+8.5%PY2026 enrollment-weighted morbidity adjustment, vs -0.1% in PY2025: a 8.6 pt regime shift
16% / 24%Share of enrollment filed with no morbidity change vs +15% or more. The market disagrees with itself
+6.3%PY2026 Rx cost trend, plus +4.0% utilization: the GLP-1 load, split
212 ptsWidest morbidity gap among the largest issuers: WellCare Health Insurance Company NJ +153.2% vs AmeriHealth HMO NJ at -58.9%
Carriers priced an essentially flat risk pool for two years. Then 2026.
Enrollment-weighted morbidity adjustment filed in individual market URRTs. Through PY2025, filed morbidity stayed within a point of neutral. PY2026 filings jumped 8.6 points in one cycle, pricing in the sicker pool left behind by enhanced subsidy expiry. The small group market is the control: its filed morbidity moved from +0.4% to +1.5%.
Filed morbidity adjustment, individual market
Enrollment-weighted percent change in URRT filings, PY2024 to PY2026
There is no consensus morbidity assumption. There are two.
Distribution of PY2026 filed morbidity adjustments, by share of projected enrollment. The market split into camps: 15.6% of enrollment sits with filings that assumed no morbidity change at all, while 23.6% sits above +15%. The middle is thin. Part of the split is geography: Texas books priced the cliff while Florida's two largest filings, half the zero camp by weight, priced through it. But Florida, Georgia and Tennessee hold both camps inside the same state, and the PY2027 experience data will grade them.
Filed morbidity adjustment, PY2026 distribution
Share of projected individual market enrollment, by filed assumption
Reading it: the darker bars mark the two camps. Weighted median +5.2%. The zeros are not bookkeeping: zero-camp filings also show below-market other-adjustment and demographic factors, and project roughly two years of plain trend in total claims (+21% vs +50% in the +15% camp), so a carrier filing at 0% against a market pricing +8.5% is genuinely claiming a better pool, or underpricing its renewal book.
Filed assumptions, 3 plan years
Enrollment-weighted averages across all individual market URRT filings. Trend rows are year-1 annualized factors. Click any assumption to see where it landed, state by state and carrier by carrier.
| Assumption | PY2024 | PY2025 | PY2026 | YoY swing |
|---|---|---|---|---|
| Morbidity adjustment | -0.6% | -0.1% | +8.5% | +8.6 pt |
| Demographic shift | -0.1% | -1.7% | +0.1% | +1.8 pt |
| Rx cost trend | +5.4% | +5.1% | +6.3% | +1.2 pt |
| Rx utilization trend | +3.1% | +3.8% | +4.0% | +0.2 pt |
| Inpatient cost trend | +4.3% | +4.4% | +4.3% | -0.1 pt |
| Outpatient cost trend | +4.5% | +4.6% | +4.3% | -0.3 pt |
Where the morbidity assumption landed hardest
Filed morbidity adjustment alongside the realized enrollment-weighted rate change, individual market. The two do not move in lockstep: a state can carry a moderate headline increase over an aggressive morbidity assumption, with the difference living in trend, demographics and plan design.
| State | Morbidity adj | Rate change | Enrollment | |
|---|---|---|---|---|
| ARArkansas | +29.9% | +24.0% | 293,376 | |
| TXTexas | +19.8% | +35.6% | 3,243,953 | |
| LALouisiana | +18.0% | +24.3% | 253,017 | |
| MSMississippi | +16.9% | +43.9% | 241,184 | |
| GAGeorgia | +16.2% | +34.6% | 1,205,123 | |
| MOMissouri | +13.7% | +23.0% | 310,359 | |
| OKOklahoma | +13.5% | +27.1% | 281,806 | |
| KSKansas | +13.2% | +26.3% | 160,697 | |
| MDMaryland | +12.5% | +13.3% | 289,175 | |
| NVNevada | +12.1% | +26.3% | 115,633 | |
| TNTennessee | +12.0% | +37.4% | 480,846 | |
| NCNorth Carolina | +11.9% | +28.2% | 676,309 | |
| OHOhio | +11.6% | +20.4% | 495,090 | |
| NHNew Hampshire | +11.2% | +28.2% | 62,839 | |
| SCSouth Carolina | +10.8% | +19.4% | 544,575 | |
| VAVirginia | +8.7% | +21.6% | 367,603 | |
| MTMontana | +8.6% | +23.7% | 79,018 | |
| KYKentucky | +8.3% | +30.2% | 85,176 | |
| VTVermont | +7.7% | +6.7% | 36,742 | |
| ILIllinois | +7.2% | +30.5% | 375,160 | |
| COColorado | +6.9% | +23.6% | 327,970 | |
| NJNew Jersey | +6.6% | +16.3% | 432,051 | |
| MIMichigan | +6.2% | +20.1% | 507,489 | |
| INIndiana | +5.9% | +26.4% | 276,735 | |
| NMNew Mexico | +5.2% | +36.6% | 75,591 | |
| AZArizona | +5.0% | +46.7% | 269,657 | |
| WIWisconsin | +5.0% | +22.1% | 284,001 | |
| FLFlorida | +4.8% | +35.8% | 3,128,754 | |
| WYWyoming | +4.4% | +25.7% | 37,745 | |
| UTUtah | +4.1% | +14.2% | 329,092 | |
| WAWashington | +3.8% | +24.9% | 270,966 | |
| MEMaine | +3.7% | +23.9% | 65,735 | |
| PAPennsylvania | +3.0% | +21.5% | 529,324 | |
| RIRhode Island | +2.8% | +21.1% | 53,815 | |
| IDIdaho | +2.5% | +9.9% | 123,935 | |
| MNMinnesota | +2.5% | +22.9% | 206,382 | |
| NDNorth Dakota | +2.5% | +8.9% | 55,237 | |
| AKAlaska | +2.2% | -2.0% | 27,696 | |
| DEDelaware | +2.2% | +29.4% | 39,022 | |
| ALAlabama | +2.0% | +21.0% | 426,464 | |
| CACalifornia | +2.0% | +10.3% | 2,205,671 | |
| WVWest Virginia | +2.0% | +11.2% | 43,045 | |
| IAIowa | +1.4% | +15.3% | 127,283 | |
| NYNew York | +1.3% | +7.7% | 238,159 | |
| SDSouth Dakota | +1.3% | +6.3% | 55,068 | |
| CTConnecticut | +1.1% | +16.8% | 149,369 | |
| HIHawaii | +1.1% | +11.7% | 34,421 | |
| OROregon | +1.1% | +10.2% | 138,116 | |
| MAMassachusetts | +0.9% | +11.7% | 443,176 | |
| NENebraska | +0.6% | +28.9% | 52,920 | |
| DCDistrict of Columbia | -0.6% | +8.8% | 14,105 |
Issuers by projected membership
Every individual market issuer in the PY2026 file, largest first, all states. The zero-morbidity camp is not small carriers rounding: some of the largest books in the country filed no morbidity deterioration while peers in the same cycle filed +15% or more. Shaded cells mark zero-adjustment filings.
| Issuer | State | Morbidity adj | Rx cost trend | Rx util trend | Avg members |
|---|---|---|---|---|---|
| Blue Cross and Blue Shield of Texas | TX | +16.9% | +10.0% | +2.2% | 789K |
| Health Options, Inc. | FL | +7.2% | +5.0% | +7.6% | 709K |
| Oscar Health Maintenance Organization of Florida, Inc. | FL | 0.0% | 0.0% | 0.0% | 692K |
| Kaiser Foundation Health Plan, Inc. | CA | +3.0% | +3.5% | +5.7% | 664K |
| California Physicians' Service, dba Blue Shield of California | CA | +0.7% | +10.0% | -0.1% | 633K |
| Centene Venture Company Florida | FL | 0.0% | 0.0% | 0.0% | 614K |
| UnitedHealthcare of Texas, Inc. | TX | +22.2% | +2.9% | +8.1% | 359K |
| Blue Cross Blue Shield of Florida | FL | +6.3% | +4.4% | +9.9% | 333K |
| SelectHealth, Inc. | UT | +6.1% | +11.8% | +3.9% | 278K |
| Blue Cross Blue Shield of North Carolina | NC | +8.5% | +6.6% | +5.7% | 265K |
| Horizon Healthcare Services, Inc. | NJ | +5.2% | +8.8% | +3.8% | 254K |
| Celtic Insurance Company | TX | +26.4% | +7.7% | +4.8% | 242K |
| Ambetter of Peach State Inc. | GA | +25.5% | +4.8% | +3.1% | 237K |
| BlueCross BlueShield of SC | SC | +8.2% | +13.1% | -6.6% | 231K |
| Oscar Insurance Company | TX | +42.3% | +4.1% | +5.2% | 229K |
| Blue Cross and Blue Shield of Illinois | IL | +2.4% | +5.6% | +2.9% | 219K |
| Anthem Blue Cross (DMHC) | CA | +2.8% | +7.2% | +7.5% | 211K |
| Local Initiative Health Authority for Los Angeles County, dba L.A. Care Health Plan | CA | +1.2% | +20.3% | +3.0% | 204K |
| Baylor Scott & White Health Plan | TX | +2.6% | +4.6% | +0.2% | 189K |
| Tufts Health Public Plans, Inc. | MA | +1.6% | +8.2% | +16.7% | 177K |
| Blue Cross and Blue Shield of Alabama | AL | -1.8% | +6.6% | +1.6% | 173K |
| Oscar Health Plan of Georgia | GA | +11.3% | +3.6% | +5.0% | 161K |
| Superior Health Plan | TX | +31.0% | +11.3% | +3.5% | 161K |
| UnitedHealthcare Insurance Company | AL | -2.5% | +4.9% | +7.7% | 140K |
| WellSense Health Plan | MA | 0.0% | +8.7% | +3.2% | 133K |
| AmeriHealth Insurance Company of New Jersey | NJ | +1.9% | +8.8% | 0.0% | 130K |
| Celtic Insurance Company | MO | +17.8% | +4.8% | +4.7% | 125K |
| Community Health Choice | TX | +7.8% | +8.3% | +4.0% | 122K |
| Keystone Health Plan East | PA | +1.8% | -2.8% | +7.0% | 118K |
| Celtic Insurance Company | TN | +22.9% | +8.7% | +4.2% | 115K |
| CareFirst BlueChoice, Inc. | MD | +9.9% | +7.0% | +3.0% | 109K |
| HealthKeepers, Inc. | VA | +6.8% | +9.1% | +7.2% | 107K |
| Health Net of California | CA | +3.4% | +7.0% | +3.2% | 103K |
| USAble Mutual Insurance Company | AR | +8.1% | +6.4% | +1.0% | 97K |
| UPMC Health Options, Inc. | PA | 0.0% | +13.7% | -0.1% | 96K |
| New York Quality Healthcare Corporation | NY | 0.0% | +5.6% | +3.5% | 94K |
| UnitedHealthcare of Florida, Inc. | FL | +20.8% | +2.9% | +8.2% | 92K |
| Ambetter of North Carolina Inc. | NC | +20.0% | +8.9% | +4.2% | 92K |
| Coordinated Care Corporation | WA | +6.6% | +6.3% | +4.8% | 89K |
| Sentara Health Plans | VA | +0.4% | +5.7% | +1.0% | 89K |
| Blue Cross and Blue Shield of Oklahoma | OK | +10.7% | +13.0% | -0.7% | 88K |
| BlueCross BlueShield of Tennessee, Inc. | TN | 0.0% | +3.7% | +7.8% | 88K |
| Anthem Health Plans, Inc. | CT | +2.0% | +4.6% | +6.0% | 85K |
| Blue Care Network of Michigan | MI | +5.3% | +0.2% | +2.5% | 83K |
| Buckeye Community Health Plan | OH | +22.3% | +7.1% | +4.7% | 81K |
| HMO Louisiana, Inc. | LA | +16.6% | +9.8% | +2.0% | 81K |
| Blue Cross Blue Shield of Arizona, Inc. | AZ | -2.6% | +3.0% | +10.1% | 77K |
| Kaiser Foundation Health Plan of Colorado | CO | -2.0% | +6.0% | 0.0% | 75K |
| HMO Colorado, Inc. | CO | +9.7% | +10.3% | +1.5% | 75K |
| Meridian Health Plan of Michigan | MI | +7.9% | +4.8% | +3.7% | 74K |
| Priority Health | MI | +3.8% | +16.5% | +2.3% | 74K |
| Highmark Inc. | PA | +3.1% | +5.0% | +3.7% | 72K |
| Mass General Brigham Health Plan | MA | +1.5% | +10.2% | +2.5% | 70K |
| Community Insurance Company | OH | +9.6% | +7.2% | +10.9% | 68K |
| ConnectiCare Benefits Inc. | CT | 0.0% | +12.7% | +2.7% | 68K |
| Cigna Health and Life Insurance Company | FL | +11.6% | +8.3% | +1.5% | 68K |
| Molina Healthcare of Florida, Inc | FL | +15.6% | +4.5% | +8.4% | 68K |
| Alliant Health Plans | GA | 0.0% | +12.4% | +2.7% | 67K |
| Absolute Total Care, Inc | SC | +25.6% | +9.8% | +4.2% | 67K |
| HMO MINNESOTA | MN | +3.3% | +7.2% | +3.4% | 65K |
| Celtic Insurance Company | AL | +21.7% | +12.5% | +3.7% | 65K |
| UnitedHealthcare of Arizona, Inc. | AZ | +16.3% | +2.9% | +5.9% | 63K |
| Ambetter of Magnolia Inc. | MS | +26.8% | +7.4% | +4.1% | 61K |
| Anthem Insurance Companies, Inc. | IN | +8.0% | +8.1% | +4.7% | 61K |
| Optimum Choice, Inc. | MD | +28.9% | +3.2% | +8.2% | 60K |
| Arizona Complete Health | AZ | +1.5% | +5.7% | +4.1% | 60K |
| Oscar Buckeye State Insurance Corporation | OH | +6.8% | +6.0% | +4.8% | 58K |
| Kaiser Foundation Health Plan of Georgia | GA | +6.1% | +2.0% | +1.0% | 58K |
| Celtic Insurance Company | OK | +24.6% | +11.5% | +4.0% | 58K |
| Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. | GA | +13.5% | +6.8% | +6.1% | 57K |
| Healthy Alliance Life Insurance Company | MO | +10.1% | +6.1% | +8.6% | 57K |
| Medical Health Insuring Corp of Ohio | OH | 0.0% | +5.5% | +2.3% | 56K |
| Wellmark Health Plan of Iowa, Inc | IA | 0.0% | +10.4% | +2.4% | 56K |
| Ambetter Health of Louisiana | LA | +16.3% | +10.7% | +3.6% | 56K |
| QCA Health Plan, Inc. | AR | +60.5% | +8.2% | +5.0% | 53K |
| AmeriHealth Caritas Florida, Inc. | FL | +13.9% | +5.0% | +6.6% | 52K |
| Blue Cross Blue Shield of Michigan Mutual Insurance Company | MI | +3.4% | -3.2% | +5.8% | 52K |
| Celtic Insurance Company | KS | +22.4% | +7.5% | +4.1% | 51K |
| UCare Minnesota | MN | +4.1% | +10.2% | +2.3% | 51K |
| Coordinated Care Corporation | IN | 0.0% | 0.0% | 0.0% | 51K |
| Cigna Health and Life Insurance Company | TN | +10.2% | +7.2% | +1.5% | 50K |
| Molina Healthcare of Ohio, Inc. | OH | +17.2% | +2.7% | +2.6% | 49K |
| UnitedHealthcare Insurance Company | TN | +5.0% | +3.2% | +7.7% | 48K |
| Florida Health Care Plan, Inc. | FL | +11.8% | +8.0% | 0.0% | 48K |
| AMGP Georgia Managed Care Company, Inc. | GA | +22.8% | +6.9% | +6.2% | 46K |
| Celtic Insurance Company | IL | +22.5% | +9.9% | +4.9% | 45K |
| Celtic Insurance Company | AR | +60.7% | +8.2% | +4.9% | 45K |
| Celtic Insurance Company | NE | 0.0% | 0.0% | 0.0% | 45K |
| Molina Healthcare of California, Inc | CA | +5.7% | +2.1% | +24.9% | 44K |
| Cigna Health and Life Insurance Company | CO | +10.4% | +7.2% | +1.5% | 44K |
| Healthfirst PHSP, Inc. | NY | +1.5% | +10.7% | +6.5% | 43K |
| Kaiser Foundation Health Plan of the Mid-Atlantic States | MD | +1.7% | +5.6% | +5.6% | 43K |
| CHRISTUS Health Plan | TX | +19.1% | +7.2% | +1.6% | 43K |
| UnitedHealthcare of North Carolina, Inc. | NC | +5.0% | +2.9% | +8.2% | 43K |
| Ambetter Health | PA | +19.6% | +5.8% | +3.9% | 42K |
| Compcare Health Services Insurance Corporation | WI | +6.4% | +7.5% | +9.3% | 42K |
| Capital Advantage Assurance Company | PA | +3.0% | +11.4% | +2.4% | 41K |
| HealthPartners, Inc. | MN | +1.5% | +3.4% | +4.3% | 41K |
| Inland Empire Health Plan | CA | +3.2% | +13.0% | +3.2% | 40K |
| Health First Commercial Plans, Inc. | FL | +3.2% | +9.8% | +2.5% | 39K |
| UnitedHealthcare Insurance Company | LA | +15.5% | +3.2% | +7.7% | 39K |
| Providence Health Plans | OR | +0.4% | +10.3% | +4.3% | 39K |
| Highmark West Virginia, Inc. | WV | +0.1% | +1.0% | +4.8% | 38K |
| CareSource Indiana, Inc. | IN | +8.4% | +8.5% | +8.6% | 37K |
| Rocky Mountain Health Maintenance Organization, Incorporated | CO | +17.4% | +6.0% | +7.2% | 37K |
| Blue Cross of Idaho | ID | +0.8% | +4.7% | +4.7% | 37K |
| SelectHealth | ID | +2.6% | +7.0% | +3.0% | 37K |
| Molina Healthcare of South Carolina, Inc. | SC | +3.2% | +2.6% | +3.8% | 36K |
| University of Utah Health Insurance Plans | UT | -6.0% | +7.0% | +5.9% | 36K |
| Sharp Health Plan | CA | +1.7% | +7.7% | +4.0% | 35K |
| Anthem Health Plans of Kentucky, Inc. | KY | +1.9% | +6.0% | +9.2% | 35K |
| Regence BlueCross BlueShield of Oregon | OR | +4.4% | +5.0% | +2.7% | 34K |
| Moda Health Plan, Inc | OR | 0.0% | +7.0% | +2.5% | 33K |
| USAble HMO, Inc. d/b/a Octave | AR | +4.5% | +6.4% | +1.0% | 33K |
| Medica Insurance Company | MN | 0.0% | +4.0% | +4.2% | 33K |
| Molina Healthcare of Mississippi, Inc | MS | +7.1% | -0.2% | +20.3% | 33K |
| Health Plan of Nevada, Inc. | NV | +12.9% | +2.7% | +7.3% | 32K |
| Kaiser Foundation Health Plan of Washington | WA | 0.0% | +2.0% | +18.0% | 32K |
| Blue Cross Blue Shield of New Mexico | NM | +6.4% | +12.9% | +2.8% | 31K |
| QCC Insurance Company, Inc. | PA | +1.5% | -2.8% | +7.0% | 31K |
| Anthem Health Plans of Maine, Inc. | ME | +4.6% | +5.2% | +6.9% | 31K |
| Oscar Insurance Company | TN | +20.0% | +3.8% | +5.0% | 31K |
| CareSource | OH | +12.1% | +12.5% | +2.0% | 29K |
| Blue Cross and Blue Shield of Montana | MT | +13.2% | +7.2% | +4.4% | 29K |
| Highmark BCBSD Inc. | DE | +2.6% | +1.0% | +5.5% | 29K |
| Oscar Garden State Insurance Corporation | NJ | +3.7% | +5.1% | +5.2% | 29K |
| Neighborhood Health Plan of Rhode Island | RI | +1.5% | +5.7% | +4.4% | 28K |
| Fallon Community Health Plan | MA | +2.4% | +9.5% | -1.0% | 28K |
| Highmark Coverage Advantage | PA | +0.7% | +5.0% | +4.2% | 27K |
| Blue Cross Blue Shield of North Dakota | ND | +4.8% | +3.4% | +3.4% | 27K |
| UnitedHealthcare Benefits of Texas, Inc. | TX | 0.0% | 0.0% | 0.0% | 27K |
| Highmark Benefits Group | PA | -2.1% | +5.0% | +3.7% | 26K |
| UnitedHealthcare Community Plan, Inc. | MI | +14.0% | +2.9% | +8.1% | 26K |
| Blue Cross Blue Shield of Wyoming | WY | +4.8% | +5.5% | +5.2% | 26K |
| Western Health Advantage | CA | +2.1% | +10.9% | +2.4% | 25K |
| HMO Partners, Inc. d/b/a Health Advantage | AR | +5.4% | +6.4% | +1.0% | 25K |
| Harvard Pilgrim Healthcare, Inc. | MA | 0.0% | +16.4% | +5.7% | 25K |
| Cigna Health and Life Insurance Company | MS | +19.1% | +7.2% | +1.5% | 25K |
| CareSource Georgia Co. | GA | +26.0% | +19.2% | -0.5% | 25K |
| UnitedHealthcare of Illinois, Inc. | IL | +13.0% | +2.9% | +8.1% | 25K |
| UnitedHealthcare Insurance Company | MO | +17.0% | +3.1% | +10.1% | 25K |
| Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. | VA | +4.0% | +5.5% | +5.4% | 24K |
| Molina Healthcare of Washington, Inc. | WA | -3.4% | +18.1% | +3.0% | 24K |
| LifeWise Health Plan of Washington | WA | +8.9% | +7.6% | +1.5% | 24K |
| QualChoice Life and Health Insurance Company, Inc. | AR | +53.3% | +8.2% | +4.7% | 24K |
| Dean Health Plan | WI | 0.0% | +3.0% | +3.1% | 24K |
| Regence BlueShield of Idaho | ID | +3.4% | +4.0% | +4.0% | 24K |
| WellCare Health Plans of Kentucky | KY | +18.2% | +6.8% | +3.5% | 23K |
| Molina Healthcare of Texas, Inc. | TX | -21.3% | +2.0% | +3.3% | 23K |
| Sanford Health Plan | ND | 0.0% | +0.4% | +5.6% | 22K |
| Anthem HP, LLC | NY | +0.7% | +3.6% | +5.2% | 22K |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc | MA | 0.0% | +20.7% | +5.4% | 22K |
| Regence BlueShield | WA | -0.2% | +5.0% | +4.5% | 22K |
| Cigna Health and Life Insurance Company | VA | +12.3% | +7.2% | +1.5% | 22K |
| Hawaii Medical Service Association | HI | 0.0% | +5.4% | +3.5% | 22K |
| PacificSource Health Plans | OR | -4.2% | +3.3% | +4.5% | 21K |
| UnitedHealthcare Insurance Company | MA | 0.0% | +4.0% | +4.9% | 21K |
| Blue Cross and Blue Shield of Vermont | VT | +8.7% | +2.9% | +13.4% | 21K |
| HMO Colorado, Inc. dba HMO Nevada | NV | +15.9% | +6.8% | +7.4% | 20K |
| Sunshine State Health Plan, Inc. | FL | +31.1% | +5.5% | +4.0% | 20K |
| Common Ground Healthcare Cooperative | WI | +4.0% | +10.0% | +2.0% | 20K |
| Blue Cross and Blue Shield of Nebraska | NE | +2.5% | +4.4% | +2.0% | 20K |
| UnitedHealthcare of Wisconsin, Inc. | WI | +11.0% | +2.9% | +8.1% | 20K |
| Kaiser Foundation Health Plan of the Northwest | OR | +4.0% | +6.0% | 0.0% | 20K |
| Sendero Health Plans, Inc. | TX | 0.0% | +6.3% | +2.9% | 20K |
| Medica Insurance Company | NE | 0.0% | +4.2% | +4.4% | 19K |
| County of Santa Clara dba Valley Health Plan | CA | +2.8% | +14.5% | +2.7% | 19K |
| Celtic Insurance Company | NH | +15.9% | +6.5% | +4.2% | 19K |
| MVP Health Plan, Inc. | NY | +7.7% | +6.9% | +3.1% | 19K |
| Excellus Health Plan, Inc | NY | 0.0% | +0.3% | +4.0% | 19K |
| Avera Health Plans, Inc. | SD | +3.0% | +11.1% | +2.4% | 18K |
| Blue Cross & Blue Shield of Rhode Island | RI | +4.8% | +0.5% | +8.7% | 18K |
| Maine Community Health Options | ME | +3.0% | +13.8% | +3.0% | 18K |
| Sanford Health Plan | SD | 0.0% | +0.4% | +5.6% | 18K |
| AmeriHealth Caritas North Carolina, Inc. | NC | +6.6% | +8.0% | +7.0% | 18K |
| Oscar Health Plan of North Carolina, Inc. | NC | +26.7% | +6.2% | +5.0% | 17K |
| Premera Blue Cross Blue Shield of Alaska | AK | 0.0% | +3.6% | +3.5% | 17K |
| SilverSummit Healthplan Inc. | NV | +15.0% | +6.5% | +4.0% | 17K |
| Montana Health Cooperative | MT | +4.0% | +8.0% | +10.0% | 17K |
| Optimum Choice, Inc. | VA | +70.5% | +7.0% | +7.7% | 16K |
| Oscar Insurance Company | KS | +2.3% | +4.6% | +5.0% | 16K |
| Security Health Plan of Wisconsin, Inc. | WI | +9.0% | +6.7% | +6.7% | 16K |
| Community Health Plan of Washington | WA | +5.0% | +10.0% | +2.5% | 16K |
| Cigna HealthCare of North Carolina, Inc. | NC | +12.6% | +7.2% | +1.5% | 15K |
| AvMed, Inc. | FL | +9.4% | +10.8% | +2.1% | 15K |
| Blue Cross and Blue Shield of Kansas. Inc. | KS | +8.6% | +5.1% | +5.1% | 15K |
| Quartz Health Benefit Plans Corporation | WI | +2.9% | +20.1% | +3.9% | 15K |
| UnitedHealthcare of Ohio, Inc. | OH | +15.5% | +3.2% | +7.7% | 14K |
| CFMI, Inc. | MD | +2.6% | +5.0% | +0.5% | 14K |
| Regence BlueCross BlueShield of Utah | UT | -6.0% | +4.7% | +2.6% | 14K |
| Cigna HealthCare of Georgia | GA | +14.7% | +7.2% | +1.5% | 14K |
| Jefferson Health Plan | PA | +5.4% | +5.5% | +5.5% | 14K |
| Harvard Pilgrim Healthcare, Inc. | ME | +2.0% | +17.0% | +2.9% | 14K |
| Molina Healthcare of Michigan, Inc. | MI | +11.7% | -0.9% | +3.6% | 13K |
| Cigna HealthCare of Texas, Inc. | TX | +6.9% | +8.3% | +1.5% | 13K |
| MVP Health Plan, Inc. | VT | +6.2% | +8.6% | +3.3% | 13K |
| Kaiser Foundation Health Plan, Inc - Hawaii | HI | +3.0% | +4.4% | 0.0% | 13K |
| CareSource West Virginia Co. | WV | +7.8% | +7.6% | +2.1% | 13K |
| Medica Insurance Company | MO | -3.0% | +2.6% | +2.6% | 12K |
| Medica Community Health Plan | WI | 0.0% | +3.3% | +3.4% | 12K |
| Iowa Total Care | IA | 0.0% | 0.0% | 0.0% | 12K |
| CommunityCare HMO, Inc. | OK | +5.9% | +12.0% | +4.0% | 12K |
| PacificSource Health Plans | MT | +3.6% | +3.3% | +4.5% | 11K |
| Oscar Insurance Company | IA | +10.5% | +4.9% | +4.8% | 11K |
| Network Health | WI | +4.3% | +9.3% | +2.5% | 11K |
| Capital Health Plan | FL | +5.7% | +9.8% | +2.5% | 11K |
| UnitedHealthcare Insurance Company | NJ | +29.1% | +3.2% | +7.7% | 11K |
| Geisinger Health Plan | PA | 0.0% | +6.0% | -0.5% | 11K |
| HealthPartners Insurance Company | MN | +1.5% | +3.4% | +2.0% | 11K |
| UnitedHealthcare of Oklahoma, Inc. | OK | +3.9% | +2.9% | +8.1% | 10K |
| Presbyterian Health Plan | NM | +3.4% | +2.8% | +2.8% | 10K |
| SelectHealth | CO | +1.4% | +6.1% | +4.0% | 10K |
| Blue Cross & Blue Shield of Mississippi | MS | +4.1% | +8.8% | 0.0% | 10K |
| Regence BlueCross BlueShield of Oregon | WA | +2.8% | +5.5% | +3.8% | 10K |
| Sierra Health and Life Insurance Company, Inc. | NV | +10.4% | +2.7% | +7.3% | 10K |
| Cigna Healthcare of Florida, INC. | FL | +6.9% | n/a | n/a | 10K |
| HealthPartners Insurance Company | WI | +5.5% | +3.6% | +3.0% | 10K |
| SelectHealth | NV | +2.9% | +10.5% | +1.5% | 10K |
| Louisiana Health Service & Indemnity Company | LA | +36.3% | +9.8% | +2.0% | 10K |
| GHMSI, Inc. | MD | +2.6% | +5.0% | +0.5% | 10K |
| Cox Health Systems Insurance | MO | +5.9% | +14.2% | +2.0% | 10K |
| Premera Blue Cross | WA | +5.0% | +7.6% | +2.0% | 9K |
| Oscar Health Plan, Inc. | AZ | +14.0% | +5.8% | +5.2% | 9K |
| UnitedHealthcare Insurance Company | KS | -8.7% | +2.9% | +8.1% | 9K |
| GHMSI, Inc. | DC | -1.3% | +4.1% | +2.7% | 9K |
| Aspirus Health Plan, Inc. | WI | +5.2% | +11.3% | +2.5% | 9K |
| UnitedHealthcare of New Mexico, Inc. | NM | +13.1% | +3.2% | +9.0% | 9K |
| Celtic Insurance Company | DE | 0.0% | 0.0% | 0.0% | 9K |
| Denver Health Medical Plan, Inc. | CO | +2.4% | +9.0% | +2.5% | 8K |
| Medica Insurance Company | OK | 0.0% | +3.3% | +3.4% | 8K |
| UnitedHealthcare of Mississippi, Inc. | MS | -6.5% | +7.0% | +7.7% | 8K |
| Health New England | MA | 0.0% | +10.5% | +3.0% | 8K |
| Mountain Health Cooperative | ID | +4.0% | +8.0% | +9.0% | 8K |
| CareFirst BlueChoice, Inc. | VA | +9.4% | +6.0% | +3.0% | 8K |
| Molina Healthcare of New Mexico, Inc. | NM | -6.8% | -0.1% | +2.5% | 7K |
| Wellmark of South Dakota, Inc | SD | 0.0% | +5.8% | +1.4% | 7K |
| Medica Insurance Company | IA | 0.0% | +2.5% | +2.6% | 7K |
| Oscar Insurance Corporation of Ohio | OH | +10.6% | +5.2% | +5.2% | 7K |
| Celtic Insurance Company | IN | 0.0% | 0.0% | 0.0% | 7K |
| Kaiser Foundation Health Plan of the Northwest | WA | +3.0% | -1.5% | +2.9% | 7K |
| CHRISTUS Health Plan Louisiana | LA | +37.7% | +7.8% | +1.7% | 7K |
| BlueChoice HealthPlan Inc. | SC | +8.2% | +9.3% | -3.8% | 7K |
| Oscar Insurance Corporation | NY | +0.8% | +6.0% | +5.2% | 7K |
| Moda Health Plan, Inc | AK | +8.0% | +8.0% | +2.5% | 6K |
| St. Luke's Health Plan | ID | +4.0% | +10.0% | +2.5% | 6K |
| UHC | NY | +8.6% | +3.2% | +6.1% | 6K |
| Molina Healthcare of Utah, Inc. | UT | -4.1% | +4.2% | +2.8% | 6K |
| Hometown Health Plan Inc. | NV | +10.2% | +5.9% | +4.7% | 6K |
| AmeriHealth Caritas VIP Next, Inc. | DE | +3.6% | +6.6% | +4.2% | 6K |
| MetroPlus | NY | +2.5% | +11.8% | 0.0% | 6K |
| Oscar Health Plan, Inc. | IL | +29.6% | +5.3% | +5.4% | 6K |
| InStil Health Insurance Company | SC | 0.0% | 0.0% | 0.0% | 6K |
| WellCare Health Insurance Company of New Jersey, Inc. | NJ | +153.2% | +9.0% | +3.6% | 5K |
| Imperial Insurance Companies Inc. | TX | +5.9% | +5.0% | +2.4% | 5K |
| Independent Health Benefits Corporation | NY | 0.0% | +13.3% | +2.8% | 5K |
| Molina Healthcare of Illinois, Inc | IL | +28.7% | +4.2% | +23.6% | 5K |
| UnitedHealthcare of Georgia, Inc. | GA | +7.4% | +2.9% | +8.2% | 5K |
| Mending Health | OK | +2.5% | +12.9% | +3.6% | 5K |
| Oscar Insurance Company | MO | +2.3% | +5.0% | +4.9% | 5K |
| 22 Health | FL | 0.0% | 0.0% | 0.0% | 5K |
| Cigna Health and Life Insurance Company | IN | +30.5% | +7.2% | +1.5% | 5K |
| Moda Health Plan, Inc | ID | +5.0% | +7.0% | +2.5% | 5K |
| Oscar Insurance Company of Florida | FL | +42.0% | +5.5% | +5.1% | 5K |
| Group Health Cooperative of South Central Wisconsin | WI | +4.1% | +9.7% | +1.1% | 5K |
| Oscar Insurance Company | NE | +2.0% | +6.0% | +5.3% | 5K |
| Anthem Health Plans of VA, Inc. | VA | +3.0% | +9.0% | +7.2% | 5K |
| Moda Health Plan, Inc. | TX | 0.0% | +7.0% | +2.5% | 5K |
| Chinese Community Health Plan | CA | -26.0% | +15.6% | +6.7% | 4K |
| PacificSource Health Plans | ID | +4.3% | +3.3% | +4.5% | 4K |
| Summa Insurance Company | OH | +10.0% | +6.2% | +5.2% | 4K |
| Cigna HealthCare of Arizona, Inc. | AZ | +9.4% | +8.3% | +1.5% | 4K |
| Buckeye Health Plan Community Solutions, Inc. | OH | 0.0% | 0.0% | 0.0% | 4K |
| UnitedHealthcare of Oregon, Inc. | WA | +9.4% | +2.9% | +7.7% | 4K |
| Blue Cross and Blue Shield of Kansas City | MO | +5.9% | +13.3% | +1.8% | 4K |
| Community First Insurance Plans | TX | +2.3% | +13.1% | +3.9% | 4K |
| Select Health of South Carolina, Inc. | SC | +4.6% | +6.3% | +5.1% | 4K |
| Oscar Insurance Company | MI | +14.6% | +8.0% | +5.2% | 4K |
| Harbor Health Insurance Company | TX | 0.0% | n/a | n/a | 4K |
| Harvard Pilgrim Healthcare, Inc. | NH | +1.3% | +16.1% | +2.7% | 3K |
| Medica Health Plans | ND | 0.0% | +4.0% | +4.2% | 3K |
| Highmark BlueCross BlueShield of Western and Northeastern New York | NY | 0.0% | +7.9% | -1.7% | 3K |
| Boston Medical Center Health Plan, Inc. | NH | 0.0% | 0.0% | 0.0% | 3K |
| CDPHP | NY | 0.0% | +9.8% | +2.2% | 3K |
| Peach State Health Plan, Inc. | GA | 0.0% | 0.0% | 0.0% | 3K |
| CareSource North Carolina Co. | NC | +95.3% | +14.0% | +2.5% | 3K |
| Blue Cross and Blue Shield of Kansas City | KS | +5.9% | +13.3% | +1.8% | 3K |
| Wellpoint Washington, Inc. | WA | 0.0% | 0.0% | 0.0% | 3K |
| Hometown Health Providers Insurance Company | NV | +0.9% | +5.9% | +4.7% | 3K |
| UnitedHealthcare of South Carolina, Inc. | SC | +9.7% | +2.9% | +8.2% | 3K |
| MercyCare HMO, Inc. | WI | +4.0% | +9.0% | +2.7% | 3K |
| Antidote Health Plan of Ohio | OH | 0.0% | +12.5% | +2.7% | 3K |
| Oscar Insurance Company | OK | +4.0% | +5.8% | +5.1% | 3K |
| Medical Mutual of Ohio | OH | 0.0% | 0.0% | 0.0% | 3K |
| UnitedHealthcare Insurance Company | WY | 0.0% | 0.0% | 0.0% | 3K |
| Cigna HealthCare of Illinois, Inc. | IL | -0.5% | +7.2% | +1.5% | 3K |
| Sutter Health Plan | CA | 0.0% | +13.4% | +1.4% | 3K |
| CareFirst BlueChoice, Inc. | DC | +0.7% | +7.3% | +3.4% | 2K |
| Health Insurance Plan of Greater New York (HIP) | NY | 0.0% | +6.8% | +3.9% | 2K |
| Geisinger Quality Options | PA | 0.0% | +6.0% | -0.5% | 2K |
| Molina Healthcare of Kentucky, Inc. | KY | +4.7% | +3.0% | +8.8% | 2K |
| ConnectiCare Insurance Company Inc. | CT | 0.0% | +12.7% | +2.7% | 2K |
| McLaren Health Plan Community | MI | +0.9% | +5.1% | +2.0% | 2K |
| Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. | DC | +0.9% | +5.7% | +5.4% | 2K |
| UnitedHealthcare Insurance Company | NE | 0.0% | 0.0% | 0.0% | 2K |
| Community Health Choice Texas, Inc. | TX | 0.0% | 0.0% | 0.0% | 2K |
| Paramount Insurance Company | OH | +2.7% | +10.6% | -1.4% | 2K |
| Health Alliance Plan of Michigan | MI | +3.9% | +3.5% | +2.0% | 2K |
| UPMC Health Plan, Inc. | PA | 0.0% | +13.7% | -0.1% | 2K |
| UnitedHealthcare Insurance Company | NH | 0.0% | n/a | n/a | 2K |
| Taro Health | ME | +9.6% | +12.4% | +3.9% | 2K |
| Oscar Insurance Company | AL | 0.0% | 0.0% | 0.0% | 2K |
| Imperial Insurance Companies Inc. | AZ | +2.0% | +5.4% | +3.1% | 1K |
| Alliance Health and Life Insurance Company | MI | +4.0% | +3.5% | +2.0% | 1K |
| Oscar Health Plan, Inc. | MS | 0.0% | 0.0% | 0.0% | 1K |
| Oscar Health Plan of Pennsylvania, Inc. | PA | +7.4% | +4.8% | +5.0% | 1K |
| GHMSI, Inc. | VA | +1.4% | +10.0% | +2.0% | 1K |
| Bankers Reserve Life Insurance Company of Wisconsin | NE | 0.0% | 0.0% | 0.0% | 1K |
| Asuris Northwest Health | WA | -0.1% | +5.5% | +4.4% | 1K |
| Access to Care Health Plan | TX | 0.0% | 0.0% | 0.0% | 1K |
| Quartz Health Plan Minnesota Corporation | MN | +3.4% | +13.7% | +7.4% | 1K |
| MercyCare HMO, Inc. | IL | +3.3% | +9.0% | +2.7% | 1K |
| Antidote Health Plan of Arizona | AZ | 0.0% | +11.7% | +2.5% | 1K |
| Molina Healthcare of Idaho, Inc. | ID | +4.1% | +5.1% | +2.8% | 1K |
| ConnectiCare Inc. | CT | 0.0% | +12.7% | +2.7% | 1K |
| Partners Insurance Company, dba Jefferson Health Plans | PA | 0.0% | 0.0% | 0.0% | 1K |
| Imperial Insurance Companies Inc. | NV | +5.9% | +4.5% | +3.1% | 1K |
| AmeriHealth Caritas Louisiana, Inc. | LA | 0.0% | 0.0% | 0.0% | 1K |
| Oscar Insurance Company | VA | +5.9% | +5.4% | +5.5% | 1K |
| SSMHIC Insurance Company | MO | 0.0% | +2.3% | +2.4% | 1K |
| Ambetter Health of Florida, Inc. | FL | 0.0% | 0.0% | 0.0% | 1K |
| Health Net Community Solutions of Arizona, Inc. | AZ | 0.0% | 0.0% | 0.0% | 1K |
| Bankers Reserve Life Insurance Company of Wisconsin | KS | 0.0% | 0.0% | 0.0% | 0K |
| Bankers Reserve Life Insurance Company of Wisconsin | TN | 0.0% | 0.0% | 0.0% | 0K |
| Bankers Reserve Life Insurance Company of Wisconsin | OK | 0.0% | 0.0% | 0.0% | 0K |
| Bankers Reserve Life Insurance Co. | MO | 0.0% | 0.0% | 0.0% | 0K |
| Keystone Health Plan Central | PA | -41.5% | +11.4% | +2.4% | 0K |
| BridgeSpan Health Company | WA | -26.8% | +5.0% | +4.1% | 0K |
| UnitedHealthcare Insurance Company | SD | 0.0% | 0.0% | 0.0% | 0K |
| Medica Insurance Company | KS | 0.0% | +2.6% | +2.6% | 0K |
| UnitedHealthcare Plan of the River Valley, Inc. | IA | 0.0% | 0.0% | 0.0% | 0K |
| Celtic Insurance Company | SC | 0.0% | 0.0% | 0.0% | 0K |
| Providence Health Plan | WA | 0.0% | 0.0% | 0.0% | 0K |
| UnitedHealthcare of the Midlands, Inc. | ND | 0.0% | 0.0% | 0.0% | 0K |
| BridgeSpan Health Company | UT | +2.3% | +4.7% | +2.6% | 0K |
| Celtic Insurance Company | MS | 0.0% | 0.0% | 0.0% | 0K |
| BridgeSpan Health Company | OR | +8.2% | +5.0% | +2.7% | 0K |
| Imperial Health Plan of the Southwest, Inc. | UT | +5.9% | +6.9% | +3.1% | 0K |
| HPHC Insurance Co. | ME | +2.0% | +17.0% | +2.8% | 0K |
| Ambetter Health of Texas, Inc. | TX | 0.0% | 0.0% | 0.0% | 0K |
| Baylor Scott & White Insurance Company | TX | +6.5% | -1.6% | -0.3% | 0K |
| UHIC | NY | +8.6% | +3.2% | +6.1% | 0K |
| Molina Healthcare of Nevada, Inc. | NV | +3.2% | +4.5% | +2.8% | 0K |
| Aetna Life Insurance Company | NY | +30.0% | +5.4% | +4.3% | 0K |
| The Health Plan of West Virginia, Inc. | WV | 0.0% | +8.3% | +2.1% | 0K |
| The Health Plan of West Virginia, Inc. | OH | 0.0% | +8.2% | +2.1% | 0K |
| AmeriHealth HMO, Inc. | NJ | -58.9% | +8.8% | 0.0% | 0K |
| Wisconsin Physicians Service Insurance Corporation | WI | 0.0% | +4.6% | +5.6% | 0K |
| Sentara Health Insurance Company | VA | 0.0% | 0.0% | 0.0% | 0K |
| UnitedHealthcare of New England, Inc. | ME | 0.0% | +4.7% | +5.0% | 0K |
| UnitedHealthcare Insurance Company | ME | 0.0% | +4.7% | +5.0% | 0K |
| Molina Healthcare of Wisconsin, Inc. | WI | +4.7% | 0.0% | 0.0% | 0K |
Entries, exits and where the members went
Issuer licenses present in the PY2025 file but absent from PY2026, and vice versa, individual market. 34 filers left carrying 2.82M lives at their last filing; 28 entered carrying 73K. Book shifts among continuing issuers show where the members landed. Some exits are corporate consolidations rather than market withdrawals: the book moves to an affiliate under a different license, and the affiliate's growth appears in the shifts table.
| Exited after PY2025 | State | Last book |
|---|---|---|
| Celtic Insurance Company | FL | 963,528 |
| Aetna Health Inc. (a FL corp.) | FL | 565,522 |
| Aetna Health Inc. (a PA corp.) | NC | 312,222 |
| Aetna Health Inc. (a TX corp.) | TX | 237,375 |
| Banner Health and Aetna Health Plan Inc. | AZ | 105,915 |
| Aetna Health Inc. (a GA corp.) | GA | 94,328 |
| Aetna Life Insurance Company | NJ | 74,292 |
| Aetna Health of Utah Inc. | UT | 67,237 |
| Nebraska Total Care, Inc. | NE | 64,917 |
| Aetna Health Inc. (a PA corp.) | IL | 37,399 |
| Aetna Life Insurance Company | MO | 35,763 |
| Health Alliance Medical Plans, Inc. | IL | 33,753 |
| Pennsylvania Health & Wellness Inc. | PA | 29,211 |
| Innovation Health Plan, Inc. | VA | 27,090 |
| CareSource Kentucky Co. | KY | 22,460 |
| Aetna Life Insurance Company | KS | 22,194 |
| Aetna Health Inc. (a PA corp.) | OH | 15,694 |
| Aetna Health Inc. (a PA corp.) | VA | 14,593 |
| Aetna Health of California Inc. | CA | 14,038 |
| Chorus Community Health Plans | WI | 13,854 |
| Mountain Health Cooperative | WY | 13,233 |
| Physicians Health Plan | MI | 11,566 |
| Aetna Health of Utah Inc. | NV | 7,557 |
| AultCare Insurance Company | OH | 6,536 |
| Aetna Health Inc. (a PA corp.) | IN | 4,898 |
| Aetna Life Insurance Company | IL | 4,490 |
| Aetna Health Inc. (a PA corp.) | DE | 4,069 |
| Primewell Health Services of Mississippi, Inc. | MS | 3,910 |
| Quartz Health Benefit Plans Corporation | IL | 3,190 |
| Aetna Health Inc. (a PA corp.) | MD | 2,144 |
| UPMC HEALTH COVERAGE INC. | PA | 2,093 |
| HPHC Insurance Co. | MA | 234 |
| Celtic Insurance Company | NC | 36 |
| Partners Insurance Company of New Jersey, dba Jefferson Health Plans | NJ | new |
| Entered for PY2026 | State | Current book |
|---|---|---|
| Ambetter Health | PA | 60,055 |
| HealthPartners Insurance Company | MN | 10,459 |
| UPMC Health Plan, Inc. | PA | 2,013 |
| Access to Care Health Plan | TX | 925 |
| Ambetter Health of Texas, Inc. | TX | new |
| UnitedHealthcare Insurance Company | SD | new |
| Bankers Reserve Life Insurance Company of Wisconsin | TN | new |
| Health Net Community Solutions of Arizona, Inc. | AZ | new |
| Community Care Health Plan of Nevada, Inc | NV | new |
| Wellpoint Washington, Inc. | WA | new |
| 22 Health | FL | new |
| AmeriHealth Caritas Louisiana, Inc. | LA | new |
| Oscar Insurance Company | AL | new |
| Cigna Healthcare of Florida, INC. | FL | new |
| Bankers Reserve Life Insurance Company of Wisconsin | KS | new |
| Harbor Health Insurance Company | TX | new |
| Celtic Insurance Company | NE | new |
| Bankers Reserve Life Insurance Company of Wisconsin | OK | new |
| Oscar Health Maintenance Organization of Florida, Inc. | FL | new |
| Bankers Reserve Life Insurance Company of Wisconsin | NE | new |
| UnitedHealthcare Benefits of Texas, Inc. | TX | new |
| Ambetter Health of Florida, Inc. | FL | new |
| Avera Health Plans, Inc. | IA | new |
| Oscar Health Plan, Inc. | MS | new |
| Medical Mutual of Ohio | OH | new |
| CareSource Nevada Co. | NV | new |
| UnitedHealthcare Insurance Company | NH | new |
| UnitedHealthcare of the Midlands, Inc. | ND | new |
| Largest book shifts, continuing issuers | State | PY2025 | PY2026 | Change |
|---|---|---|---|---|
| Oscar Insurance Company of Florida | FL | 753,210 | 1,124,915 | +49.3% |
| Blue Cross and Blue Shield of Texas | TX | 1,316,049 | 1,082,299 | -17.8% |
| Superior Health Plan | TX | 256,070 | 475,005 | +85.5% |
| Celtic Insurance Company | TX | 296,984 | 487,491 | +64.1% |
| Oscar Insurance Company | TX | 119,961 | 265,713 | +121.5% |
| Ambetter of Peach State Inc. | GA | 506,771 | 640,524 | +26.4% |
| Cigna HealthCare of Texas, Inc. | TX | 138,898 | 23,396 | -83.2% |
| Oscar Health Plan of Georgia | GA | 343,195 | 230,917 | -32.7% |
| Cigna HealthCare of Georgia | GA | 137,357 | 34,905 | -74.6% |
| Celtic Insurance Company | IN | 105,620 | 6,262 | -94.1% |
Identity is the state plus HIOS issuer id; re-licensed entities with heavily overlapping names are treated as continuations, not churn. Enrollment is each issuer's current enrollment at filing (Worksheet 2). A zero-book entry is a new filer with no members yet at filing time.
The demand side: selections, net premiums and the mid-year curve
The assumptions above priced a pool-composition shock; this is the shock arriving. OEP 2026 closed at 23.13M plan selections nationally, -4.9% from 2025, while the average premium consumers actually pay after subsidy jumped by half or more in the states that filed the steepest morbidity. States are ranked by that net-premium jump. The mid-year column is each state's 2025 effectuated-enrollment trajectory (latest month vs January; positive means year-round special enrollment is still adding members, negative means the pool is already shrinking in-year).
| State | OEP 2026 selections | vs 2025 | Net premium | Change | 2025 mid-year | Filed morbidity |
|---|---|---|---|---|---|---|
| MSMississippi | 313,392 | -7.3% | $41 → $131 | +219.5% | -10.2% | +16.9% |
| GAGeorgia | 1,324,295 | -12.3% | $74 → $164 | +121.6% | -1.6% | +16.2% |
| OKOklahoma | 261,887 | -15.0% | $78 → $161 | +106.4% | -3.9% | +13.5% |
| WVWest Virginia | 55,879 | -16.7% | $101 → $208 | +105.9% | -1.8% | +2.0% |
| AZArizona | 357,144 | -15.6% | $113 → $229 | +102.7% | -0.9% | +5.0% |
| LALouisiana | 296,648 | +1.2% | $72 → $144 | +100.0% | +10.1% | +18.0% |
| NMNew Mexico | 83,103 | +18.1% | $152 → $299 | +96.7% | +8.8% | +5.2% |
| TNTennessee | 569,310 | -11.4% | $72 → $141 | +95.8% | -8.0% | +12.0% |
| ALAlabama | 455,776 | -4.6% | $65 → $126 | +93.8% | +0.1% | +2.0% |
| NENebraska | 128,492 | -6.0% | $114 → $217 | +90.4% | +3.7% | +0.6% |
| SCSouth Carolina | 587,567 | -7.0% | $73 → $139 | +90.4% | -1.1% | +10.8% |
| MOMissouri | 365,734 | -12.3% | $91 → $173 | +90.1% | -5.7% | +13.7% |
| NCNorth Carolina | 761,457 | -21.9% | $97 → $180 | +85.6% | -12.8% | +11.9% |
| INIndiana | 300,049 | -16.5% | $120 → $222 | +85.0% | -2.0% | +5.9% |
| OHOhio | 469,616 | -19.5% | $126 → $233 | +84.9% | -4.0% | +11.6% |
| WYWyoming | 41,545 | -10.9% | $134 → $235 | +75.4% | +5.4% | +4.4% |
| UTUtah | 387,336 | -8.2% | $70 → $120 | +71.4% | +1.5% | +4.1% |
| MIMichigan | 497,064 | -6.4% | $131 → $222 | +69.5% | +2.9% | +6.2% |
| SDSouth Dakota | 50,951 | -6.9% | $125 → $211 | +68.8% | -0.1% | +1.3% |
| IAIowa | 123,304 | -9.9% | $141 → $235 | +66.7% | +0.7% | +1.4% |
| VTVermont | 30,344 | -7.7% | $220 → $364 | +65.5% | +4.2% | +7.7% |
| MAMassachusetts | 403,624 | +3.7% | $198 → $325 | +64.1% | +8.4% | +0.9% |
| KYKentucky | 89,028 | -8.6% | $180 → $288 | +60.0% | +10.0% | +8.3% |
| VAVirginia | 370,086 | -4.8% | $135 → $215 | +59.3% | +0.1% | +8.7% |
| RIRhode Island | 43,446 | +3.2% | $155 → $246 | +58.7% | +12.0% | +2.8% |
| FLFlorida | 4,538,772 | -4.2% | $67 → $106 | +58.2% | -0.0% | +4.8% |
| NDNorth Dakota | 41,014 | -4.4% | $145 → $229 | +57.9% | +2.3% | +2.5% |
| IDIdaho | 120,426 | +2.6% | $129 → $202 | +56.6% | -0.5% | +2.5% |
| OROregon | 118,372 | -15.3% | $272 → $426 | +56.6% | -2.3% | +1.1% |
| TXTexas | 4,172,233 | +5.2% | $57 → $89 | +56.1% | +2.5% | +19.8% |
| COColorado | 277,238 | -1.9% | $205 → $318 | +55.1% | +8.0% | +6.9% |
| NJNew Jersey | 509,192 | -0.8% | $179 → $277 | +54.7% | +7.2% | +6.6% |
| AKAlaska | 26,079 | -9.2% | $223 → $344 | +54.3% | +1.7% | +2.2% |
| MDMaryland | 255,612 | +3.4% | $184 → $284 | +54.3% | +4.1% | +12.5% |
| NVNevada | 104,286 | -5.8% | $152 → $234 | +53.9% | +2.4% | +12.1% |
| MTMontana | 73,255 | -5.1% | $151 → $230 | +52.3% | +2.2% | +8.6% |
| KSKansas | 192,811 | -3.6% | $106 → $160 | +50.9% | +2.1% | +13.2% |
| WIWisconsin | 291,336 | -7.1% | $167 → $250 | +49.7% | +2.4% | +5.0% |
| NHNew Hampshire | 66,024 | -6.1% | $230 → $342 | +48.7% | -3.7% | +11.2% |
| HIHawaii | 23,380 | -5.0% | $252 → $372 | +47.6% | +2.0% | +1.1% |
| DEDelaware | 44,663 | -15.6% | $217 → $320 | +47.5% | -4.9% | +2.2% |
| MNMinnesota | 139,251 | -8.1% | $307 → $437 | +42.3% | +5.8% | +2.5% |
| CACalifornia | 1,927,371 | -2.6% | $187 → $264 | +41.2% | +4.4% | +2.0% |
| MEMaine | 58,523 | -9.5% | $245 → $340 | +38.8% | +2.2% | +3.7% |
| PAPennsylvania | 501,459 | +1.0% | $187 → $251 | +34.2% | +6.1% | +3.0% |
| ARArkansas | 160,307 | -3.8% | $124 → $162 | +30.6% | +0.3% | +29.9% |
| CTConnecticut | 156,745 | +3.7% | $223 → $277 | +24.2% | +9.2% | +1.1% |
| ILIllinois | 448,568 | -3.7% | $190 → $230 | +21.1% | +3.8% | +7.2% |
| NYNew York | 210,704 | -4.9% | $532 → $636 | +19.5% | +10.5% | +1.3% |
| WAWashington | 290,109 | -5.9% | $288 → $343 | +19.1% | +2.4% | +3.8% |
| DCDistrict of Columbia | 16,053 | +7.5% | $610 → $725 | +18.9% | +9.5% | -0.6% |
Sources: CMS Marketplace OEP state-level public use files (plan selections, average premium after APTC) and CMS effectuated enrollment tables (monthly state series). Net premium is the average consumers pay after advance premium tax credits; the 2025-to-2026 jump is the enhanced-subsidy expiry as experienced at the household level, the driver behind both the enrollment decline and the filed morbidity above.
Every assumption filed here gets graded
Each late October
The verdict file
CMS ships the initial PUF with final filed factors just as open enrollment opens, then trues it up each spring with quarterly refilings. This page rebuilds on both.
PY2027 onward
Assumptions vs actuals
The next cycle's experience data grades the +8.5% morbidity call, camp by camp. Did the zero-adjustment carriers know their pools, or miss the cliff?
Methodology
Source. CMS Rate Review Public Use Files (Unified Rate Review Template), plan years 2024 to 2026. Single risk pool, ACA-compliant plans; 2251 filings across both markets. Every filing carries its SERFF tracking number, company and HIOS issuer ID in the underlying data.
Weighting. Assumption factors are weighted by each filing's projected member months (Worksheet 1). Rate changes are plan-level cumulative changes weighted by current enrollment (Worksheet 2), renewing plans only: terminated plans keep their members in the file with a 0% "change" that is a crosswalk, not a rate action (2.33M PY2026 lives, 1.12M of them one Oscar Florida entity mid-consolidation), and new plans have no prior rate. Aggregates therefore reflect the rate action renewing members actually experience. Prior-year quarterly small group refilings shipped inside the annual PUF are excluded to prevent double counting.
Caveats. These are filed values, which can precede final state action in some jurisdictions. A zero morbidity entry can reflect a carrier embedding morbidity in other adjustment fields; the benchmark flags the filing as filed rather than reinterpreting it. Multiplicative URRT factors are restated as percent change.
Cadence. Rebuilt on each PUF release. Data as of March 27, 2026. Source: CMS Rate Review Data.