2027 Rate Changes - Mississippi: +21% indy market; +10% sm. group

ACA exchange enrollment has dropped by more than 26% in Mississippi since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were already down 7.3% vs. OEP 2025...but effectuated enrollment was 16.9% lower year over year in January and  26.4% lower as of February.

That's over 68,000 Mississippians who already lost coverage in just the first two months of the year...a number which has almost certainly continued to get worse 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:

AMBETTER OF MAGNOLIA:

Ambetter of Magnolia Inc. 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 Mississippi Insurance Department, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Mississippi to assist in the review of Ambetter of Magnolia Inc.’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 $602.49 per member per month (PMPM). Incurred claims in 2025 were $603.74, or 100.21% 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 90.68%. 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 18.6% applies to approximately 103,134 individuals. Ambetter of Magnolia Inc.’s projected administrative expenses for 2027 are $105.60 PMPM. Administrative expense does not include $35.80 for taxes and fees. The historical administrative expenses for 2026 were $89.76 PMPM, which excludes taxes and fees. The projected loss ratio is 85.1% which satisfies the federal minimum loss ratio requirement of 80.0%.

BLUE CROSS BLUE SHIELD OF MISSISSIPPI:

Table 2.1 summarizes proposed rate changes by product effective January 1, 2027. The following are significant factors driving the proposed rate changes discussed below.

Attribution Analysis of Proposed Rate Changes

The aggregate proposed rate change is 9.68%. For the current mix of members, the proposed rate change is 9.55% for Blue Care and 10.38% for Blue Care Kids, resulting in an aggregate 9.68% change as calculated in the URRT.

Medical and Prescription Drug Inflation & Utilization Trend

Medical and Prescription Drug inflation and utilization trend development is detailed in Exhibit 5.

Claims Change: Other

In addition to the trend changes detailed in Exhibit 5, we also adjusted claims for: morbidity, shifts in drug utilization, drug rebate changes, and the paid-to-allowed calibration. These adjustments are described in more detail on Exhibit 5.

New Taxes, Fees and Administrative Expenses

Changes to the overall premium level are needed because of required changes in federal/state taxes and fees. In addition, there are anticipated changes in the administrative expenses and commission arrangements. The following is a list of any anticipated changes and comments regarding the adjustment:

EXHIBIT 2. PROPOSED RATE CHANGES (REDACTED)

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 Mississippi Insurance Department, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Mississippi 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 $481.50 per member per month (PMPM). Incurred claims in 2025 were $617.41, or 128.23% 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 109.85%. 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 20.4% applies to approximately 370 individuals. Celtic Insurance Company’s projected administrative expenses for 2027 are $102.53 PMPM. Administrative expense does not include $21.55 for taxes and fees. The historical administrative expenses for 2026 were $80.34 PMPM, which excludes taxes and fees. The projected loss ratio is 86.5% which satisfies the federal minimum loss ratio requirement of 80.0%.

OSCAR HEALTH:

The purpose of this document is to present rate change justification for Oscar Health Plan, Inc (Oscar’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 March 2026, the proposed average rate increase for renewing plans is 32.6%. 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 24,093 members.

2. Reason for Rate Increase(s)

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

Medical and Prescription Drug Inflation & 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.

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 targeted risk margin.

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 OF MISSISSIPPI:

UHCMS is filing 2027 rates for individual products. The proposed rate change is 25.95% and will affect 17,185 individuals. The rate changes vary between 18.92% and 40.39%. 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 $78,643,311. Incurred claims during this period were $46,650,245 and UHCMS expects to pay $16,211,431 for risk adjustment. The loss ratio, or portion of premium required to pay medical claims, for plan year 2025 is 74.7%.

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.
• Reduction of premium subsidies: Expanded federal premium tax credits expired at the end of 2025. As a result, the morbidity of the insured population is expected to increase, as healthier individuals are more likely to exit 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

UHCMS 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 andadministrative costs for the 2027 plan year.

It's worth noting that both Cigna and Molina appear to be dropping out of the individual market in Mississippi. Unfortunately I don't know the effectuated enrollment either one had in Mississippi as of spring 2026; I had to go with a rough guesstimate for each based on their enrollment a year earlier plus the confirmed total on exchange enrollment as of February. The effectuated enrollment of BCBS MS is also redacted, so I had to go with a rough estimate there as well.

As a result, there are two averages listed below: The unweighted average rate increase for the five remaining carriers is 21.5%; the weighted average, assuming my BCBS estimate is close, is slightly lower at 21.1%. Either way, that's still over $2,000 more in premiums alone per year for unsubsidized enrollees.

Meanwhile, the Mississippi small group market is looking at a non-weighted average rate increase of 10% (I could only find effectuated enrollment for one of the two carriers):