2027 Rate Changes - West Virginia: +17.3% indy market; +19.6% sm. group market

ACA exchange enrollment has dropped by 13% in West Virginia since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Interestingly, while plan signups during the 2026 Open Enrollment Period were down nearly 17% vs. OEP 2025, effectuated enrollment as of February was actually only down 13%...it was down nearly 20% year over year in January, but actually increased slightly between January and February, which I believe makes West Virginia one of the only states to see that happen this year. Huh.

We'll have to see what develops over the rest of the year, of course, but this is especially unusual given that West Virginia has by far the highest unsubsidized premiums in the country this year (and will next year as well, as you'll see if you read further).

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:

HIGHMARK BCBS WV:

Highmark West Virgina (“Highmark WV”) is requesting an average ACA individual market rate increase of 18.3%, ranging from 15.1% to 21.8%. Products submitted with this filing will have effective dates from January 1, 2027 to December 31, 2027. This rate change is projected to affect 33,791 members.

Historical Financial Experience:

Highmark WV incurred an underwriting gain in its ACA individual market programs in 2025.

Change in Medical Service Costs:

The projected average cost of medical care for the projected population is expected to increase. The increase will emerge in utilization and average cost per service and is spread across all types of services.

Change in Benefits and Cost Sharing:

Some cost sharing parameters were changed in order to maintain compliance with Federal AV requirements.

Administrative Costs and Anticipated Operating Results:

The anticipated administrative costs and operating results are not excessive or unreasonable. In accordance with regulations, the projected medical loss ratio is over 80%.

THE HEALTH PLAN OF WV:

4.3: Proposed Rate Changes (Redacted)

With CareSource pulling out of the WV market entirely, that leaves just two insurance carriers participating in the state's individual market: Highmark BCBS and The Health Plan of WV. Unfortunately, I don't have effectuated enrollment data for either CareSource or THP of WV, so I've had to make educated guesses based on the known on-exchange enrollment as of February; I pegged this at ~12,000 for CareSource and ~9,000 for THPWV. Assuming those are reasonably close, that puts the preliminary rate increase being requested by carriers in the West Virginia individual market at around 17.3%.

This, in turn, would put unsubsidized (full price) ACA insurance policy premiums at over $1,500 per month per enrollee on average. Even if THP of WV's enrollment is higher than 9,000, it would only shave a few tenths of a point off of the average rate hikes.

As for WV's small group market, it looks like The Health Plan of WV is pulling out of that next year, leaving three carriers with weighted average rate hikes of 19.6%.