RI Health Insurance Companies Requesting Rate Increases of 20% to 28%

RI Health Insurance Companies Requesting Rate Increases of 20% to 28%

On Friday, the Office of Health Insurance Commissioner (OHIC) released the individual, small group, and large group market premium rates requested by Rhode Island’s insurers.

The rate increases are almost all over 20%, and for individual buyers, Blue Cross Blue Shield of RI is asking for a 28% increase.

The potential rate increases are a blow to Rhode Islanders and businesses.

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The requests were filed as part of OHIC’s rate review process (for coverage effective on or after January 1, 2026).

“Health insurers are asking working Rhode Islanders and employers to take on significant additional costs for their health benefit plans,” said Health Insurance Commissioner Cory King. He continued: “These costs represent a significant financial burden and OHIC will scrutinize the insurers’ requests as part of our review to determine whether they are justified.”

 

Tables 1 – 3, below, summarize the insurers’ requests. Two insurers, Blue Cross Blue Shield of Rhode Island (BCBSRI) and Neighborhood Health Plan of Rhode Island (NHPRI), filed rates for plans to be sold on the individual market to persons who do not receive insurance through their employer. In addition to BCBSRI and NHPRI, UnitedHealthcare filed small group market rates. Five insurers (BCBSRI, UnitedHealthcare, Harvard Pilgrim Health Care of New England, Inc (HPHC)/HPHC)

 

 

 

 

 

 

 

Insurance Company (HPIC), Aetna, and Cigna) filed large group rates.

In the individual market, requested average rate increases for 2026 range from 21.2% to 28.9%. For comparison, 2025 approved rate increases averaged 7.8% in the individual market. A unique driver of the requested rate increases in the individual market is the planned expiration of federal Enhanced Premium Tax Credits (EPTCs). EPTCs lower qualifying Rhode Islanders premiums when they purchase their coverage through HealthSource RI.

 

Originally authorized by the American Rescue Plan Act of 2021 and extended by the Inflation Reduction Act of 2022, under current law the EPTCs are due to sunset after 2025 unless they are extended by Congress. Insurers project that fewer individuals will choose to purchase insurance after these tax credits expire. The expiration of EPTCs is adding 9.7% to BCBSRI’s requested increase and 4.9% to NHPRI’s requested increase for individual market plans.

In the small group market, insurers requested average increases for 2026 ranging from 20.3% to 22.2%. For comparison, 2025 approved rate increases averaged 12.4%.

Large group market requested average rate increases for 2026 range from 13.5% to 26.4%. Large group market approved rate increases for 2025 averaged 11.2%.

Insurer filings identified several key factors influencing the requested rate increases for 2026. These include:

- Expected increases in expenditures on health care services, including payments to hospitals and professional providers, and higher spending on prescription drugs.
- Increased utilization of glucagon-like peptide-1 (GLP-1) drugs for weight loss. But, those costs should be offset by improved health.
- Impact of tariffs on imported drug prices and the prices of imported ingredients for domestically manufactured drugs.
- Additional contribution to reserve margins above what was approved in 2025 rates.

 

OHIC will review all data, pricing assumptions, administrative charges, and other information to assess the reasonability of the premium requests by each insurer. The Commissioner may approve as filed, modify, or reject an insurer’s rate filing in accordance with powers vested in the Office by the Rhode Island General Laws. It is important to note that decisions on rates are based on data and actuarial analysis.

In a departure from process over the last three years, the Rhode Island Attorney General’s Office has confirmed with OHIC that it will not be conducting an independent actuarial review of the rate filings for the small group and large group markets. In past years, the Attorney General hired actuaries to review the rate filings and submitted recommendations to OHIC.

The proposed rate increases do not apply to self-funded employer groups that account for approximately 65% of Rhode Islanders with employer-sponsored coverage. Self-funded employers pay the health care expenses of their employees and dependents directly, commonly relying on health insurance companies for administrative services, such as member enrollment, provider contracting, and claims processing.

OHIC will also review each health insurer’s coverage and benefit contracts with consumers to ensure that plans sold in Rhode Island meet all benefit, access, and member cost sharing standards required by state and federal law. OHIC’s final decision to approve, modify, or reject the proposed rates is expected by September.

 

This year the individual market rates filed by BCBSRI and NHPRI will be considered as part of an administrative hearing process. The hearings are scheduled for the following dates:

BCBSRI: June 30th and July 1st.

NHPRI: July 15th and July 16th.

This story was first published 6/13/25 2:31 PM