2027 Rate Changes - Kansas: +19.5% indy market, +11.5% sm. group market

ACA exchange enrollment has dropped by 20% in Kansas since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were only down 3.6% vs. OEP 2025...but effectuated enrollment was 9.3% lower year over year in January, rising to 20% lower as of February.

That's over 36,000 Kansans who already lost coverage in just the first two months of the year...a number which has likely continued to climb 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 (Ambetter):

Bankers Reserve Life Insurance Co. is filing rates for the individual block of business, effective January 1, 2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum.

This information is intended for use by the Kansas Insurance Department, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Kansas to assist in the review of Bankers Reserve Life Insurance Co.’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 $0.00 per member per month (PMPM). Incurred claims in 2025 were $0.00, or 0.00% 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 0.00%. 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.

This confused me a bit at first as they also say that they have over 1,300 current enrollees until I realized that they said they received no revenue in 2025, not this year; I assume that means they newly-entered the Kansas market in 2026.

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 16.7% applies to approximately 1,324 individuals. Bankers Reserve Life Insurance Co.’s projected administrative expenses for 2027 are $99.98 PMPM. Administrative expense does not include $13.22 for taxes and fees. The historical administrative expenses for 2026 were $77.86 PMPM, which excludes taxes and fees. The projected loss ratio is 86.8% which satisfies the federal minimum loss ratio requirement of 80.0%.

BLUE CROSS BLUE SHIELD OF KANSAS CITY:

Blue Cross and Blue Shield of Kansas City (BCBSKC) is filing rates for individual plans in Kansas. The overall average premium increase for individual plans in 2027 is 15.4% compared to the 2026 individual rates. The changes for plans range from 11.3% to 22.6%. This does not include and additional small increase for attaning a new age. That is, an individual’s premium rates will increase each year as they get older, even if the rates for their plan do not change. This small increase is not factored in to the average increases stated above.

In developing assumptions and setting rates for 2027, BCBSKC used data from its own claim experience, as well as information received from Wakely, a company which provides free services to aid insurance companies which provide coverage to individuals and small groups.

In 2025, the “experience period” used as a starting point for developing rates for 2027, BCBSKC experienced a medical loss ratio (MLR) of 98.5%. This means that 98.5% of premium and risk transfer received was spent on medical and drug claims. Our projected loss ratio for Affordable Care Act (ACA) individual plans in 2027 is 82.5%.

Scope and Range of the Rate Increase

The new 2027 rates will apply to any individual that first purchases or renews coverage for the year 2027. As of April 30, 2026, 2,685 members are enrolled in BCBSKC plans impacted by this rate filing. The average increase of 15.4% for the plans in question is an average, and changes vary by plan.

Key Drivers Behind Rate Increase

Rates were not high enough to pay for medical claims, drug claims, and company expenses in 2025, and they will need to be increased in 2027. However, BCBSKC made many changes to its 2026 and 2027 plans, and expects claims to decrease in 2027 which will result in a lower rate increase than would otherwise be needed.

Changes in Medical Service Costs

• All else held equal, BCBSKC expects medical costs to go up 8.5% from 2026 to 2027, primarily due to members seeking services at a greater rate next year, and the continued increase in the cost of those services.
• BCBSKC also expects the average health status of members covered by BCBSKC ACA individual plans to improve in 2027, resulting in a separate 4.0% decrease in medical and drug costs.

Other Factors

• Administrative expenses are expected to make up 12.0% of premium in 2027, which is slightly higher than the 11.8% assumed for 2026.
• In addition to the above, changes to the benefits of some plans, and how many people are expected to enroll in each plan and network resulted in a decrease of 3.0% to rates in 2026.

BLUE CROSS BLUE SHIELD OF KANSAS:

Blue Cross and Blue Shield of Kansas is filing rates for Individual plans in Kansas. This filing proposes to raise the average premium rate by 15.68 percent.

Scope and range of the rate increase

The proposed rates will apply to policies that start or renew during the period beginning January 1, 2027 and ending December 31, 2027. As of May 1, 2026, 19,157 members are enrolled in BCBSKS Individual plans affected by this rate increase for period beginning January 1, 2027 and ending December 31, 2027. The proposed increase of 15.68 percent is an average. The actual premium increase a member of one of these plans will receive depends on such things as the member's choice of plan, the member's age, the member's location in the state, and any changes in federal government tax subsidies. The lowest rate increase for a given plan is 3.38 percent and the highest is 21.96 percent.

Key drivers for this filing

The key drivers for this filing are:

• Projected claims per member per month came in higher than anticipated compared to a year ago.
• Projected medical and drug trends are expected to come in higher than in previous years.

Changes in medical service costs

The 2025 actual claims PMPM came in higher than what was projected last year. The 18.02% decrease in enrollment was a large contributor to the increase in PMPM costs, as claims remained within 9.31% of their 2024 level in 2025. Additionally, Medical and Drug cost trends are expected to continue to rise higher than previous years driven by increases in contracted provider reimbursement amounts and service mix and intensity.

Financial experience of the product

For 2025, BCBSKS experienced a loss of 13.9 percent of premium. For 2026, BCBSKS is projecting a loss of 3.0 percent of premium. The company's 2026 Individual block of business is expected to have a medical loss ratio of greater than 80 percent, as required by federal law. BCBSKS expects this to be the case again in 2027 and 2028 as well.

Administrative costs and anticipated profits

BCBSKS has priced these plans administrative costs as 10.1 percent of premium, which is a 0.8 percent increase compared to last year's pricing assumption. The company expects that the requested premium increase will produce no profit or loss in 2027.

CELTIC INSURANCE CO:

Celtic Insurance Company is filing rates for the individual block of business, effective January 1, 2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum.

This information is intended for use by the Kansas Insurance Department, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Kansas 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 $612.78 per member per month (PMPM). Incurred claims in 2025 were $526.34, or 85.89% 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 82.79%. 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 16.7% applies to approximately 90,836 individuals. Celtic Insurance Company’s projected administrative expenses for 2027 are $98.04 PMPM.

Administrative expense

does not include $32.60 for taxes and fees. The historical administrative expenses for 2026 were $84.40 PMPM, which excludes taxes and fees. The projected loss ratio is 84.2% which satisfies the federal minimum loss ratio requirement of 80.0%.

OSCAR INSURANCE CO:

The purpose of this document is to present rate change justification for Oscar Insurance Company's Individual Affordable Care Act (ACA) products, with an effective date of January 1, 2027, and to comply with the requirements of Section 2794 of the Public Health Service Act as added by Section 1003 of the Patient Protection and Affordable Care Act (ACA).

Using in-force business as of May 2026, the proposed average rate increase for renewing plans is 20.0%. Rate increases vary by plan due to a combination of factors including shifts in benefit leveraging and cost-sharing modifications. This rate increase is absent of rate changes due to attained age. The rate increase impacts an estimated 13,410 members.

2. Reason for Rate Increase(s)

The significant factors driving the proposed rate change include the following:

Medical and Prescription Drug Inflation and Utilization Trends

The projected premium rates reflect the most recent emerging experience which was trended for anticipated changes due to medical and prescription drug inflation and utilization.

Prospective Benefit Changes

Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value Calculator and state requirements, as well as for strategic product considerations.

Anticipated Changes in the Average Morbidity of the Covered Population

Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.

UNITEDHEALTHCARE INSURANCE CO:

UHIC is filing 2027 rates for individual products. The proposed rate change is 34.81% and will affect 22,178 individuals. The rate changes vary between 29.68% and 36.48%. 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 $175,245,693. Incurred claims during this period were $135,160,591 and UHIC expects payments of $32,812,226 for risk adjustment. The loss ratio, or portion of premium required to pay medical claims, for plan year 2025 is 95.85%.

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 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

UHIC 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 worth noting that Medica Insurance Co, which is pulling out of Kansas, also has around 600 enrollees there.

Combined, these all amount to a whopping 29% weighted average rate increase for unsubsidized enrollees in 2027, pushing the average per enrollee up to around $890 per month:

Meanwhile, the Kansas small group market is looking at a non-weighted average rate increase of 11.5% (I could only find effectuated enrollment for two of the three carriers on the KS market):