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Small employers' premiums for fully insured health plans could jump in some states in 2026 but continue along roughly the same path as in 2025 in other states.
A look at the small-group rate proposals filed in six jurisdictions shows that the requested increases vary widely. Here's how the median requested increases for 2026 compare to the original median requested increases for 2025:
District of Columbia: 9.9%, up from 5.6%.
Illinois: 7.7%, up from 5.4%.
Minnesota: 11.2%, down from 11.8%.
New York: 19.6%, up from 19.3%.
Oregon: 10.5%, down from 11.5%.
Rhode Island: 20.8%, up from 10.6%.
A sampling of rate proposals for individual carriers shows that:
Anthem Blue Cross, a subsidiary of Elevance Health, is the only small-group offering coverage through Connecticut's state-based Affordable Care Act public exchange, and it's requesting a 13.2% average increase for 2026, down from an average increase of 13.6% for 2025.
Cigna has pushed its initial average increase request for Illinois up to 8.2%, from 6.4% for this year.
A UnitedHealth subsidiary has increased its average increase request for group health insurance offered in the District of Columbia to 7.7%, from 5.8% for this year.
Health insurers usually file their proposed rates for a calendar year in the spring before that year begins. Some states post helpful summaries of what the insurers have proposed for the individual market, the small-group market, or both, and some do not. The states then tend to announce the final rates a few weeks later.
The rates are subject to change. Regulators could reject or change some of the rates. Insurers might be able to ask for changes in some situations.
This year, issuers are facing the usual concerns about medical inflation.
Issuers also face uncertainty about how actual and proposed federal "tariffs," or import taxes, will affect the economy; how looming changes in federal Medicaid funding and Affordable Care Act premium tax credit rules affect who has what kind of health coverage; and how healthy the people with various types of coverage will turn out to be.
Executives from Molina, an insurer that focuses on the individual market, said during a conference call with securities analysts Thursday that regulators have responded to the uncertainty by giving insurers more time to set their final 2026 rates.
The fully insured small-group market: States and the federal Affordable Care Act have imposed many requirements on the fully insured small-group market that do not apply to self-insured plans or the fully insured large-group market, and use of small-group health insurance has been dwindling.
The number of U.S. small-group coverage fell to 11.5 million in 2021, down 39% from the total in 2011, according to a paper published earlier this year on a website affiliated with the Journal of the American Medical Association.
The health rate backdrop: Issuers of stop-loss insurance, or insurance for employers' self-insured health plans, have reported that claim costs for self-insured plans started to surge about a year ago and seem to be continuing to surge.
Analysts at PwC recently predicted that the underlying medical cost increase trend for employers' self-insured health plans will be 8.5% in 2026. A year ago, they were predicting the medical cost trend for 2025 would be 8%. The PwC figures exclude the impact of increases in deductibles, network changes and other changes employers might make to try to hold down the actual cost of providing coverage.
The federal Center for Consumer Information and Insurance Oversight, a federal agency in charge of Affordable Care Act programs that affect commercial health insurance, estimated in March that actual average monthly premiums for fully insured small-group coverage rose 6.1% in 2024.
Related: Actual small-group health premiums rise 6.1%
Unlike the PwC figure, the CCIIO figure includes the effects of any changes employers made in their coverage, not just the underlying health care costs.
Small-group market watchers are still waiting to see what the rising cost of health care means for group insurance premiums.
Increases in the individual market appear to be large.
Companies like Centene, Molina Healthcare and Oscar Health say claims for people with commercial individual coverage have been higher than they expected.
Analysts at the Peterson Center on Healthcare and KFF reported last week that the typical proposed rate increase for individual coverage for 2026 is 15%. A year ago, the analysts reported that the typical increase request for 2025 was just 7%.
"Early indications are that individual market insurers will be increasing premiums in 2026 by more than they have since 2018," the analysts warned.
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