By Stacey Pogue, Billy Dering, JoAnn Volk, and Kevin Lucia
It’s the start of price evaluation season for state insurance coverage departments. Though most proposed premium charges for 2026 protection won’t be public till the top of July, some state regulators require submissions in Could or June and launch various ranges of data early within the course of. These early price filings present an preliminary take a look at how insurers are responding to market developments and coverage modifications.
This 12 months, insurers are setting their charges for 2026 whereas Congress and the administration weigh the next three insurance policies that are projected to trigger premiums to spike and the variety of folks with Market protection to plummet:
Any of those insurance policies, defined additional in different CHIRblog posts, individually might have a notable affect on premiums for 2026 and past. Insurers are going through the chance that each one three modifications could possibly be in place earlier than 2026 protection takes impact, and large uncertainty—which may additionally drive up charges—about which particular provisions will finally take impact and when.
The next is a round-up of data launched thus far by states on proposed price modifications for 2026 particular person market protection and associated evaluation.
Eye-popping proposed will increase for 2026
A couple of states with earlier price submitting deadlines have launched abstract data on proposed price modifications within the particular person market. Some states have launched a weighted statewide common price improve proposed throughout all insurers, others have posted common price modifications proposed by every insurer, and a few have posted each. As proven within the desk beneath, abstract data launched by state insurance coverage regulators so far uniformly exhibits 2026 common charges heading in a single path: up, usually considerably. Statewide common proposed will increase, the place launched by the state, all present double-digit price hikes, starting from 10% in Oregon to 24% in Rhode Island.
Desk: Common Proposed Particular person Market Charge Will increase, Choose States, Plan Yr 2026
| State | Statewide Common Proposed Enhance | Vary | Further data | |
| Lowest common price request by provider | Highest common price request by provider | |||
| Connecticut | 17.8% | 5.9% (CTCare off-exchange) | 26.1% (ConnectiCare) | Proposed charges don’t embody scheduled ePTC expiration, which might improve proposed charges by a further 3.5% to six.8% of premium by provider. |
| Illinois | — | 0.2% (Oscar) | 27.0% (BCBS) | |
| Iowa | — | 6.6% (Oscar) | 26.8% (Medica) | |
| Maryland | 17.1% | 8.1% (Wellpoint) | 18.7% (CareFirst BlueChoice) | Proposed charges embody scheduled ePTC expiration. If Congress extends ePTC, statewide common proposed price improve would as an alternative be 7.9% |
| Massachusetts | 13.4% | 9.9% (Fallon) | 16.2% (Boston Medical Heart) | |
| Minnesota | — | 7.2% (Quartz) | 26.0% (Medica) | |
| New York | — | 0.9% (EmblemHealth) | 66.4% (UnitedHealthcare Insurance coverage Co) | |
| Oregon | 9.7% | 3.9% (PacificSource) | 12.9% (Kaiser) | |
| Pennsylvania | 19% | — | — | |
| Rhode Island | 23.7% | 21.2% (Neighborhood Well being Plan) | 28.9% (BCBS) | Proposed charges embody scheduled ePTC expiration, which provides 4.9% to 9.7% of premium by provider to proposed price improve. |
| Vermont | — | 6.2% (MVP) | 23.3% (BCBS) | |
| Washington | 21.2% | 9.6% (Regence BlueShield) | 37.3% (United Healthcare) | Proposed charges embody scheduled ePTC expiration. If Congress extends ePTC, proposed price will increase could possibly be decreased by as a lot as 6.4% of premium. |
Be aware: Common proposed price change statewide and/or by provider for 2026 ACA particular person market (or merged market, as relevant) protection as posted by states as of June 23, 2025. See linked supply supplies for additional data.
A couple of state insurance coverage regulators supplied context in regards to the magnitude of the proposed spike in particular person market charges for 2026. Rhode Island’s regulator famous the “requested price will increase are the best in over a decade,” whereas Maryland’s mentioned they “are the best for the reason that implementation of Maryland’s reinsurance program in 2019.”
Insurers level to lack of ePTC and uncertainty round federal coverage modifications
A handful of states additionally publish the detailed supporting documentation filed by insurers comparatively early in comparison with different states. These paperwork clarify the assumptions utilized by insurers and their justifications for the forms of proposed price will increase proven above. We reviewed* insurer justifications from three of those states, Maryland, Maine, and Vermont, to see how anticipated coverage modifications and uncertainty round them are impacting proposed charges for 2026.
Expiration of ePTC drives up charges
Quite a lot of components affect proposed price modifications, together with modifications to the unit value of well being care companies and provides, utilization, advantages, and the lined inhabitants. Along with these kind of components that generally drive annual modifications, insurers in our pattern states universally cited the expiration of ePTC on the finish of 2025 as having a key affect on proposed price will increase. As defined in excerpts from filings beneath, the top of ePTC is predicted to create a smaller, sicker threat pool, driving up charges.
- In Maine, Group Well being Choice proposed a 34% common price improve. It explains that with the lack of ePTC, enrollment will drop, and so they “anticipate the remaining threat pool in 2026 [will] have larger healthcare wants, on common, as more healthy customers usually tend to lapse protection.”
- In Maryland, Optimum Selection proposed a mean price improve of 18.6%. It pointed to the top of ePTCs driving decrease enrollment, and consequently, “[h]ealthier members are anticipated to depart at a disproportionately larger price than these with vital healthcare wants, growing market morbidity in 2026.”
- In Vermont, Blue Cross Blue Defend proposed a mean price improve of 23.3%, which includes “a further improve of 6.6 p.c” from the lack of ePTC. The provider anticipates that the top of ePTC “will shrink the inhabitants with protection and worsen the chance pool, requiring larger premiums for the remaining members.”
- Additionally in Vermont, MVP proposed a 6.2% common improve and assumes wholesome people with subsidies will drop protection when ePTCs expire at twice the speed of different sponsored people, resulting in a sicker threat pool.
Coverage-induced turbulence might additional drive up charges or spur insurer exits
As a common rule, state insurance coverage regulators require insurance coverage firms to submit proposed charges that replicate present regulation. In different phrases, proposed charges shouldn’t try to anticipate future modifications in regulation, equivalent to enactment of H.R. 1 or the finalization of the proposed Market Integrity rule.
Due to this fact, insurers in most states needed to set their charges for 2026 amidst vital uncertainty from the shifting federal coverage panorama. Some states requested insurers to file a couple of set of charges for 2026, reflecting uncertainty over whether or not ePTC would expire or be prolonged by Congress and/or whether or not cost sharing discount (CSR) funds would stay unfunded. However even with these contingencies, filings for 2026 had caveats hinting at considerations about coverage modifications which will occur after charges are submitted for regulator evaluation.
- In Maryland, Wellpoint, which proposed a mean 8.1% improve, flagged uncertainty about ePTCs and assumptions about CSR funds whereas cautioning that that, “[f]uture modifications in laws, regulation and/or court docket selections might have an effect on the extent to which the premium charges are neither extreme nor poor. Wellpoint reserves the best to file revised charges within the occasion of modifications to the regulatory atmosphere during which they have been developed.”
- In Maine, Anthem proposed an 18.0% common price improve. The insurer cautions that “the charges proposed on this submission replicate the regulatory framework and insurer participation out there as of June 5, 2025. If the regulatory framework or insurer participation out there modifications after this date, proposed charges might not be acceptable and ought to be reevaluated for revision and resubmission.”
- In Vermont, MVP notes that it filed two units of charges, one with and one other with out, continued ePTC, however the provider “reserves the best to switch the submitted charges,” on condition that eventual PTC modifications might differ from each of the modeled eventualities.
- In Maryland, Optimum Selection proposed a mean 18.6% price improve for 2026, and famous that the proposed Market Integrity rule (which was simply finalized, a month after this price submitting), “will result in more healthy enrollees leaving the market and an total worsening of the chance pool.”
Uncertainty about ACA coverage shifts may also feed into selections about whether or not insurers stay in present markets. Aetna, for instance, not too long ago introduced it could exit ACA Marketplaces totally after 2025 due partly to uncertainty over federal ACA coverage. This transformation impacts 1 million customers throughout 17 states, together with Maryland.
- In Maryland, Optimum Selection proposed a mean 18.6% price improve for 2026. After flagging regulatory concerns associated to ePTC expiration and CSR funds, the provider warned,”[t]he submission of those charges doesn’t assure that OCI will proceed to take part within the particular person market in 2026.”
Insurance policies advancing in Congress could have profound results on the person market
Many of the states which have launched early price filings function their very own state-based Market and have expanded Medicaid underneath the Inexpensive Care Act. Proposed charges are prone to be even larger in states that haven’t expanded Medicaid. A sobering new report from Wakely predicts “a a lot smaller and fewer secure particular person market” throughout all states if Congress enacts H.R. 1 as handed by the Home (which includes modifications proposed within the Market Integrity rule, lots of which have now been made closing) and fails to increase ePTC. Wakely estimates that particular person market enrollment might plummet by 47% to 57% on common, with even bigger enrollment losses, as much as 64%, in non-Medicaid enlargement states. In whole, the person market would lose an estimated 11 million to 14 million enrollees, dropping to low ranges not seen “for the reason that early years of the Marketplaces, if not decrease.”
As enrollment shrinks, “morbidity” will improve. In different phrases, individuals who retain protection shall be sicker and have larger well being care wants than those that drop protection, driving up premiums. The mixed impacts of simply these insurance policies would trigger “giant gross premium will increase” of 7-12% on common, and much larger common internet premium will increase for sponsored people as premium tax credit shrink.
Insurance coverage regulators in some states are additionally elevating considerations in regards to the totality of impacts of federal insurance policies on the desk on premiums and protection. For instance, Maryland Insurance coverage Commissioner Marie Grant famous that whereas the “vital price will increase” already filed for 2026 replicate the lack of ePTC, “current actions by Congress have the potential to additional decrease tax credit for Marylanders to assist buy well being protection and additional improve charges on this important market.”
Takeaway
Early data on proposed particular person market charges for 2026 exhibits widespread and substantial price will increase. Among the many many components driving up charges, some usually are not enterprise as regular. As a substitute, insurers are responding to an array of disruptive federal ACA coverage modifications. Early price filings clearly replicate the affect of 1 shoe dropping–the scheduled expiration of ePTC– and in addition concern about different sneakers which will nonetheless drop. Insurers anticipate steep declines in enrollment, will increase in morbidity amongst remaining enrollees, and vital premium will increase on account of federal coverage modifications. Moreover, the excessive diploma of uncertainty round proposed insurance policies that would take impact by 2026, has prompted caveats by insurers and state regulators that charges might change at any level. With dire projections of smaller, sicker, and costlier Marketplaces after federal ACA coverage modifications, we might even see different insurers exit the Marketplaces altogether, on the heels of Aetna’s current announcement. Even with these early filings, the affect of the coverage modifications is changing into clear – decrease enrollment and better premiums. Continued monitoring of price filings over the subsequent couple of months will assist to disclose the complete scope of how a lot these federal insurance policies will erode the person medical insurance market.
*Authors’ word: Our evaluation of early 2026 particular person market price filings was largely restricted to the narratives within the actuarial memoranda that should accompany every price submitting. These memos clarify, in lay language, insurers’ previous expertise, present assumptions, and predictions for the subsequent plan 12 months. The findings summarized on this weblog usually are not essentially generalizable to the broader universe of particular person market price filings for plan 12 months 2026, nor do they replicate the entire components underlying price requests or variations between insurers submitting particular person market charges on this set of states. The authors thank Norah C. Ludke and Logan DeLeire for his or her help monitoring and documenting insurers’ price filings.
