2027 Rate Changes - Idaho: +13.1% indy mkt, +10.6% sm. group mkt

Idaho is one of a handful of states where plan selections during the 2026 Open Enrollment Period actually increased year over year, by around 2.6%, in spite of the enhanced federal subsidies expiring back in December.

Two months into the year, however, effectuated enrollment is actually down slightly (by around 2.2%, or roughly 2,500 enrollees).

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 Idaho Insurance Dept. website. For PacificSource, which is pulling out of the entire individual market nationally, I had to make an educated guess as to their current effectuated enrollment; it was around 4,300 people a year earlier.

Overall, individual market carriers are seeking a weighted average 13.1% premium increase next year in Idaho, which currently has the lowest average ACA premiums in the country:

Blue Cross of Idaho Health Services, Inc.

The filed overall average rate change for January 1, 2027, is 14.01%. This average rate change does not indicate that every individual’s rate will change by this amount, as rates are affected by the ages of those covered, family coverage, the date of policy renewal and benefits chosen. We have estimated that rate changes by member, prior to the impact of aging, for the 30,382 members enrolled as of March 2026 will range between 0.5% and 26.1% including the impact of benefit and cost sharing changes.

Rate changes will vary by metal level:

Metal Level Average Rate Increase

• Gold 14.1%
• Silver 15.0%
• Bronze 13.7%
• Catastrophic 8.0%

Average increases also vary by rating area.

Rating Area Average Rate Increase

• 1 12.9%
• 2 20.4%
• 3 6.6%
• 4 20.3%
• 5 16.0%
• 6 12.3%

Most Significant Factors

The rate change described above is driven by the following factors:

• Paid Claims Expense: 9.31%
• Administrative Expenses -0.47%
• State Based Reinsurance 2.68%
• Risk Adjustment 2.99%
• Margin 2.72%
• Other: -3.22%

Moda Health Plan, Inc.

Individual Health Benefit Plans

Rate Change

The average rate change is 26.82%. The maximum is 30.97%, and the minimum is 24.80%. The number of individuals impacted by this rate change is 4,801.

Most Significant Factors

Moda Health Plan’s 2025 Idaho Individual experience was used to develop 2027 rates. This experience was determined to be 93.97% credible based on having 57,398 member months in the experience period and needing 65,000 members to be fully credible.

The most significant factor contributing to the increase is Moda Health Plan’s emerging Idaho Individual experience and an 9.2% annual trend. The other significant factor contributing to the increase is the manual rate component. Moda Health Plan’s 2025 Oregon Individual experience trended forward to the 2027 rating period and adjusted to an Idaho cost basis was used to develop the manual rate.

Other factors impacting the overall rate change are changes in reinsurance, risk adjustment, and silver loading assumptions.

MOLINA Healthcare:

In accordance with the 2027 Idaho Standards document, the following rate increase justification has been provided.

RATE CHANGE

Molina’s rate filing reflects the following rate changes by metal tier, averaging 12.9% Molina has 670 members in plans that are renewing enrolled effective March 2026 and reported as of March 2026. The rate change calculation below is consistent with Worksheet 2, Section II of the URRT, which only includes members on renewing plans.

Mountain Health Cooperative (MHC) has 6,689 insureds enrolled who will be affected by 2027 Individual Market rate changes if they continue their coverage. Before federal subsidies, the average change in premium for these individuals will be 19.4%. The requested rate change varies by product with the smallest average change of 15.1% for Link Platinum and the largest average change of 50.3% for Access Catastrophic .

Regence BlueShield of Idaho Preliminary Rate Increase Justification for 2027

The projected average rate change for plans effective January 1, 2027 is 8.4% which is an average rate change of about $40 per member per month (pmpm). Because 8.4% (or about $40) is an average, it is possible to have a different rate change. Factors affecting a member's premium are age, tobacco use, family composition, plan, and geographic area. Expected cost differences by product are updated every year to ensure premium differences are appropriate. Regence has approximately 23,000 members enrolled in this line of business as of March 2026.

SelectHealth

Rate Change

The Individual plan rates are increasing by 11.30 percent on average. The actual rate change varies by selected benefit plan and area. The number of individuals impacted is 31,709.

Contributing Factors

The rate change described above is driven by the following factors:

• The composition of the single risk pool
• Medical and pharmacy cost increases
• Expiration of Enhanced Subsidies
• Changes to the Idaho High Risk Pool Reinsurance program

1) The claims experience and health risk for the ACA risk pool continue to be high. Inflation and deductible leveraging are also increasing costs. 2) The utilization and costs for these plans are projected to increase for facility, provider, and pharmacy claims. 3) The enhanced subsidies expired at the end of 2025. 4) The Idaho High Risk Pool Reinsurance program is covering less of the total claims for 2027 compared to the prior year.

St. Luke’s Health Plan, Inc.

RATE CHANGE

We estimate an overall average premium rate change of 14.4% for the 20,385 individual members enrolled with St. Luke’s Health Plan, Inc. (SLHP) as of March 2026.

Rate changes are:

• +15.2% for the Expanded Bronze plan
• +19.1% for the Expanded Bronze HDHP plan
• +9.7% for the Silver 5800 plan
• +13.0% for the Gold plan
• +13.6% in Rating Areas 3 and 4
• +16.0% in Rating Area 5

MOST SIGNIFICANT FACTORS

The rate change described above is driven by the following factors:

• Changes in experience and demographics, based on SLHP’s fully credible claims experience: +1.8%
• Changes due to Idaho’s 1332 waiver program: +2.6%
• Medical and pharmacy cost trend: +5.3%
• Changes in projected risk adjustment: +1.7%
• Changes in retention: +1.7%
• Changes in plan designs: +2.4%
• Changes in morbidity due to the expiration of enhanced premium subsidies at the end of 2025: -1.8%

Meanwhile, Idaho's small group market carriers are asking for 10.6% rate hikes on average: