News Summary
Health insurance companies in Rhode Island are seeking significant rate increases for 2026, with proposals ranging from 20% to 28%. The proposed hikes include a notable 28% increase from Blue Cross Blue Shield for individual market plans. Factors behind the increases include rising healthcare costs and the potential expiration of federal Enhanced Premium Tax Credits. The Office of the Health Insurance Commissioner (OHIC) is set to review these proposals, with a decision expected by September.
Rhode Island Health Insurance Companies Seek Significant Rate Increases for 2026
Rhode Island health insurance companies have filed for rate increases ranging from 20% to 28% for coverage in the year 2026, presenting a potential financial burden for residents and employers. The largest proposed increase comes from Blue Cross Blue Shield of Rhode Island, which is requesting a 28% rise for individual market plans.
The requests were submitted as part of the Office of the Health Insurance Commissioner (OHIC)’s rate review process, aimed at evaluating coverage that would take effect on or after January 1, 2026. The projected rate increases for individual market plans are notably higher than the previous year’s average of 7.8%, with new averages anticipated between 21.2% and 28.9%.
Details on Proposed Increases
In addition to the individual market, the rate hike requests include average increases for small group market plans estimated between 20.3% and 22.2%, which contrasts sharply with the 12.4% approved for 2025. Large group market plans are facing proposed average increases ranging from 13.5% to 26.4%, compared to an average of 11.2% for the previous year.
The planned increases in the individual market are attributed to multiple factors, including the anticipated expiration of federal Enhanced Premium Tax Credits (EPTCs). These credits currently aid eligible Rhode Islanders by lowering their premiums. Without them, fewer individuals may purchase insurance, adding an estimated 9.7% to Blue Cross Blue Shield’s requested increase, and 4.9% to the requests made by Neighborhood Health Plan of Rhode Island (NHPRI).
Factors Influencing Rate Increases
Insurance companies have cited rising healthcare expenditures as a major contributor to the planned rate increases. This includes escalating costs for hospital services and prescription drugs. Furthermore, a significant rise in the utilization of glucagon-like peptide-1 (GLP-1) drugs for weight management has also influenced these financial requests. Additional factors include the impact of tariffs on imported drug prices and the need for contributions to reserve margins that exceed those approved in 2025 rates.
Regulatory Review and Next Steps
The OHIC is set to conduct a comprehensive review of the filings, scrutinizing the data and pricing assumptions provided by the insurers, as well as their administrative charges, to determine the overall reasonability of the requests. Unlike previous years, the Rhode Island Attorney General’s Office will not perform an independent actuarial review for small and large group market rates this year.
It’s important to note that the proposed rate increases do not affect self-funded employer groups, which constitute about 65% of Rhode Islanders with employer-sponsored insurance.
The OHIC is committed to ensuring that all health plans offered in Rhode Island conform with both state and federal regulations regarding benefits and member cost-sharing. A decision regarding the proposed rate increases is expected to be finalized by September.
Administrative hearings for the individual market rates filed by Blue Cross Blue Shield of Rhode Island and NHPRI are scheduled for June 30 and July 1, as well as July 15 and July 16, respectively.
Deeper Dive: News & Info About This Topic
- GoLocalProv: RI Health Insurance Companies Requesting Rate Increases of 20% to 28%
- Providence Journal: RI’s Proposed $14.3B Budget
- Boston Globe: Rhode Island Medicaid Patients May Lose Coverage
- Encyclopedia Britannica: Health Insurance
- Turn to 10: UnitedHealthcare Medicare Advantage Patients to Lose Coverage
- Google Search: Rhode Island health insurance rate increases
