Individual-market insurers filed an enrollment-weighted morbidity adjustment of +7.2% into their final plan year 2027 ACA rates, on top of the +8.5% they filed for 2026, according to actuary.info's analysis of the Rate Review public use file CMS posted on November 4. The weighted cumulative rate change on renewing plans was +14.4%, after +26.2% a year earlier.
The file holds the final Unified Rate Review Template data for every 2027 single risk pool filing: 344 individual-market filings and 307 small group filings, after dropping prior-year quarterly refilings. CMS posted it as 2027 open enrollment got under way, on its usual late-autumn schedule, a week and a half later in the year than the plan year 2025 file's October 24 release in 2024. The full state, carrier and factor tables are on the ACA Filing Assumptions Benchmark.
The final figures land three months after KFF put the median proposed 2027 increase at 15% across 276 insurers with public filings, as this site reported in August, and after the preliminary filings reviewed in July showed a second subsidy-loss morbidity load of about four points in the memoranda that itemized one.
Key Takeaways
- Insurers priced a second year of risk-pool deterioration: the weighted individual-market morbidity factor is +7.2% for 2027 after +8.5% for 2026, and the two compound to about 16%.
- The renewing-plan rate change halved from its 2026 level: +14.4% enrollment-weighted, against +26.2% for 2026 and +6.5% for 2025.
- Loads of 10% or more cover 33.2% of individual enrollment, while filings with no morbidity adjustment cover 17.2%, up from 15.6% a year ago.
- Rx utilization trend overtook Rx unit cost trend for the first time in the four-year series: +5.3% utilization against +4.7% cost, after +4.0% and +6.3% for 2026.
- Small group morbidity rose to +2.4% from +1.5%, with a +12.3% renewing-plan rate change, so the subsidy effect stays concentrated in the individual market.
- Issuer exits moved 1.39 million lives out of the renewing-plan base, which fell to 17.5 million from 20.6 million; Cigna's 11 state books, with 444,599 lives, were the largest group.
What the final filings priced in
The 2027 individual-market morbidity factor is the second consecutive load after two years at or below zero. Insurers filed a weighted -0.6% for 2024 and -0.1% for 2025, then +8.5% for 2026 and +7.2% for 2027, according to the benchmark. Compounded, the two loads come to about 16%.
The weighted median moved the other way. It rose to +6.2% from +5.2%, so the gap between the enrollment-weighted mean and the median narrowed to one point from 3.3. For 2026, the largest books filed materially worse morbidity than the typical filing; for 2027 the typical filing caught up with them.
The weighted cumulative rate change on renewing plans was +14.4%, against +26.2% for 2026, +6.5% for 2025 and +6.0% for 2024. Over the two subsidy-expiry years the renewing-plan rate change compounds to about 44%. The demographic shift factor stayed near neutral at +0.3%, against +0.1% for 2026 and -1.7% for 2025.
The filing count fell to 344 from 373, and renewing lives at filing fell to 17.5 million from 20.6 million. The issuer exits covered below account for 1.39 million of that difference; the rest sits in terminated plans at continuing issuers and in lower current enrollment on the plans that renewed.
| Plan year | Filings | Morbidity, weighted | Morbidity, median | Demographic shift | Renewing-plan rate change | Renewing lives at filing |
|---|---|---|---|---|---|---|
| 2024 | 379 | -0.6% | 0.0% | -0.1% | +6.0% | 15,658,462 |
| 2025 | 379 | -0.1% | 0.0% | -1.7% | +6.5% | 19,516,129 |
| 2026 | 373 | +8.5% | +5.2% | +0.1% | +26.2% | 20,566,675 |
| 2027 | 344 | +7.2% | +6.2% | +0.3% | +14.4% | 17,543,796 |
Sources: actuary.info analysis of the CMS Rate Review public use files for plan years 2024 to 2027, individual market, annual filings only. Factors are enrollment-weighted across filings that reported them; the rate change is the enrollment-weighted cumulative change on renewing plans, excluding terminated and new plans.
One method note applies throughout. A blank URRT factor arrives in the public file as a zero, and the benchmark treats any factor at or below 0.05 as not reported and leaves it out of the weighted averages; renewing lives are the current enrollment each plan carried at the time it filed, so they measure the base the rates were priced on and say nothing about 2027 sign-ups.
The morbidity distribution and the state spread
Filings covering 33.2% of individual enrollment assume a morbidity load of +10% or more: 23.8% of enrollment sits in the +10% to +15% band and 9.4% at +15% or above. For 2026 the top band alone held 23.6% of enrollment, as this site reported in August, so the heaviest loads thinned while the +10% to +15% band filled.
At the other end, filings with no morbidity adjustment cover 17.2% of enrollment, up from 15.6% for 2026, and filings with a negative factor cover 2.4%. The middle bands hold the rest: 12.1% of enrollment between zero and +2.5%, 13.3% between +2.5% and +5%, 9.5% between +5% and +7.5%, and 12.3% between +7.5% and +10%.
South Carolina carries the highest state load at +16.3% with a +22.5% renewing-plan rate change on 329,550 lives. Arkansas follows at +15.0%, then Texas at +12.9%, Georgia at +11.5%, Louisiana at +11.2% and Montana at +11.0%. West Virginia filed the lowest at -4.3% on 32,581 lives, with the District of Columbia at -1.0%, Delaware and Massachusetts at +0.2% and Idaho at +0.6%.
Arkansas stands out for the pairing. Its +15.0% morbidity load is the second highest in the country, while its +7.4% renewing-plan rate change is the third lowest, behind only Vermont at +3.1% and Iowa at +5.7%. The state also lost two issuer entities from its 2026 roster: Celtic Insurance Co, with 85,093 lives at its 2026 filing, and QualChoice, with 39,352, filed no 2027 individual plans there. The highest renewing-plan rate changes are Arizona at +28.5%, Montana at +24.6%, New Mexico at +24.4% and Alaska at +23.7%.
| State | Morbidity, weighted | Renewing-plan rate change | Renewing lives at filing |
|---|---|---|---|
| Texas | +12.9% | +14.6% | 3.14M |
| Florida | +6.3% | +10.3% | 2.35M |
| California | +2.3% | +9.9% | 2.19M |
| Georgia | +11.5% | +20.4% | 0.91M |
| North Carolina | +8.3% | +13.9% | 0.67M |
| New Jersey | +9.0% | +20.0% | 0.50M |
| Pennsylvania | +2.4% | +15.2% | 0.47M |
| Massachusetts | +0.2% | +10.7% | 0.42M |
Sources: actuary.info analysis of the CMS plan year 2027 Rate Review public use file, individual market, eight largest states by renewing-plan enrollment at filing.
Texas, the largest state at 3.14 million renewing lives, shows the carrier spread inside one risk pool. Blue Cross and Blue Shield of Texas filed +11.6% on 797,512 lives, Oscar Insurance Co filed +13.5% on 417,342, Celtic Insurance Co, the Centene entity, filed +13.2% on 289,275, and UnitedHealthcare of Texas filed +27.0% on 344,265. Four large books in the same state, pricing the same pool, span 15.4 points of morbidity.
Elsewhere the large books cluster low. Kaiser Foundation Health Plan in California filed +3.0% on 745,457 lives and Blue Shield of California +2.2% on 632,687; SelectHealth in Utah filed +2.7% on 293,150. In Florida, Centene Venture Co filed +7.7% on 697,442 lives and Health Options Inc, Florida Blue's HMO, filed +12.5% on 454,674, while Oscar HMO of Florida, the largest single individual-market book in the file at 1.58 million lives, filed a factor of 1.000 for morbidity and for every trend line, so its book sits in the no-adjustment band and pulls each weighted average toward zero. BCBS of South Carolina filed +16.3% on 271,762 lives, the figure that sets its state's load.
Trend by service category and the small group control
Every utilization trend in the individual-market filings rose for 2027. Rx utilization trend climbed to +5.3% from +4.0%, inpatient utilization to +3.0% from +2.0%, and outpatient utilization to +3.4% from +2.9%. On the cost side, inpatient unit cost trend rose to +5.0% from +4.3% and outpatient to +4.6% from +4.3%, while Rx unit cost trend fell to +4.7% from +6.3%.
That puts Rx utilization above Rx unit cost for the first time in the four-year series. For 2024 the pair was +5.4% cost and +3.1% utilization; for 2025, +5.1% and +3.8%; for 2026, +6.3% and +4.0%. The combined Rx trend barely moved, at about 10.2% for 2027 against about 10.6% for 2026, so the filings shifted the same pharmacy load from price to volume. Blue Cross and Blue Shield of Texas filed an Rx unit cost trend of +9.1%, nearly double the weighted national figure.
The small group market, which shares carriers, networks and provider contracts with the individual market and none of its subsidy mechanics, filed a weighted morbidity factor of +2.4% for 2027, against +1.5% for 2026, +0.4% for 2025 and +0.5% for 2024, with a weighted median of +0.8%. Its renewing-plan rate change was +12.3% after +11.7%, on 7.29 million renewing lives across 307 filings. Filings with no morbidity adjustment cover 39.8% of small group enrollment, and loads of +10% or more cover 6.4%.
Small group trend ran close to the individual market: Rx cost +6.0% and utilization +4.8%, inpatient +5.0% and +2.7%, outpatient +4.8% and +4.4%. The states with the heaviest small group loads are North Carolina at +12.2% with a +19.4% rate change on 156,974 lives, Texas at +10.3% with +19.5% on 444,603, Oklahoma at +7.6% and Illinois at +7.0% with +18.1% on 350,580. Ohio filed the highest small group rate change at +21.9%, then Arizona at +21.1%; Mississippi filed the lowest at +3.4%. California, the largest small group state at 1.53 million renewing lives, filed +0.8% morbidity and a +10.4% rate change.
The exits and the base the rates were priced on
Forty-six issuer-state combinations that filed 2026 individual plans filed none for 2027, and those books carried 1,392,381 lives at their 2026 filing. Seventeen issuer-state combinations entered, with 106,881 lives between them. The renewing-plan base the 2027 rates were priced on was 17.5 million lives, against 20.6 million a year earlier; exits and plan terminations move lives out of that base, and it is a different measure from effectuated enrollment.
Cigna accounts for 11 of the exits, one in each state where it sold individual plans, and those books carried 444,599 lives at their 2026 filings. The five largest are Cigna Health and Life Insurance Co's books in Florida (94,604 lives), Tennessee (89,125), Colorado (68,341), Mississippi (53,064) and Virginia (45,639); the rest are in Georgia, Texas, North Carolina, Indiana, Arizona and Illinois. Cigna said on April 30 that it would leave the individual market, affecting plans for 369,000 members in 11 states, according to Colorado Politics. KFF's participation tracker, updated October 28, says the company "has decided to leave the individual market in 2027 to focus on other segments" and counts 11 carriers exiting a marketplace for 2027 and seven entering new state marketplaces.
"We continuously warned that the failure of the federal government to extend tax credits would have huge market disruptions," Michael Conway, Colorado's Division of Insurance Commissioner, said of the Cigna decision, according to Colorado Politics.
The largest single exit is Baylor Scott & White Health Plan in Texas, at 240,770 lives. The plan's marketplace page says it "notified regulators of its intent to discontinue Individual Marketplace Plans after Dec 31, 2026," while continuing to serve employer groups and Medicare Advantage members.
The second largest, UPMC Health Options in Pennsylvania at 110,957 lives, looks like a book moved between UPMC entities: UPMC Health Network entered the Pennsylvania file with 106,881 lives, the entire entrant total, so the same members appear in both the exit and entry counts.
Other issuer entities that filed no 2027 individual plans in a state where they filed for 2026:
- Celtic Insurance Co, Arkansas: 85,093 lives
- Medical Health Insuring Corp of Ohio: 60,084
- CareSource Indiana: 59,863
- UCare Minnesota: 52,111
- CareSource, Ohio: 46,541
- Providence Health Plans, Oregon: 39,974
- QualChoice, Arkansas: 39,352
The other 16 entering issuer-state books, UPMC Health Network aside, filed with no current enrollment at all.
Further Reading
- KFF's 2027 ACA Median Lands at 15%, Splitting Trend From Subsidy Cliff: the proposed-rate count these final filings follow.
- ACA 2027 Rates Add a Second 4-Point Subsidy-Loss Morbidity Load: the preliminary memoranda that first itemized a second-year load.
- The 2026 ACA Filings Split Into Two Morbidity Camps, and One Is Wrong: the 2026 distribution this year's bands compare against.
- How to Read an ACA Rate Filing Field by Field: where each factor in the URRT comes from.
Sources
- CMS, Rate Review Data page
- CMS, plan year 2027 Rate Review public use file (zip), posted November 4, 2026
- actuary.info, ACA Filing Assumptions Benchmark, updated November 2026
- KFF, "How Much and Why ACA Marketplace Premiums Are Going Up in 2027," updated August 3, 2026
- KFF, "Tracking Insurer Participation Changes in the ACA Marketplaces in 2027," updated October 28, 2026
- Colorado Politics, "Cigna to pull out of individual health market, affecting thousands in Colorado," June 8, 2026
- Baylor Scott & White Health Plan, Individual & Family Marketplace Plans