2026 Rate Changes - West Virginia: +11.3%; ~70,000 enrollees are facing MASSIVE rate hikes in January

Overall preliminary rate changes via the SERFF database, West Virginia Insurance Dept. and/or the federal Rate Review database.

CareSource WV:

(unfortunately, CareSource WV's actuarial memo is heavily redacted)

Highmark BCBS WV:

Highmark West Virgina (“Highmark WV”) is requesting an average ACA individual market rate increase of 17.0%, ranging from 15.2% to 23.3%. Products submitted with this filing will have effective dates from January 1, 2026 to December 31, 2026. This rate change is projected to affect 28,179 members.

Historical Financial Experience:

Highmark WV incurred an underwriting gain in its ACA individual market programs in 2024.

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:

(unfortunately, The Health Plan of WV's actuarial memo is heavily redacted)

As noted, unfortunately I only have actual current enrollment data for one of the three WV carriers. For the other two I had to make an educated guess based on the total WV individual market enrollment, which should be roughly ~70,000 or so.

If I assume equal enrollment in both CareSource and The Health Plan of WV, I get a weighted average rate hike of 11.3%.

(It's worth noting that CareSource and THPWV have virtually identical rate increases anyway, so the weighted average should be the same regardless of the breakout between the two).

HOWEVER, It's important to remember that this is for unsubsidized enrollees only; for subsidized enrollees, ACTUAL net rate hikes will likely be MUCH HIGHER for most enrollees due to the expiration of the improved ACA subsidies & the Trump CMS "Affordability & Integrity" rule changes.

Meanwhile, I have no enrollment data at all for some of the small group carriers; the unweighted average 2026 rate hike there is 16.1%.