Among the 318 small group market insurers offering ACA-compliant coverage, premium changes for 2026 range from a decrease of -5% to an increase of 32%. The majority of ACA-compliant small group insurers (68% or 216 insurers) are requesting premium increases in the 5% to 15% range, but about 10% (31 insurers) are proposing premium increases of 20% or more. Only 3 insurers have requested rate decreases for the upcoming year. A table in the appendix shows proposed premium increases by state and insurer.
These proposed rates are preliminary and may change; finalized 2026 rate changes are expected to be published in late summer or early fall.
Similar to the individual market, rising healthcare costs are a major driver of proposed premium increases in the small group market for the 2026 plan year. Insurers note that the costs of services such as hospitalizations, physician care, and prescription drugs continue to rise annually, which prompts premium adjustments to keep pace with increased expenditures. For 2026, insurers commonly estimate the underlying increase in the cost of healthcare (medical trend, which is a function of price and utilization) is about 9%.
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