That health insurance individual market and small group premiums will increase in 2026 is no surprise.  That the small group average increase could be as high as 18.9% is a shock.  The last significant average increase was 14.6% in 2024.

That the individual market average increase could be as high as 26% is stunning but not unprecedented.  Average rates increased by 33% in 2017 and 27.1% in 2018.

Actual increases have not been determined yet by the Maine Bureau of Insurance.  Nevertheless, many small employers and individuals will find it more costly than ever to obtain health care coverage.

According to a Bureau of Insurance briefing for legislators in January:

• Maine’s health insurance premiums are among the highest in the nation.
• Rates are increasing due to an aging population (Maine’s the oldest state in the nation), higher reimbursements paid to health care providers and accelerating prescription drug prices.

Anthem explains the factors driving its increases in the small group market include:

“The primary drivers of premium increases are associated with increased cost of benefit expense for this ACA compliant block and the changes in the regulatory requirements.  Increased cost of benefit expense is driven by increases in the price of services primarily from hospitals, physicians and pharmacies, coupled with members increasing their use of health care services, also called “utilization”.  Increases in the price of services are driven by technological advances, new specialty medications, and a variety of other factors.

“Increased utilization is driven by member level utilization and selection patterns in the Guaranteed Issue, Community Rated ACA market. The changes in the regulatory requirements include, but not limited to, the reduction of the coverage from the Maine Guaranteed Access Reinsurance Association (MGARA) program as result of the merging of the Individual and Small Group ACA markets in Maine.

More detailed information, including a summary table of requested increases, and announcement of a Bureau of Insurance public hearing on August 15 can be found here: www.maine.gov/pfr/insurance/consumers/rates