2026 Rate Changes - Hawaii: +11.9%; ~36,000 enrollees facing MASSIVE rate hikes starting in January

Overall preliminary rate changes via SERFF database, state insurance dept. website and/or the federal Rate Review database.

Hawaii Medical Service Association:

Our requested rates include only the amounts needed to cover the expected health care benefits of our members, the cost of administering their benefits, expected Affordable Care Act (ACA) fees, and a small charge to help manage the risk of offering benefits to this population.

We based our rate increase request on a review of past costs of benefits and other expenses. These historical costs are adjusted for trend, to account for expected changes in use of medical services, cost inflation, and other factors that affect the cost of care. We also adjusted costs for benefit changes, which were largely made to comply with government mandated plan designs. Administrative expenses have been relatively flat over the past couple of years.

The overall requested rate increase for our plans is 12.8%. The increases range from a low of 11.0% for the Platinum PPO plan to a high of 16.4% for the Catastrophic plan. The Catastrophic plan is the only plan exceeding a 15% increase. There are 21,945 members, including 386 Catastrophic plan members, enrolled in our ACA Individual plans as of March 2025.

HMSA has moderate rate increases for ACA Individual plans over the past several years. From 2022 to 2025, we managed to keep the average annual rate increase to 6.0%.

We understand that any rate increase creates hardship for some members. However, the increase is necessary to keep up with the costs of covering this population and ensure the plan remains viable in the future. HMSA expects to offer plans in all metallic levels (Bronze, Silver, Gold, Platinum) as well as a Catastrophic Plan.

Kaiser Foundation Health Plan:

The aggregate rate change for this population is 10.4%.

The average rate change does not indicate that every member’s rate will change by this amount, as rates are affected by the ages of those covered, tobacco consideration, and plan chosen.

The rate changes shown are primarily driven by the claims experience of the single risk pool, medical inflation, risk adjustment transfers, and projected changes in the risk profile of the membership.

Unfortunately, the Kaiser Foundation actuarial filing doesn't clarify what their actual 2025 individual market enrollment is, so I've had to enter an estimate based on an assumed total Hawaii individual market enrollment of roughly 36,000 people. This is based on 2025 Open Enrollment running 11% higher than in 2024.

It's important to remember that this is for unsubsidized enrollees only; for subsidized enrollees, ACTUAL net rate hikes will likely be MUCH HIGHER for most enrollees due to the expiration of the improved ACA subsidies & the Trump CMS "Affordability & Integrity" rule changes.

Meanwhile, I have no enrollment data at all for most of the small group carriers; the unweighted average 2026 rate hike there is around 12.0%