2027 Rate Changes - Missouri: +12.4% indy mkt; +16.5% sm. group

ACA exchange enrollment has dropped by a whopping 25% in Missouri since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were already down over 12% vs. OEP 2025...but effectuated enrollment in was 18% year over year as of January and 25% lower in February. That's over 86,000 Missourians who have lost their individual market healthcare coverage.

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 Missouri Dept. of Commerce & Insurance, with the SERFF numbers allowing me to dig into more detail on each carrier's filings for both markets (including effectuated enrollment numbers).

Overall, MO carriers are asking for rate hikes averaging 12.4% marketwide (Medica Central Insurance Co. is apparently leaving the market, as they have no filing and aren't listed in the summary, but as far as I can tell they only have a few hundred enrollees who might have been absorbed into the main Medica Insurance Co. anyway):

BANKERS RESERVE LIFE INSURANCE CO:

2027 Premium Rate Change and Key Drivers of the Change

Bankers Reserve Life Insurance Co.’s proposed rate change is 11.3% and it applies to 2,442 members. The most significant driver of the rate increase is a deterioration in statewide morbidity.

A Brief Description of the Overall Experience of the Policy

This filing has no credible experience. The estimated 2025 Medical Loss Ratio (MLR) is 74.1%. The projected 2027 MLR is 86.5%. MLR describes the percentage of premium payments used to pay medical claims and to improve the quality of care. Our estimate for 2027 is that 86.5% of premiums paid to Bankers Reserve Life Insurance Co. will be used to pay member claims and support activities that improve the quality of the care we offer.

Description of the Process Used to Develop the 2027 Premium

Our 2027 estimates were developed using 2025 claims and other information from Celtic Insurance Company available through 3/31/2026, taking into account the following:

• Our 2025 claim cost was $529.03 per member per month. This is the average monthly amount of money paid in claims for each member.
• Risk Adjustment and Statewide Average Premium - As part of the Affordable Care Act (ACA), if an insurer provides insurance to sicker people, that insurer receives money from the other insurers who provided insurance to healthier people. Our 2025 program result was used to help us set our estimate for 2027.
• Increased use of medical services - In general, insured people use more medical services over time, due in part to new treatments becoming available.
• Benefit Design - There were no changes in benefits compared to 2026.
• Administrative expense - Administrative expenses include employee pay, office expenses, and other business costs. They do not include payment for our members’ medical services or taxes and fees. Projected administrative expenses for 2027 are $95.67 PMPM, and historical administrative expenses for 2026 were $75.27 PMPM.

BLUE CROSS BLUE SHIELD OF KANSAS CITY:

Blue Cross and Blue Shield of Kansas City (BCBSKC) is filing rates for individual plans in Missouri. The overall average premium increase for individual plans in 2027 is 10.6% compared to the 2026 individual rates. The changes for plans range from 5.5% to 16.2%. This does not include and additional small increase for attaining 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 103.5%. This means that 103.5% 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 84.0%.

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, 5,416 members are enrolled in BCBSKC plans impacted by this rate filing. The average increase of 10.4% 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 9.3% 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 4.6% decrease in medical and drug costs.

Other Factors

• Administrative expenses are expected to make up 11.9% of premium in 2027, which is lower than the 13.8% 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 3.2% to rates in 2026.

CELTIC INSURANCE CO:

2027 Premium Rate Change and Key Drivers of the Change

Ambetter Health’s proposed rate change is 10.3% and it applies to 151,880 members. The most significant driver of the rate increase is an increase in unit cost trend.

A Brief Description of the Overall Experience of the Policy

Ambetter Health began business in Missouri in 2018, with plans offered in 40 counties; Ambetter Health will be offering plans in 109 counties for 2027. Premium rates were increased in 2026 and will be increased in 2027. We expect this, in addition to rising claim costs, to increase the estimated 2025 Medical Loss Ratio (MLR) of 76.9% to 83.5% for 2027. The MLR describes the percentage of premium payments used to pay medical claims and to improve the quality of care. Our estimate for 2027 is that 83.5% of premiums paid to Ambetter Health will be used to pay member claims and support activities that improve the quality of the care we offer.

Description of the Process Used to Develop the 2027 Premium

Our 2027 estimates were developed using 2025 claims and other information available through 3/31/2026, taking into account the following:

• Our 2025 claim cost was $464.71 per member per month. This is the average monthly amount of money paid in claims for each member.
• Risk Adjustment and Statewide Average Premium - As part of the Affordable Care Act (ACA), if an insurer provides insurance to sicker people, that insurer receives money from the other insurers who provided insurance to healthier people. Our 2025 program result was used to help us set our estimate for 2027.
• Increased use of medical services - In general, insured people use more medical services over time, due in part to new treatments becoming available.
• Benefit Design - There were no changes in benefits compared to 2026.
• Cost Sharing Reduction (CSR) Subsidies - "Cost Sharing Reduction" requires us to reduce the share of medical costs that low-income members pay when they have coverage with a Silver plan.
• Administrative expense - Administrative expenses include employee pay, office expenses, and other business costs. They do not include payment for our members’ medical services or taxes and fees. Projected administrative expenses for 2027 are $92.06 PMPM, and historical administrative expenses for 2026 were $80.67 PMPM.

COX HEALTH SYSTEMS INSURANCE CO:

Purpose and Scope of Rate Justification:

This letter explains the rate change for Cox Health Systems Insurance Company’s (CHSIC) calendar year 2027 rates. This letter is for health plans offered to individuals. These plans are offered through the website Healthcare.gov. CHSIC will offer plans in these Missouri counties: Barry, Christian, Greene, Lawrence, Stone, Taney and Webster.

Only new plans will be offered in 2027. All current 2026 plans will be terminated.

Data, Information and Assumptions Used to Develop the Rates:

To set rates for 2027, CHSIC used their costs for their business in Missouri. CHSIC believes members will use services like prior years. The non-claim expenses are based on actual expenses from the prior year.

Main Factors in determining rates:

• We assume claim costs for medical and pharmacy services will go up. Today, health care costs are rising 9.9% per year. This means the premium rates were increased to cover the higher claim costs.
• Hospital costs are expected to go up for visits at Cox Medical Centers. This caused the premium to go up.
• We are assuming CHSIC will have to make a Risk Adjustment payment. This caused the premium to go up.

Overall Experience of the Individual ACA Market:

Premium and costs for CHSIC in Missouri are shown below for calendar years 2023, 2024 and 2025. The Medical Loss Ratio (MLR) for each year is shown. If the MLR is less than 80%, CHSIC would be required to refund money to the consumers. In every year shown, the MLR is greater than 80%, so CHSIC is not required to pay any money back.

Projected Claims and Non-Claims Expense:

Rates are set to pay for estimated claim costs and non-claim expenses. Medical and pharmacy claims are 91.0% of the premium rate. Non-claim expenses, including taxes and fees, are 7.0% of the premium rate. Premiums include a 2.0% profit.

HEALTHY ALLIANCE LIFE INSURANCE CO:

Scope and Range of the Rate Increase

Healthy Alliance Life Insurance Company (HALIC) has filed for premium rate changes for its Affordable Care Act (ACA) compliant Individual health insurance plans. This filing includes an average rate change of 12.67%, effective January 1, 2027, with plan prices changing between 10.21% and 15.66%. The price changes will impact about 40,000 people that have HALIC plans now and will keep HALIC plans next year. An insured person’s actual rate increase could be higher or lower depending on their benefit, where they live, how old they are, number of children, and if they use tobacco.

Data from HALIC’s 2025 ACA-compliant plans has been used to develop the proposed rates. HALIC has made assumptions around how that data will change between 2025 and 2027. Assumptions include how much the health of people will change between 2025 and 2027 (morbidity), who will purchase what kind of plans in 2027 (demographics and benefits), how much medical and pharmacy costs will change between 2025 and 2027 (trend), and how much HALIC’s costs will be to run its business operations in 2027 (non-benefit expenses). In addition to these assumptions, some of the most significant factors underlying the rate change are changes in the purchasing population.

Claims are expected to increase from $496.22 in 2025 to $671.62 in 2027. Projected administrative expenses are 6.6%, taxes and fees are 5.2%, and a profit and risk load is 5.1%.

Financial Experience of the Product

Per HealthCare.gov, the medical loss ratio (MLR) is, “A basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions.” Anthem expects the proposed rate increase will result in a MLR of 86.1%, which is greater than the minimum MLR requirement of 80% as defined in the Affordable Care Act. In the event Anthem’s MLR is less than the Federal required minimum, Anthem will refund the difference to insured people.

Changes in Medical Service Costs

Medical costs change every year and will generally increase. By looking at past data, it is possible to recognize a pattern to this change and this is used to predict the future cost of medical services (trend).

This trend is usually found to be increasing over time and is due to increases in the cost of services and number of services used.The cost of services increases due to the amount charged for medical services by hospitals and physicians and drug companies, increases in the number of services individuals are using, and advances in technology. Increases in the number of services result from the overall population getting older, product design, and many other factors.

Administrative Costs and Anticipated Profits

HALIC’s administrative costs have not changed by much between 2026 and 2027. Additionally, HALIC is filing for the same profit and risk margin as it did in 2026. As mentioned above, HALIC is mindful of MLR requirements and is filing premium increases that are expected to meet the terms of this requirement. HALIC did not add a specific amount to its plan prices due to the individual mandate going away.

Market Uncertainty

This rate increase is based on several assumptions. If something changes to cause those assumptions to be incorrect, HALIC may need to change plan prices, areas that we sell plans, and/or plans that we offer.

MEDICA INSURANCE CO:

1) Scope and Range of Rate Increase

Medica Insurance Company (Medica) is requesting a rate change for its individual market business in Missouri. The rate change will take effect on January 1, 2027 and will impact an estimated 12,843 members. The average rate change will be 25.6% and will result in rate changes that vary across plan designs. This includes changes to the costs of care.

Medica uses 2025 data from Missouri, which includes estimates of changes to the below through 2027:

• Population Medica expects to insure
• Cost of medical services
• Cost of pharmacy services
• Taxes and fees

The significant factors that impact the rate change include those listed above. Claim costs per member per month are expected to change from $507.55 in 2025 to $633.84 in 2027.

2) Financial Experience of the Product

In 2025, 111.0% of premium dollars went towards medical services after taxes and fees were removed. Under the ACA, individual products are required to pay at least 80% of premium dollars, after taxes and fees were removed, towards medical services.

For 2027, Medica is expecting that 88.7% of premium dollars will be spent on medical services in Missouri after taxes and fees were removed.

3) Changes in Medical Service Costs

Medical cost changes, in both number of services and costs of services, make up the largest increase to Medica’s premium rates. Additionally, impacts due to better rates with hospitals and doctors and reviewing recent experience also aid in determining premium changes. Finally, relationships with providers are helping to improve premium rates through a lower overall cost for care.

4) Changes in Benefits

Medica updates the plan designs offered each year, which impacts each plan’s cost-sharing (e.g. deductibles, copayments, etc.). These updates follow federal rules for how much of costs the insurance company will cover under that plan. Because these updates will be different for each plan, the rate changes will also be different by plan.

5) Administrative Costs and Anticipated Margins

Medica expects the cost to administer coverage per member per month (PMPM) for 2027 to be $84.80 which is higher than the 2025 value of $77.74. The main drivers of Medica’s administrative expenses are employee salaries and benefits, agent commissions, claim processing/IT, and clinical/network services

OSCAR INSURANCE CO:

Rate Increase Justification

1. Scope and Range of Rate Increase

The purpose of this document is to present rate chang e justification for Oscar Insurance Company’s (Oscar’s) Missouri individual Affordable Care Act (ACA) products, with an effective date of January 1, 2027, and to comply with the requirements of the Missouri Department of Insurance. The average rate increase for renewing plans is 15.9%. Rate increases vary by plan due to a combination of factors including plan design and geographic rating factors. This rate increase is absent of rate changes due to members aging. The rate increase impacts an estimated 18,672 members.

2. Reason for Rate Increase(s)

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

Medical and Prescription Drug Trends

• The projected premium rates reflect trends for anticipated changes in cost and usage of medical and prescription drug services.

Administrative Expenses, Taxes and Fees, and Risk Margin

• Changes to the overall premium level are needed because of required changes in federal and state taxes and fees. In addition, there are anticipated changes in both administrative expenses and profit.

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 new and updated offerings which are more consumer friendly and easier to understand. The AV calculator is used to determine whether health insurance plans offer enough coverage to meet ACA requirements and to set metal levels.

Anticipated Changes in the Average Health of the Covered Population

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

3. How the Plan Spends Your Premium

Oscar plans to spend the premium it collects in 2027 on the following claims and non-claims expenses:

• Claims and Risk Adjustment transfers to other carriers: 83.8% of premium
• Administrative expenses: 9.1% of premium
• Taxes and fees: 5.0% of premium
• Profit: 3.9% of premium

Under the Affordable Care Act (ACA), individual market carriers are required to pay at least 80% of premium dollars, after taxes and fees are removed, toward medical claims. This ratio is referred to as the medical loss ratio (MLR). Oscar’s projected federal MLR using the ACA-defined formula is 86.5% for 2027.

UNITEDHEALTHCARE INSURANCE CO:

Qualified Health Plan Issuers are required to provide a justification for the requested rate increase in Missouri. Below is justification for the rate increase effective January 1, 2027, for UnitedHealthcare Insurance Company (UHIC) individual medical plans offered in Missouri that are fully compliant with the Patient Protection and Affordable Care Act (ACA).

Scope and Range for the Rate Increase:

The overall average rate change is +16.5%, and the rate change by plan varies from +13.4% to +21.1%.

The most significant factors underlying the average rate change are described below:

• Medical and pharmacy costs are increasing and we are changing our premium rates to reflect
• this increase.
• Expected changes in market morbidity as some healthier members leave the market due to
• changes in premium subsidy availability.
• Changes in non-claims expenses.

The actual rate change for an individual depends on plan selection, location, age, family size, and tobacco usage.

Components of Premium:

Premiums are calculated using estimated medical and pharmacy claims, benefit designs, and other non-claims expenses. These are described below:

• Medical and pharmacy claims: UHIC estimates the cost of claims that its members will have in 2027. Consistent with ACA requirements, the estimated costs built into each plan is based on UHIC’s average health status.
• Benefit design: each plan has a different set of benefits including deductible, copayment, and out-of-pocket maximum. These benefits impact plan premiums.
• Non-claims expenses: in addition to the medical and pharmacy claims paid by UHIC, there are additional costs that UHIC pays to support each plan. These include administrative expenses, overhead, taxes and fees.

In the small group market, Missouri carriers are asking for weighted average increases of 16.5% next year, with National Health Insurance Co. apparently dropping out: