2026 Rate Changes - North Dakota: +4.0%, but up to ~59,000 enrollees are still likely facing MASSIVE rate hikes

Overall preliminary rate changes via the SERFF database, North Dakota Insurance Dept. and/or the federal Rate Review database.

Blue Cross Blue Shield of ND:

(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.)

Medica Health Plans:

Medica Health Plans (MHP) is requesting a rate change for its Affordable Care Act (ACA) individual market business in North Dakota. The rate change will take effect on January 1, 2026 and will impact an estimated 3,454 members. The average rate change will be 17.9% and will result in rate changes that vary across plan designs. This includes changes to the costs of care.

MHP uses 2024 data from North Dakota in addition to Minnesota data that has been adjusted to reflect North Dakota cost characteristics to develop premium rates. This data includes estimates of changes to the below through 2026:

• Population Medica expects to insure
• Cost of medical services
• Cost of pharmacy services
• Taxes and fees

The significant factors that impact the rate change include those listed above. Claim costs per member per month are expected to change from $488.27 in 2024 to $568.32 in 2026.

In 2024, 89.3% of premium dollars went towards medical services. Under the ACA, individual products are required to pay at least 80% of premium dollars, after taxes and fees are removed, toward medical services. For 2026, MHP is expecting that 86.0% of premium dollars will be spent on medical services.

Medical cost changes, in both number of services and costs of services, make up the largest increase to MHP’s premium rates. Additionally, impacts due to better rates with hospitals and doctors and reviewing recent experience also aid in determining premium changes. Finally, relationships with providers are helping to improve premium rates through a lower overall cost for care.

MHP updates the plan designs offered each year, which impacts each plan’s cost-sharing (e.g. deductibles, copayments, etc.). These updates follow federal rules for how much of costs the insurance company will cover under that plan. Because these updates will be different for each plan, the rate changes will also be different by plan.

MHP expects the cost to administer coverage per member per month (PMPM) for 2026 to be $68.20, which is higher than the 2025 value of $63.90. The main drivers of MHP’s administrative expenses are employee salaries and benefits, agent commissions, claim processing/IT, and clinical/network services.

Sanford Health Plans:

(Unfortunately, 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.)

As noted above, I only have actual enrollment data for one of the three insurance carriers in North Dakota's individual market next year. This makes calculating a weighted average far more difficult, but I've made an educated guess.

ND had around 43,000 on-exchange enrollments during the 2025 OEP. Using 2024 CMS liability risk score data I estimate total 2025 individual market enrollment of around 59,000, of which 3,454 are enrolled via Medica...just ~6% of the total.

That leaves around 55,500 enrolled via either BCBS or Sanford. If I assume equal enrollment in each, the semi-weighted average comes in at +4.0%...by far the lowest average increase I've seen so far. This is because even though Medica is asking for a much higher 17.9% increase, the other two carriers, which combine for ~94% of all enrollments, are asking for modest increases of 4.9% and 1.4% respectively.

While ND is officially "semi-weighted," BCBS and Sanford being so close to each other means that the fully-weighted average would remain within a fairly narrow range (2% to 5%) even if one of them had 10x the enrollment of the other.

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

Meanwhile, I have no enrollment data at all for three of the four small group carriers; the unweighted average 2026 rate hike there is around 6.6%.