...This letter is formal notice that Aetna Health Inc. (“AHI”) intends to exit from the Individual health insurance market in Virginia effective January 1, 2026. Subject to the Department’s review, we will mail the 180-day notices of discontinuance to covered individuals.
As of May 2025, our records show that AHI has 9,810 subscribers and 13,721 total members in Virginia.
I still have the preliminary 2026 rate filings to analyze for about 10 more states, but I'm taking a break to go back and revisit ARKANSAS.
Back on July 18th, I posted my original analysis of ACA-compliant individual & small group market filings for Arkansas insurance carriers. At the time, I found that the weighted average increases being requested for individual market policies averaged a disturbingly high 26.2%. Here's what the breakout looked like:
(unfortunately, CareSource WV's actuarial memo is heavily redacted)
Highmark BCBS WV:
Highmark West Virgina (“Highmark WV”) is requesting an average ACA individual market rate increase of 17.0%, ranging from 15.2% to 23.3%. Products submitted with this filing will have effective dates from January 1, 2026 to December 31, 2026. This rate change is projected to affect 28,179 members.
Historical Financial Experience:
Highmark WV incurred an underwriting gain in its ACA individual market programs in 2024.
Change in Medical Service Costs:
The projected average cost of medical care for the projected population is expected to increase. The increase will emerge in utilization and average cost per service and is spread across all types of services.
(Unfortunately, Avera hasn't provided a justification summary and has almost completely redacted their actuarial memo, making it impossible for me to know what their current enrollment is; see below)
The proposed rate change of 27.3% applies to approximately 204,837 individuals. Absolute Total Care’s projected administrative expenses for 2026 are $90.21 PMPM. Administrative expense does not include $17.94 for taxes and fees. The historical administrative expenses for 2025 were $78.35 PMPM, which excludes taxes and fees. The projected loss ratio is 82.6% which satisfies the federal minimum loss ratio requirement of 80.0%.
Scope, Range, and Best Estimate of the Rate Increase
Blue Cross and Blue Shield of Oklahoma (BCBSOK) is filing new rates to be effective January 1, 2026, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate increases for these plans is 12.3% to 51.5%.
...Changes in allowable rating factors, such as age, geographical area, or tobacco use, may also impact the premium amount for the coverage.
There are currently 128,181 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.
(Aetna/CVS is pulling out of the ACA individual market in every state; I've made an educated guess as to their current enrollees, who aren't counted as part of the weighted average as they'll have to shop around for a new carrier this fall. See below.)
Antidote Health Plan:
(Antidote's actuarial memo is heavily redacted so I don't know their current enrollment; I've had to make an educated guess. See below.)
(Unfortunately, BCBSND's actuarial memo is heavily redacted, so I don't know their current enrollment. I've had to make an educated guess on that; see below.)
Blue Cross and Blue Shield of New Mexico (BCBSNM) is filing new rates to be effective January 1, 2026, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate changes for these plans is an increase of 18.4% to an increase of 49.6%.
The cost relativities among plans are different from the experience period to the prospective rating period due to anticipated non-uniform changes in network reimbursement levels. Additionally, the rates vary by plan due to the leveraging and utilization differences driven by variations in member cost sharing. Therefore, the proposed rates and rate changes may vary by plan.
Changes in allowable rating factors, such as age and geographical area, may also impact the premium amount for the coverage.
(Aetna/CVS is pulling out of the entire individual market nationally; I've estimated their current enrollment, see below for methodology)
AmeriHealth HMO:
AmeriHealth HMO, Inc. ("AHNJ”) is revising premium rates for the New Jersey Individual Health ACA compliant products, effective from January 1, 2026. Rate increases average 16.8%, ranging from 16.8% to 16.8%. The proposed revisions to each plan are shown on the last page of this exhibit. About 35 members will be affected.
