Merged Market Summary for Proposed Rates Effective for 2026
The following tables depict the proposed overall weighted average premium increase and the key assumptions behind premium development for the merged (individual and small employer) market filed by insurance carriers as part of the Massachusetts Division of Insurance rate review process (for rates effective in 2026). This information is subject to change as the rate review process continues.
The Health Care Access Bureau within the Massachusetts Division of Insurance is currently reviewing these assumptions. This review process will culminate in a final decision in August 2025.
There are 711,563 consumers enrolled in merged (individual/small group) market plans (data as of December 2024).
Every year, even when the ACA is running smoothly, there are always changes in market participation, as different insurance carriers enter or exit the individual market in certain states or either expand or shrink what parts of the state they offer healthcare policies in.
2026 is no exception, and given the massive turmoil the ACA exchanges are undergoing right now (due primarily to the expiring federal tax credits as well as regulatory changes made by the Trump Regime's so-called "Integrity & Affordability Rule"), there's either 13 or 32 insurance carriers throwing in the towel in one or more states, depending on how you count a carrier operating in multiple states or under multiple subsidiary brandings.
It's important to keep in mind that the following list probably isn't comprehensive--it includes the carriers which I've confirmed are pulling out statewide (with one exception: Meridian Health Plan of Michigan is only pulling out of parts of the state). There's likely one or two that I've missed, especially given that several of these have only made their final decisions within the past week or so.
The Affordable Care Act premium tax credits at the center of federal shutdown discussions help almost 217,000 Washingtonians pay their monthly health insurance costs through Washington Healthplanfinder
OLYMPIA, Wash. – Washington Health Benefit Exchange CEO Ingrid Ulrey issued a statement today about Affordable Care Act tax credits that help Americans pay for health insurance, and which have become a central issue in the debate regarding the government shutdown.
“As we enter the third week of the federal government shutdown with a focus on the enhanced premium tax credits (ePTCs), it is important to remember what is at stake for Washingtonians.
“This year, these tax credits help nearly 217,000 Washingtonians afford the coverage they need for themselves and their families. If the enhanced level of these tax credits is allowed to expire, it will be people in our most rural counties, those who run small businesses or who are self-employed and older adults who are not yet eligible for Medicare who will face the steepest premium increases.
Funding supports free one-to-one assistance to residents looking for coverage through the State’s Official Health Insurance Marketplace
TRENTON — Governor Phil Murphy and New Jersey Department of Banking and Insurance Commissioner Justin Zimmerman today announced $5 million in Navigator grant awards among 30 community organizations to provide assistance in connecting uninsured residents to health coverage through Get Covered New Jersey, the State’s Official Health Insurance Marketplace, during the Open Enrollment Period and throughout the year. The 2025–2026 Open Enrollment Period starts November 1, 2025, and ends January 31, 2026.
Grant-funded Navigators will provide free, unbiased outreach, education, and enrollment assistance, in more than 10 languages in all 21 counties, to residents shopping for quality, affordable health insurance and will also assist residents in applying for financial help. Since 2019, the Murphy Administration has awarded over $28 million to fund Navigator organizations.
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.
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.
Just a few days ago I reported that the final, approved 2026 individual market rate filings in Michigan have been published to the SERFF database, for an overall weighted average rate increase of 20.1% marketwide:
This hasn't been officially published by the Michigan Dept. of Insurance & Financial Services yet, and technically speaking the filings aren't 100% approved yet, but 10 out of 11 filings have been moved to "complete pending form review" which I think just means that a supervisor has to give the paperwork a final once-over to make sure there are no typos etc.
*Also, Meridian Health Plan (which holds an impressive 30% of the total ACA indy market in MI when you include the carriers dropping out) is listed as "draft decision forwarded to Manager" so if any of them end up being off I'd guess it would be that one.
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
Florida has over ~4.7 MILLION residents enrolled in ACA exchange plans, 97% of whom are currently subsidized. I also estimate they have perhaps ~112,000 unsubsidized off-exchange enrollees.
Combined, that's over 4.8 million people, or a stunning 20.3% of their total population. 1 in 5 Floridians are enrolled in ACA exchange healthcare coverage (assuming CMS's 6.6% net national attrition rate applies to Florida specifically, the actual number of current enrollees is more like 4.5 million, or 19% of the state population).
Originally posted 7/21/25; See important updates below.
It's a little awkward to try & pull quotes from Georgia's actuarial memos because they're heavily redacted (see attachments below), but fortunately I also have access to other "just the facts" filing documents which include the hard data I need to compile my weighted averages. These forms--officially called "Rate Filing Transmittal Form LH-T1" and "Unified Rate Review" forms--include, among lots of other numbers, the preliminary avg. rate change being requested for the carrier's individual (or small group) market plans, as well as the number of current effectuated enrollees they have.
In addition, I have alternate rate filings for Georgia individual market carriers which specifically state what their requested rate changes would be if the enhanced premium tax credit subsidies provided by the American Rescue Plan Act & Inflation Reduction Act were to be extended for at least one more year, providing a clear apples to apples comparison.
