2027 Rate Changes - Oklahoma: +21.5% indy market; +16.2% small group market

ACA exchange enrollment has dropped by NEARLY A THIRD in Oklahoma since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were already down 15% vs. OEP 2025...and effectuated enrollment continued to plummet, down 20% vs. a year prior in January and by over 32% year over year in February.

That's over 85,000 Oklahomans who already lost coverage in just the first two months of the year...a number which has likely continued get worse since then.

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the federal Rate Review database:

Bankers Reserve Life Insurance Co:

Bankers Reserve Life Insurance Company of Wisconsin current y provides health care coverage for over 250 members enrolled in our Ambetter Health Solutions plans in Oklahoma. Premium rates are expected to increase on average by 22.0% for members on renewing plans, effective January 1, 2027.

Annual rate changes may range between 2.1% and 29.3%, depending on what county current enrollees reside in and their current plan selection. Variations are primarily driven by underlying cost differences between different plan designs and regional cost trends. Note that these rate changes do not reflect any additional increases in a member’s calculated premium driven by aging an additional year at the point of renewal.

Financial Experience of the Product

Bankers Reserve Life Insurance Company of Wisconsin does not have sufficient historical experience to base projections using issuer specific data. Projected costs were instead developed using 2025 experience from Celtic Insurance Company, an affiliate company which covered over 105,000 lives in Oklahoma’s Individual market during 2025, adjusted for Bankers Reserve Life Insurance Company of Wisconsin’s expected population in 2027.

For reference, Celtic Insurance Company incurred $494,408,959 in estimated paid claims costs, gross of an estimated risk transfer payable of $98,730,301 from the federal risk adjustment program in 2025. Celtic Insurance Company collected $706,394,615 in premium revenue, resulting in an estimated loss ratio of 81.4% inclusive of federal risk transfer payments for 2025.

Changes in Medical Service Costs

The claims experience used as a starting point in our pricing is trended forward for projected changes in medical service costs and calibrated to Bankers Reserve Life Insurance Company of Wisconsin’s expected population in 2027. Medical service costs are projected to increase at an annualized rate of 16.7% due to medical inflation, expected changes in contracted reimbursement rates to providers, and increased utilization of health care services.

Other factors related to expected changes in the demographics of Bankers Reserve Life Insurance Company of Wisconsin’s population and overall population health are expected to drive additional increases in medical costs. Emerging trends that indicate the overall health of the insurance pool is worsening, in addition to elevated claims experience emerging in 2026 is a key driver for the proposed rate increase.

Changes in Benefits

Changes in plan benefits and member cost sharing also impact the proposed rate change. Some benefits have been adjusted, such as coverage for vision and dental care. Changes in covered benefits and cost sharing can also influence how often members use medical services. Benefit changes are expected to drive a 1.7% annualized decrease to total projected medical costs.

Additionally, changes to deductibles, copayments, and other cost sharing features affect how these medical costs are split between plans and members. Based on the proposed mix of plan designs for 2027, Bankers Reserve Life Insurance Company of Wisconsin is expected to cover approximately 74% of claims costs in 2027, with the remainder being covered by members through cost sharing.

Administrative Costs and Anticipated Margins

Bankers Reserve Life Insurance Company of Wisconsin anticipates administrative costs to increase by $9 per member per month compared to what was assumed for 2026 rates. Taxes and fees are expected to increase as a percentage of premium by less than 0.1%. The target post-tax profit margin for 2027 is set to 2.4% of premiums.

Blue Cross Blue Shield of OK:

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is filing new rates to be effective January 1, 2027, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate increases for these plans is -12.4% to 24.4%. The following are the average rate increases by product:

Product/Rate Increase

• OK PPO 14.56%
• MyBlue HMO -2.62%

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 60,034 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.

Financial Experience of the Product

Consistent with the filed URRT, earned premiums for all non-grandfathered Individual plans during calendar year 2025 were $993,261,918 and total claims incurred were $995,894,105. The proposed rates effective January 1, 2027 are expected to achieve the loss ratio assumed in the rate development.

Changes in Medical Service Costs

The proposed rates reflect expected change in year over year medical service and prescription drug costs, which includes changes in reimbursement rates to providers, changes in expected utilization of services, the mix and intensity of services, and the introduction of new procedures and technologies.

Changes in Benefits

There are no legally required changes to covered benefits and no significant changes to the benefit structure. Cost-sharing changes were made within these products allowing plans to maintain their metal status, which can contribute to the change in rates.

Administrative Costs and Anticipated Margins

The Affordable Care Act expects health plans in the individual market to spend at least 80% of each premium dollar they collect to pay for medical care and activities that improve health care quality for members. If health plans fail to spend at least 80% on medical claims and health care quality initiatives, they are required to give back money to consumers through a premium rebate. These rates assume BCBSOK will once again exceed the 80% threshold.

Celtic Insurance Co:

This information is intended for use by the Oklahoma Insurance Department, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Oklahoma to assist in the review of Celtic Insurance Company’s individual rate filing.

The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions. In 2025, earned premium was $556.44 per member per month (PMPM). Incurred claims in 2025 were $389.46, or 69.99% of premium. Netting risk adjustment from the claims results in an estimated loss ratio (incurred claims net of estimated risk adjustment transfers, divided by earned premiums) of 83.97%.

We expect unit costs to increase for 2027. Further, we have updated underlying experience for the single risk pool, expected administrative expense, and assumptions for federal risk adjustment. These factors, as well as changes to the assumed morbidity of the single risk pool and medical trend, result in a premium rate increase.

Medical trend, or the increase in health care costs over time, is composed of two components: the increase in the unit cost of services and the increase in the utilization of those services. Unit cost increases occur as care providers and their suppliers raise their prices. Utilization increases can occur as people seek more services than before. Additionally, simple services can be replaced with more complex services over time, which is known as service intensity trend. An example of service intensity trend would be the replacement of an X-ray with an MRI scan. Replacing the service with a more intense service causes the total cost of medical services to increase.

The proposed rate change of 29.0% applies to approximately 71,620 individuals. Celtic Insurance Company’s projected administrative expenses for 2027 are $97.32 PMPM. Administrative expense does not include $32.47 for taxes and fees. The historical administrative expenses for 2026 were $82.67 PMPM, which excludes taxes and fees. The projected loss ratio is 83.8% which satisfies the federal minimum loss ratio requirement of 80.0%.

CommunityCare HMO:

CommunityCare HMO, Inc. (CCOK) has submitted its 2027 filing for its Individual HMO product. The weighted average premium increase is 24.1%, with a minimum and maximum increase by plan of 11.3% and 58.2% respectively. The table below shows the rate average increase by metal level and affected policyholders.

Metal Rate Change Policyholders

• Bronze 24.4% 11,044
• Silver 21.1% 4,413
• Gold 19.2% 1,301
• Catastrophic 58.2% 1,061
• Total 24.1% 17,819

Note that this is the number of policyholders, not the number of covered lives; I'm using a ballpark estimate of around 1.4 covered lives per policyholder on average, putting CommunityCare at around 25,000 covered lives.

Financial Experience: The goal of the rate increase is to stabilize premiums to ensure solvency and the ability to pay policyholder claims. The Company’s target loss ratio for 2027 with this increase is 84%.

Key Drivers for this Filing

Financial Experience: The projected 2027 claims and resulting premiums were developed based on CCOK’s 12-month, 2025 claims experience per ACA single risk pool regulations. The impact of this updated claims experience on premiums was approximately 14.9%.

Changes in Medical Service costs: A main driver of premium increases includes changes to anticipated medical costs and utilization of services. The estimated impact is approximately 5.3% to the filed increase. The main driver of trend are medical unit cost increases and pharmacy unit cost and utilization increases.

Administrative Costs: These include costs related to claim payments, overhead, employee salaries, and taxes. These are expected to increase compared to 2025 with the estimated impact being 3%.

Changes in Benefits: The 2027 premiums contain benefit changes including changes to:

• cost sharing provisions
• out of pocket maximums

Standard plan’s benefit changes were mandated by law. CCOK’s mission is to support the healthcare needs of all Oklahomans and believes the requested increase will help best meet those goals.

Oscar Insurance Co:

(Unfortunately, Oscar's actuarial memo is heavily redacted so I've had to make an educated guess as to their effectuated enrollment based on the ~180,000 on-exchange enrollees as of February 2026 and the total enrollment of the other carriers; I'm putting it at around 19,000.)

UnitedHealthcare of Oklahoma:

UHCOK is filing 2027 rates for individual products. The proposed rate change is 30.46% and will affect 10,146 individuals. The rate changes vary between 27.88% and 31.29%. Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes.

Financial Experience of the Product

The premium collected in plan year 2025 was $69,488,920. Incurred claims during this period were $42,445,337 and UHC expects pay -$12,665,993 in risk adjustment. The loss ratio, or portion of premium required to pay medical claims, for plan year 2025 is 74.70%.

Changes in Medical Service Costs

There are many different healthcare cost trends that contribute to increases in the overall U.S. healthcare spending each year. These trend factors affect health insurance premiums, which can mean a premium rate increase to cover costs. Some of the key healthcare cost trends that have affected this year’s rate actions include:

• Increasing cost of medical services: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies.
• Increased utilization: The number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected using expensive procedures such as surgery versus simply monitoring or providing medications.
• Higher costs from deductible leveraging: Healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year.
• Impact of new technology: Improvements to medical technology and clinical practice often result in the use of more expensive services, leading to increased healthcare spending and utilization.
• Changes in market morbidity: Expanded and enhanced federal premium tax credits for consumers expired at the end of 2025. Premiums reflect the expected increase in the average cost per member due to healthier members leaving the market.

Changes in Benefits

Changes in benefits impact costs and therefore affect premium changes. Plan benefits are typically changed for one of three reasons: to comply with the requirements of the Affordable Care Act or state law, to respond to consumer feedback, or to address a particular medical cost issue to provide greater long-term affordability of the product.

The Affordable Care Act implemented requirements for the “value” that must be offered by plan designs in the Individual and Small Group markets. These are called “metal levels”. For a benefit plan to remain classified within a particular metal level from year to year, adjustments to deductibles, copayments or coinsurance are sometimes required. These adjustments impact the cost and therefore the premium increases for the plan.

Administrative Costs and Anticipated Margins

UHCOK works to directly control administrative expenses by adopting better processes and technology and developing programs and innovations that make healthcare more affordable. We have led the marketplace by introducing key innovations that make healthcare services more accessible and affordable for customers, improve the quality and coordination of healthcare services, and help individuals and their physicians make more informed healthcare decisions.

Taxes and fees imposed by the state and federal government are significant factors that impact healthcare spending and must be included as additional administrative costs associated with the plans. These fees include Affordable Care Act taxes and fees which impact health insurance costs and need to be reflected in premium. Another component of premium is margin, which is set to address expected volatility and risk in the market.

The requested rate change is anticipated to be sufficient to cover the projected benefit and administrative costs for the 2027 plan year.

It's important to also note that both Medica Insurance Co. and Mending Health (aka Taro Health) are pulling out of the Oklahoma individual health insurance market, which means that around 6,500 and 8,000 enrollees respectively will have to shop around for coverage via one of the other carriers (Mending/Taro's withdrawal letter says they have 5,000 policyholders which I'm assuming translates into roughly 8,000 actual covered lives).

Combined, these all amount to a 21.6% weighted average rate increase for unsubsidized enrollees in 2027, pushing the average per enrollee up to over $880 per month:

Meanwhile, the Oklahoma small group market is looking at an unweighted average rate increase of 16.2% (I only have the enrollment data for 4 of the 5 carriers).