(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.
(Unfortunately, Anthem has redacted their current enrollment total; see below)
This is a rate filing for the Individual market ACA-compliant plans offered by Anthem Health Plans of New Hampshire, Inc., also referred to as Anthem. The policy forms associated with these plans are listed below. The proposed rates in this filing are for a new HMO product that will be effective for the 2026 plan year beginning January 1, 2026, and apply exclusively to off-exchange plans.
Blue Cross and Blue Shield of Nebraska (BCBSNE) is setting new rates for its Individual ACA market business in Nebraska. The rate change will take effect January 1, 2026, and will impact an estimated 22,300 members. On average, rates will go up by 20.5% compared to 2025 individual rates. Depending on the network and plan, rate changes will range from a decrease of 1.1% to an increase of 33.3%. Additionally, premiums will go up a bit each year as people get older, even if their plan rates stay the same.
BCBSNE used its own claims and enrollment data, and other publicly available information to set these rates.
Blue Cross and Blue Shield of Montana (BCBSMT) filed 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 0.9% to an increase of 42.5%.
Product Blue Preferred Blue Focus 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 44,116 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.
Consistent with the filed URRT, earned premiums for Individual plans during calendar year 2024 were $252,957,302 and total claims incurred were $235,192,937. The proposed rates effective January 1, 2026, are expected to achieve the loss ratio assumed in the rate development.
The average rate increase included in this filing is 19.3%, affecting over 210,000 members.
The main factors driving the need for this increase are:
Alabama market membership loss and remaining members projected to be less healthy following expiration of enhanced premium subsidies in place since 2021
Projected claim cost trends are higher for 2025 than anticipated in the 2025 filing and are projected to continue into 2026
Administrative costs increased in 2025 and are expected to rise further in 2026 due to new eligibility and billing rules, along with a higher Exchange User Fee
The proposed rate change of 39.0% applies to approximately 142,324 individuals. Ambetter of Magnolia Inc.’s projected administrative expenses for 2026 are $89.76 PMPM. Administrative expense does not include $34.22 for taxes and fees. The historical administrative expenses for 2025 were $73.84 PMPM, which excludes taxes and fees. The projected loss ratio is 84.4% which satisfies the federal minimum loss ratio requirement of 80.0%.
Blue Cross Blue Shield of MS:
The 2026 monthly health insurance premium is made up of four pieces: estimated claim costs, administrative costs, taxes and fees, and risk/profit margin.
In early 2021, Congressional Democrats & President Biden passed the American Rescue Plan Act (ARPA), which dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier. They then extended the subsidy upgrade out by another 3 years via the Inflation Reduction Act.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the upgrade eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
