rate change justification for Oscar Insurance Company (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).</p>
<p><strong>Using in-force business as of March 2026 , the proposed average rate increase for renewing plans is 18.7%.</strong> 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. <strong>The rate increase impacts an estimated 89,993 members.</strong></p>
<p>The significant factors driving the proposed rate change include the following:</p>
<p>Medical and Prescription Drug Infl ation and Utilization Trends</p>
<p>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.</p>
<p>Administrative Expenses, Taxes and Fees, and Risk Margin</p>
<p>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.</p>
<p>Prospective Benefit Changes</p>
<p>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.</p>
<p>Anticipated Changes in the Average Morbidity of the Covered Population</p>
<p>Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.</p>
<p>Anticipated Changes in the Network Configuration</p>
<p>Changes to the overall premium level are needed because of anticipated changes in the underlying network configuration and associated unit costs.</p>
</blockquote>
<p><strong><span style="background-color:#ffff00">UNITEDHEALTHCARE INSURANCE CO:</span></strong></p>
<blockquote><p><strong>UHIC is filing 2027 rates for individual products. The proposed rate change is 28.68% and will affect 66,697 individuals</strong>. The rate changes vary between 25.63% and 39.1%. Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes.</p>
<p>Financial Experience of the Product</p>
<p>The premium collected in plan year 2025 was $516,198,330. Incurred claims during this period were $407,939,426 and UHIC expects to pay $64,915,566 in risk adjustment. The loss ratio, or portion of premium required to pay medical claims, for plan year 2025 is 90.40%.</p>
<p>Changes in Medical Service Costs</p>
<p>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:</p>
<ul>
<li>Increasing cost of medical services: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies.</li>
<li>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.</li>
<li>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.</li>
<li>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.</li>
<li><strong>Reduction of premium subsidies: Expanded and enhanced federal premium tax credits for consumers expired at the end of 2025. As a result, there will be sicker members on average in the insurance pool as healthier members exit the market.</strong></li>
</ul>
<p>Changes in Benefits</p>
<p>Changes in benefits impact costs and therefore affect premium changes. Plan benefits are typically changed for one of three reasons: to comply with the requirements of the Affordable Care Act or state law, to respond to consumer feedback, or to address a particular medical cost issue to provide greater long-term affordability of the product.</p>
<p>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.</p>
<p>Administrative Costs and Anticipated Margins</p>
<p>UHIC works to directly control administrative expenses by adopting better processes and technology and developing programs and innovations that make healthcare more affordable. We have led the marketplace by introducing key innovations that make healthcare services more accessible and affordable for customers, improve the quality and coordination of healthcare services, and help individuals and their physicians make more informed healthcare decisions.</p>
<p>Taxes and fees imposed by the state and federal government are significant factors that impact healthcare spending and must be included as additional administrative costs associated with the plans. These fees include Affordable Care Act taxes and fees which impact health insurance costs and need to be reflected in premium. Another component of premium is margin, which is set to address expected volatility and risk in the market.</p>
<p>The requested rate change is anticipated to be sufficient to cover the projected benefit and administrative costs for the 2027 plan year.</p>
</blockquote>
<p>Combined, the weighted average rate increase being requested for 2027 individual market policies in Tennessee is <strong><span style="background-color:#ffff00">15.9%.</span></strong></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/tennessee_2027_indy_prelim.jpg?itok=2vPVQQaa"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/tennessee_2027_indy_prelim.jpg?itok=2vPVQQaa" /> </a></p>
<p>As for the Tennessee <strong>small group market</strong>, it looks like one carrier is leaving (Guarantee Trust) while the remaining three are seeking an <strong>unweighted</strong> average increase of <strong><span style="background-color:#ffff00">14.7%.</span></strong></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/tennessee_2027_sm_group_prelim.jpg?itok=B8HAg2yd"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/tennessee_2027_sm_group_prelim.jpg?itok=B8HAg2yd" /> </a></p>
<p><strong><span style="background-color:#ffff00">UPDATE 9/28/26</span></strong>: The final, approved rate filings have been <a href="https://serff-sfa.naic.org/serff/sfa/home/TN">posted to the Tennessee SERFF database</a>. Most rates for both the individual and small group markets were approved as is, although there were a few changes which mostly canceled each other out (Oscar went from 18.7% to 21.4%; UHC went from 28.7% to 24.5%). A few of the effectuated enrollment numbers were also filled in and/or modified:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/tennessee_2027_indy_final.jpg?itok=1swSCs2v"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/tennessee_2027_indy_final.jpg?itok=1swSCs2v" /> </a> <a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/tennessee_2027_sm_group_final.jpg?itok=oy6L4VaM"> <img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/tennessee_2027_sm_group_final.jpg?itok=oy6L4VaM" /> </a></p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/tags/tennessee">Tennessee</a></div><div class="field-item odd"><a href="/2027-rate-changes">2027 Rate Changes</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_8">
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<pubDate>Mon, 28 Sep 2026 13:15:48 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
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<title>NATIONALLY, unsubsidized ACA premiums to jump *ANOTHER* ~15% next year (UPDATED)</title>
<link>https://acasignup.net/rate_changes/2027/national</link>
<description><span class="submitted-by">Fri, 09/25/2026 - 3:00pm</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/thumb_rate_changes_8.jpg?itok=8tkGwWry" width="300" height="158" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><em><strong><span style="background-color:#ffff00">Originally posted 8/31/26</span></strong></em></p>
<p><strong><span style="background-color:#ffff00">SEE BELOW FOR IMPORTANT UPDATES!!</span></strong></p>
<p>I've finally completed my <a href="https://acasignups.net/rate_changes/2027/main">state-by-state individual &amp; small group health insurance market</a> analyses of the <strong>preliminary 2027 rate filings</strong> for <strong>all 50 states</strong> (+DC), so it't time to take a moment to check in and see where things stand overall.</p>
<p>There's some important caveats, of course:</p>
<ul>
<li>In some states I had to make an educated guess as to the effectuated enrollment as of spring 2026 for <strong>some</strong> insurance carriers due to this data being redacted. As a result, while the average rate increases are fully weighted in most states, there are some where it's "semi-weighted"...that is, I have the hard numbers for some carriers but estimated enrollment data for others.</li>
</ul>
<ul>
<li>There's one exception to both of these: <a href="https://acasignups.net/rate_changes/2027/fl">Florida has strict "Trade Secret" regulations</a> which means <strong>all</strong> of the enrollment data is redacted, meaning the 15.3% average in the table below is <strong>unweighted</strong>.<strong> </strong>This also means that I don't know the <strong>total</strong> enrollment across the individual market for Florida either, although I do have the on-exchange enrollment as of February.</li>
</ul>
<ul>
<li>Since Florida's carriers are seeking rate hikes ranging from just 3.9% to 39%, <strong>and</strong> since <strong>Florida has by far the largest ACA enrollment in the country</strong>, this means if the weighted statewide average turns out to be significantly higher or lower than 15.3% it <strong>could skew the national average higher or lower</strong> by a couple of points as well.</li>
</ul>
<ul>
<li><strong><span style="background-color:#ffff00">Remember, these are preliminary filings only:</span></strong> These are the rate changes <strong>requested</strong> by the insurance carriers. State insurance regulators have been going over the filings and will be issuing final decisions over the next few weeks if they haven't already. In the past I've found that the preliminary filings are usually approved of as is or with only minor changes, but sometimes regulators will significantly cut the hikes down...while in other cases they may actually <strong>increase</strong> them <strong>more</strong> than the carrier requested in order to make sure the carrier can cover their claims for the following year.</li>
</ul>
<p>So far I've found three states which have issued final, approved rate changes: In <strong>Vermont</strong> and <strong>Maine</strong>, the overall weighted average was reduced by a couple of points, but in<strong> Oregon</strong> the average actually <strong>increased</strong> from 17.2% to 21.6%.</p>
<p>There's some other caveats for various states which can be found by <a href="https://acasignups.net/rate_changes/2027/main">reading their individual analyses</a>, but for the most part the table below should be reasonably accurate.</p>
<p><strong>With all of that said:</strong></p>
<ul>
<li>Total ACA-compliant individual market enrollment <strong>as of March/April 2026</strong> seems to have been <strong>roughly 20.6 million</strong>, with <strong>perhaps 18.6 million on-exchange</strong> and <strong>up to ~2 million</strong> or so enrolled in <strong>off-exchange</strong> policies. This includes some assumptions about Florida and a few other states as noted above, however.</li>
</ul>
<ul>
<li>For preliminary filings, the weighted average increases being requested range from<strong> <a href="https://acasignups.net/tags/arkansas">as little as 6% in Arkansas</a></strong> to <a href="https://acasignups.net/rate_changes/2027/az"><strong>as much as 22.9% in Arizona</strong>.</a></li>
</ul>
<ul>
<li>In dollar terms, average 2027 monthly premiums will range from <strong>$576/month in Idaho</strong> to as high as <strong>$1,542/month in West Virginia</strong>...nearly <strong>2.7x as much.</strong></li>
</ul>
<ul>
<li>In addition to West Virginia, there are several other states where the average unsubsidized premium will be more than $1,000/month next year: <strong>Alaska, Connecticut, Vermont </strong>and<strong> Wyoming.</strong></li>
</ul>
<ul>
<li>Overall, <strong>national, mostly-weighted average rates </strong>for <strong>unsubsidized</strong> ACA enrollees looks like it will be <strong><span style="background-color:#ffff00">around 15.2% higher next year.</span></strong></li>
</ul>
<ul>
<li>The average 2026 premium is around $741/month, so <strong>for 2027</strong> that would mean roughly <strong>an additional $113/month</strong> for unsubsidized enrollees, or <strong><span style="background-color:#ffff00">around $854/month nationally.</span></strong></li>
</ul>
<ul>
<li><strong><span style="background-color:#ffff00">That's over $1,300/year extra per unsubsidized enrollee on average.</span></strong></li>
</ul>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/national_by_state_preliminary.jpg?itok=uX8DmbOf"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/national_by_state_preliminary.jpg?itok=uX8DmbOf" /> </a></p>
<p>Here's what this looks like visually, with states ranked from <strong>lowest to highest average percent increase</strong> (click below for higher-res version):</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/national_2027_indy_prelim_graph.jpg?itok=JPPommDF"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/national_2027_indy_prelim_graph.jpg?itok=JPPommDF" /> </a></p>
<p>Here's the states ranked from <strong>lowest to highest average 2027 premium in actual dollars. </strong>Again, remember, this is for <strong>UNSUBSIDIZED</strong> enrollees only:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/national_2027_indy_prelim_graph2.jpg?itok=SkYx6XGD"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/national_2027_indy_prelim_graph2.jpg?itok=SkYx6XGD" /> </a></p>
<p><strong><span style="background-color:#ffff00">UPDATE 9/25/26</span></strong>: I've updated the spreadsheet below to include the <strong>final, approved</strong> 2027 rate changes across <strong><span style="background-color:#ffff00">23 states</span></strong> so far.</p>
<p>As you can see, while the averages have changed significantly in a few states, overall this has barely made a dent in the national average (the total enrollment figures are also slightly lower in a few states as updated filings have filled in a few blank spots). Nationally, these changes <strong>have only shaved a quarter of a percentage point</strong> off of the national average, <strong>which still stands at around 15%.</strong></p>
<p>Of course, these 23 states combined still only add up to about 25% of the total ACA individual market, so a dramatic change to the final rate filings in some of the larger states (especially Texas, Florida &amp; California) could easily move the needle quite a bit. Stay tuned...</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/2027_avg_rate_filings_all_states_vs_2026_23states_finalized.jpg?itok=JWBnqyXo"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/2027_avg_rate_filings_all_states_vs_2026_23states_finalized.jpg?itok=JWBnqyXo" /> </a></p>
</div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/2027-rate-changes">2027 Rate Changes</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_9">
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<pubDate>Fri, 25 Sep 2026 19:00:19 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
<guid isPermaLink="false">9972 at https://acasignup.net</guid>
<comments>https://acasignup.net/rate_changes/2027/national#comments</comments>
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<title>2027 Rate Changes - Maryland: +14.6% indy, +10.2% sm. group</title>
<link>https://acasignup.net/rate_changes/2027/md</link>
<description><span class="submitted-by">Fri, 09/25/2026 - 1:42pm</span><div class="field field-name-field-header-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="https://acasignup.net/sites/default/files/styles/400x400/public/thumb_maryland_10.jpg?itok=iGlwj7uc" width="300" height="158" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p><span style="color:#0000ff"><em><strong>Originally posted 6/26/26</strong></em></span></p>
<p><a href="https://insurance.maryland.gov/Pages/newscenter/Health-Carriers-Propose-Affordable-Care-Act-Premium-Rates-for-2027.aspx">via the Maryland Insurance Administration:</a></p>
<blockquote><p><strong>Health Carriers Propose Affordable Care Act Premium Rates for 2027</strong></p>
<p><strong>Proactive policies of the Moore Administration and General Assembly</strong> ensure that Maryland's individual premium rates <strong>remain among the lowest in the nation</strong>, in spite of <strong><span style="background-color:#ffff00">federal pressures due to changing Exchange rules and continued lack of expansion of enhanced tax credits</span></strong></p>
<p>BALTIMORE – The Maryland Insurance Administration has received the 2027 proposed premium rates for Affordable Care Act products offered by health and dental carriers in the <strong>individual, non-Medigap and small group markets</strong>, which impact approximately <strong>482,000 Marylanders</strong> and represents <strong>19% of the commercial health insurance market.</strong></p>
<p>In the individual, non-Medigap market,<strong><span style="background-color:#ffff00"> carriers are requesting an overall average rate change of 13.7%, with the average request by carrier ranging from 12% to 14.6%.</span></strong></p>
<p>“The significant rate increases filed with the Maryland Insurance Administration for the second year in a row <strong>reflect the loss of enhanced federal tax credits, which were not extended by Congress and the Trump Administration last year</strong>,” said Maryland Insurance Commissioner Marie Grant. “Without the proactive steps by Governor Wes Moore and the Maryland General Assembly to enact a state-based subsidy for 2026 and 2027, Marylanders would see significantly higher increases in premiums and out-of-pocket costs. Our team of actuaries will closely examine the assumptions behind the rate requests over the coming months to determine whether they are justified.” </p>
<p>According to health information company KFF, in the individual market, <strong>Maryland has the lowest-cost average bronze-level premium</strong> and the <strong>lowest-cost average gold-level premium</strong> in the country in 2026. Maryland's lowest-cost silver-level average premium is second only to New Hampshire.</p>
</blockquote>
<p><em>Sidenote: According to my data, <a href="https://acasignups.net/rate_changes/2026">Idaho actually has the lowest average 2026 gross premiums overall, with Maryland coming in third</a> after Idaho &amp; New Hampshire...although it's a close third.</em></p>
<blockquote><p>Under the leadership of Governor Wes Moore, Maryland created a<strong> new subsidy program through the Maryland Health Connection</strong> for those who are <strong>under 400% </strong>of the federal poverty level to help offset the expiration of the enhanced federal tax credit subsidies. The state subsidy program <strong>replaced 100% of the enhanced federal subsidies for those under 200% of federal poverty level </strong>and replaced <strong>50% of the enhanced federal subsidies for those between 250% and 400% of the federal poverty level for 2026. </strong> </p>
</blockquote>
<p><em>Sidenote: I originally thought this was a typo since it doesn't mention those earning 200 - 250% FPL, but it turns out the state subsidy <a href="https://www.marylandhbe.com/wp-content/uploads/2026/04/2027-Proposed-State-Subsidy-and-Estimated-Reinsurance-Parameters.pdf">gradually tapers off from 100% to 50% of the lost federal tax credits</a> over that income range.</em></p>
<blockquote><p><strong><span style="background-color:#ffff00">The subsidy is expected to continue for 2027</span></strong>, although the <strong>exact amount will depend on a number of variables</strong>. For example, the Health Services Cost Review Commission is<strong> reviewing a recommendation that would fund additional support for market stability.</strong></p>
</blockquote>
<p>More specifically, for 2027, <a href="https://www.marylandhbe.com/wp-content/uploads/2026/04/2027-Proposed-State-Subsidy-and-Estimated-Reinsurance-Parameters.pdf">it looks like Maryland is considering three options</a>, one of which would be identical to this year, one which would only cover 25% of the lost subsidies for those earning 250 - 400% FPL, and one of which would only cover 25% from 250 - 400% FPL while also eliminating their <strong>other</strong> subsidy program for young adults.</p>
<blockquote><p>Maryland’s rates in the individual market also remain low compared with the rest of the nation because of the continued effectiveness of the state’s 1332 State Innovation Waiver in stabilizing the market. The 1332 waiver is approved by the federal U.S. Centers for Medicate and Medicaid Services (CMS) through 2028. </p>
<p>The carriers’ requested increases are reviewed by the Maryland Insurance Administration and rates must be approved by the Commissioner before they can be used. Before approval, all filings undergo a comprehensive review of the carriers’ analyses and assumptions. By law, the Commissioner must disapprove or modify any proposed premium rates that are unfairly discriminatory or appear to be excessive or inadequate in relationship to the benefits offered.</p>
<p>The Insurance Administration will hold a public hearing on the ACA proposed rates on July 23, 2026, and <strong>expects to issue decisions in September 2026.</strong></p>
<p><strong>Small Group Market</strong></p>
<p><strong>In the small group market, carriers have requested an overall average rate increase of 13.1%</strong>, with the averages by carrier ranging from <strong>4.1% to 20.7% for 2027,</strong> reflecting increased utilization of health care services across both medical and drug service categories. These trends are happening nationally as well as in Maryland.</p>
<p>For 2026, the Insurance Administration has <strong>approved mid-year rate changes for CareFirst BlueCross BlueShield and UnitedHealthcare</strong> products in Maryland’s small group market, because of evidence of a<strong> significant increase in in-patient hospitalizations and in-patient and out-patient surgeries.</strong></p>
<p>Notably, <strong>the current approved average rates are 2.1% lower than requested for CareFirst BlueCross BlueShield and 6.4% lower than requested for UnitedHealthcare</strong>. The Insurance Administration approved an average mid-year adjustment of 5.6%, resulting in an annual rate increase of 8.2% for the third quarter of 2026 and an average annual rate increase of 8.6% for the fourth quarter for the CareFirst Blue Choice Inc. product. The Administration approved a mid-year adjustment of 1.5% for United Healthcare effective October 1, affecting about 26,200 members and resulting in a 10.1% annual increase.</p>
<p>“The Maryland Insurance Administration is required to consider mid-year Affordable Care Act rate adjustments by carriers serving small businesses based on changes in the market,” Commissioner Marie Grant said. “Our team carefully analyzed the requests and determined that some level of rate changes were justified based on significantly higher than expected claims and health care costs. However, the increases that were approved were less than what the carriers originally requested after actuarial review.”</p>
<p>The Maryland Insurance Administration, in partnership with the Maryland Health Benefit Exchange, <strong>will hold a meeting later this summer to discuss options to increase access for comprehensive health coverage for small employers</strong>. With the rising cost of health insurance, some small businesses in Maryland are opting for a higher risk health insurance option called a “level-funded health plan.” This type of group health plan may offer lower premiums that appear more affordable, particularly if groups are healthy. The reason for the potential lower rates is that <strong>these arrangements rate on health status, which is prohibited in the fully-insured small group market</strong>. However, it is important for employers to know that level-funded health plans are, in part, a type of self-insured arrangement and bring other duties and obligations for the employer. It is also important to know that <strong>level-funded health plans lack many of the protections fully insured plans have under Maryland law.</strong></p>
<p>The Insurance Administration held public hearings in April and May on the requests, which were extensively reviewed by the Office of the Chief Actuary.</p>
<p>The Insurance Administration will hold a quasi-legislative virtual public hearing on all proposed 2027 rates at 1 PM on Thursday, July 23, 2026.<br />
(See public hearing details below.)</p>
<p><strong>Summary of Proposed Rates for 2027</strong><br />
For the individual, non-Medigap market, the overall filed average annual rate change across the entire market is an increase of 13.7%. The average filed rate by carrier and the number of impacted members based on enrollment as of April 30, 2026, is:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/maryland_2027_indy_prelim.jpg?itok=0TXx0x02"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/maryland_2027_indy_prelim.jpg?itok=0TXx0x02" /> </a></p>
<p>...<a href="https://insurance.maryland.gov/Documents/newscenter/newsreleases/EXHIBITS-ACA-2027-Rates-Press-Release.pdf">Additional details regarding proposed rate changes in the individual market are provided in Exhibit 1</a>. Additional premium comparisons for bronze and gold and for an illustrative family of four are found in Exhibit 2.</p>
<p>Note that all illustrative premiums are the full unsubsidized premiums prior to the application of any Advance Premium Tax Credits (APTCs) from the federal government or the state young adult subsidy. Almost 70% of applicants who purchase a plan on <a href="http://www.marylandhealthconnection.gov receive">www.marylandhealthconnection.gov receive</a> subsidies and will not pay the full premiums shown here. Subsidies vary by a household’s income and are linked to the unsubsidized cost of the second lowest cost silver plan available to a household.</p>
<p>For the small group (50 or less full-time equivalent employees) market, the overall filed average annual rate change is an increase of 13.1%. In the small group market, a health carrier can request rate changes on a quarterly basis. The proposed average rate changes by carrier for all four quarters of 2027 and the number of impacted members based on enrollment as of March 31, 2026 is:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/maryland_2027_sm_group_prelim.jpg?itok=ynt5QVlC"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/maryland_2027_sm_group_prelim.jpg?itok=ynt5QVlC" /> </a></p>
<p>...Additional details regarding these proposed rate changes are provided in Exhibit 3. Additional premium comparisons for bronze and gold and for an illustrative familiy of four are found in Exhibit 4.</p>
<p><strong>In the individual, non-Medigap, stand-alone dental market, carriers have requested an overall average increase of 6%</strong> with averages by carrier ranging from no increase to 19.8%. In addition, a new dental carrier, Best Life and Health Insurance Company, has filed rates for new plans that will be available in 2027. The average filed rate by carrier and the number of impacted members based on enrollment as of April 30, 2026 is:</p>
<ul>
<li>Alpha Dental: DPPO 6,034 0.0%</li>
<li>CareFirst GHMSI/CFMI: DPPO 56,476 1.4%</li>
<li>Delta Dental: DPPO 28,262 10.4%</li>
<li>Dominion Dental: DHMO &amp; DPPO 12,191 19.8%</li>
</ul>
<p>Additional details regarding these proposed rate changes are provided in Exhibit 5. Illustrative premiums for both Self-Only and Family coverage can be found in Exhibit 6.<br />
Rates being reviewed by the Insurance Administration do not affect health insurance plans offered by large employers or by employers who self-insure; “grandfathered” plans purchased before March 2010; or federal plans such as Medicare (including Medicare Advantage or Medicare Supplement), Tricare and federal employee plans.</p>
<p><a href="https://insurance.maryland.gov/Documents/newscenter/newsreleases/EXHIBITS-ACA-2027-Rates-Press-Release.pdf">The six exhibits listed below provide more detail. Read EXHIBIT list.</a></p>
<ul>
<li>EXHIBIT 1: 2027 ACA, Individual Non-Medigap Market – Rate Filing Summary</li>
<li>EXHIBIT 2: Illustrative Individual Non-Medigap 2027 Premiums</li>
<li>EXHIBIT 3: 2027 ACA, Small Group Market – Rate Filing Summary</li>
<li>EXHIBIT 4: Illustrative Small Group 2027 Premiums</li>
<li>EXHIBIT 5: 2027 ACA, Individual Non-Medigap, Stand-Alone Dental Market – Rate Filing Summary</li>
<li>EXHIBIT 6: Illustrative Individual Stand-Alone Dental 2027 Premiums</li>
</ul>
<p>Rate filing documents are available on the <a href="http://www.healthrates.mdinsurance.state.md.us">Insurance Administration’s website</a>, which also includes answers to frequently asked questions about the rate review process. <strong> All interested persons may review filings and submit comments through Aug. 28, 2026.</strong></p>
<p>In addition, any interested person may participate in the <strong>virtual public hearing scheduled for July 23, 2026.</strong> Time limits may be imposed for oral testimony, depending on the number of participants. If you would like to present or offer public comments during the public hearing, please notify the Insurance Administration in advance by submitting your request to <a href="mailto:healthinsuranceratereview.mia@maryland.gov">healthinsuranceratereview.mia@maryland.gov</a>. To the extent that time and technology permit, the Insurance Administration will hear from unregistered participants who access the Zoom Webinar platform.</p>
<p><strong>Public Hearing Log-In Information:</strong></p>
<ul>
<li>When: 1 PM to 3 PM, Thursday, July 23, 2026</li>
<li><a href="https://maryland-insurance.zoomgov.com/j/1656730683">ZoomGov Link</a></li>
<li>Dial-In: (646) 828-7666</li>
<li>Webinar ID: 165 673 0683</li>
</ul>
<p>Written testimony for the public hearing may be <a href="mailto:healthinsuranceratereview.mia@maryland.gov">submitted by email</a> and must be received by <strong>Friday, July 17, 2026</strong> to be addressed at the hearing.</p>
<p>Questions about Maryland’s rate review process should be directed to Brad Boban, Chief Actuary at 410-468-2041, or <a href="mailto:bradley.boban@maryland.gov">by email.</a></p>
</blockquote>
<p><strong><span style="background-color:#ffff00">UPDATE 9/25/26:</span></strong> The <a href="https://insurance.maryland.gov/Pages/newscenter/Maryland-Insurance-Administration-Approves-2027-Affordable-Care-Act-Premium-Rates.aspx">Maryland Insurance Administration has posted the final, approved 2027 ACA rate filings</a> for the individual and small group markets. Overall, unsubsidized individual market premiums are going up by <strong>14.6% on average</strong>, while small group policies are increasing by <strong>10.2%:</strong></p>
<blockquote><p><strong>Maryland Insurance Administration Approves 2027 Affordable Care Act Premium Rates</strong></p>
<p><strong>Maryland continues to offer the lowest individual market rates in the country because of Governor Moore's and the General Assembly's proactive policies to protect state residents</strong></p>
<p>BALTIMORE — Maryland Insurance Commissioner Marie Grant today announced the Maryland Insurance Administration’s approval of <strong>2027 premium rates for individual and small group health insurance plans.</strong></p>
<p><strong>Rates for unsubsidized individual Affordable Care Act plans will increase by an average of 14.6% in 2027. </strong> <strong><span style="background-color:#ffff00">The increase reflects the expiration of tax credits that President Trump and Congress failed to reauthorize, changes made by the federal H.R. 1 to groups eligible for Exchange coverage, and rising hospitalization and pharmaceutical costs</span>. </strong>These factors have put upward pressure on premiums for consumers.</p>
<p><strong>Maryland has put in place initiatives to cushion the impact and protect consumers from higher costs</strong>, and the state <strong>will continue to use every tool available to ensure the affordability and availability of health insurance</strong> for all residents. Actions taken by Governor Wes Moore and the Maryland General Assembly are <strong>protecting Marylanders from potentially devastating nationwide increases</strong> caused by <strong>the failure of the Trump Administration and Congress to extend enhanced federal premium tax credits at the end of last year.</strong></p>
<p>According to health information company KFF, in the individual market, Maryland currently has the lowest-cost average bronze-level premium and the lowest-cost average gold-level premium in the country in 2026.</p>
<p><strong>Many Marylanders Qualify for Assistance</strong></p>
<p>Under the leadership of Governor Moore, Marylanders will continue to have the lowest rates in 2027. <strong>For state residents who qualify for financial assistance, the approved 2027 rate increase does not necessarily translate into an increase in what they pay.</strong> Maryland established a <strong>state premium assistance program</strong> through Maryland Health Connection <strong>for eligible residents with household incomes below 400% of the federal poverty leve</strong>l. The program is designed to help replace a portion of the federal assistance that expired, with the precise amount of assistance dependent on several factors. <strong>About 70 percent of Maryland Health Connection users, and 55 percent of overall market members, receive a premium subsidy.</strong></p>
<p>“Maryland residents are encouraged to carefully review their renewal notices and compare available plans during open enrollment,” Commissioner Grant advised. “Individuals should work with Maryland Health Connection and trusted advisors to determine whether they qualify for financial assistance and identify the coverage that best meets their needs.”</p>
<p><strong>Changes in the Small Group Market</strong></p>
<p><strong>In the small group market, which provides health insurance coverage to employers with 50 or fewer full-time employees, premiums will increase by an average of 10.2%</strong>. The increase is driven largely by <strong>higher costs and utilization for inpatient hospital care and prescription drugs. </strong>The approved average increase is nearly 3 percentage points lower than the 13.1% increase requested by small group carriers.</p>
<p><strong>The primary drivers of rising premiums are continued increases in medical and prescription drug costs</strong>. Hospital costs are trending upward by 7.8%, professional services by 8.6%, and prescription drugs by 14.8%.</p>
<p>The Maryland Insurance Administration is concerned about the impact of rising health care costs and declining enrollment on the future of the small group market. In response, the Insurance Administration and the Maryland Health Benefit Exchange are taking steps to better understand the challenges facing small businesses and identify opportunities to strengthen the market.</p>
<p>As part of these efforts, the agencies are inviting members of the small business community to participate in a <strong>public, virtual meeting on October 1.</strong> The discussion will focus on recent developments in the small group health insurance market and what they mean for businesses seeking to provide quality, affordable health coverage for their employees.</p>
<p><strong>Maryland is Working to Lower Costs</strong></p>
<p>Maryland will continue to pursue all necessary actions to reduce health care costs and protect consumers from rising insurance premiums.</p>
<p>The Maryland Insurance Administration will continue its rigorous review of health insurance rates and work with state partners to identify opportunities to strengthen Maryland's health insurance market, increase affordability and protect access to coverage.</p>
<p>“Maryland cannot control federal decisions, but we can control how we respond to them,” said Commissioner Grant. “We will continue working with Governor Moore, the General Assembly, the Maryland Health Benefit Exchange and everyone across the health care system to use every tool at our disposal to drive costs down and protect Maryland residents.”</p>
<p><strong>Maryland is working toward a Total Cost of Care Target to help bend the health care cost growth for all payers, including commercial payers, as a part of the state’s participation in the AHEAD Model</strong>. Maryland also has a <strong>Prescription Drug Affordability Board</strong> which has voted to apply its first upper payment limits to two prescription drugs.</p>
<p>Maryland has a long history in protecting health insurance consumers from higher costs. Maryland’s rates in the individual market remain low compared with the rest of the nation because of the continued effectiveness of the state’s 1332 State Innovation Waiver in stabilizing the market. The 1332 waiver, which allowed Maryland to establish a state-backed reinsurance program that helped lower premiums, is approved by the federal U.S. Centers for Medicare and Medicaid Services (CMS) through 2028. The approved 2027 rates are comparable to the pre-waiver 2018 rates, and the reinsurance program continues to keep rates 30% to 35% lower than they would be without it.</p>
<p><strong>Analysis of Approved Rates</strong><br />
Individual Non-Medigap Market Analysis </p>
<p><strong>About 274,000 Marylanders are covered through the individual market, down from 294,000 last year</strong>. Maryland Health Benefit Exchange data shows that the decline in enrollment is <strong>mostly a result of the loss of subsidy eligibility in Maryland’s immigrant community due to changes made by H.R. 1.</strong></p>
</blockquote>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/maryland_2027_indy_final.jpg?itok=SkPYVFCo"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/maryland_2027_indy_final.jpg?itok=SkPYVFCo" /> </a></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/maryland_2027_sm_group_final.jpg?itok=I1vPgNa_"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/maryland_2027_sm_group_final.jpg?itok=I1vPgNa_" /> </a></p>
<p>Thanks to <a href="https://acasignups.net/25/09/19/maryland-new-state-subsidy-program-backfill-100-lost-tax-credits-some-enrollees-50-it">Maryland's state-based subsidy program</a> (which backfills 100% of the lost federal tax credits for all enrollees earning up to 200% FPL, 50 - 100% for those earning 200 - 250% FPL and 50% for those earning 250 - 400% FPL), the state has <strong>only</strong> seen effectuated ACA exchange enrollment drop by around <strong>12% year over year</strong> as of August, and by <strong>just 6%</strong> on average so far in 2026, far below the national average:</p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/maryland_effectuated_month_year_table.jpg?itok=RSZFjiHZ"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/maryland_effectuated_month_year_table.jpg?itok=RSZFjiHZ" /> </a></p>
<p><a class="colorbox colorbox-insert-image" href="https://acasignups.net/sites/default/files/styles/inline_default/public/maryland_effectuated_month_year_graph.jpg?itok=fIDLwCzL"><img alt="" class="image-inline-default" src="/sites/default/files/styles/inline_default/public/maryland_effectuated_month_year_graph.jpg?itok=fIDLwCzL" /> </a></p>
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<pubDate>Fri, 25 Sep 2026 17:42:57 +0000</pubDate>
<dc:creator>Charles Gaba</dc:creator>
<guid isPermaLink="false">9910 at https://acasignup.net</guid>
<comments>https://acasignup.net/rate_changes/2027/md#comments</comments>
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