Health insurance issuers participating in Affordable Care Act (ACA)-regulated markets submit rate filings annually to state regulators summarizing recent product experience and pricing assumptions for the next plan year. Based on the datasets released by the Centers for Medicare and Medicaid Services last fall, we provide a picture of the ACA market landscape.

Key findings

• On average across all plans in all states, issuers filed 2025 rate increases of 8.0% in the small group market and 6.4% in the individual market.
• Since 2021, the average annual rate increase is 4.9% for the individual ACA market and 5.6% for the small group ACA market.
• New issuer entries offset exits in the individual market, while issuer participation declined in the small group ACA market.
• ACA enrollment hit record highs in the individual market but declined in the small group market.
• Issuers project claims from 2023 to 2025 using average claims trends of 7%, with higher trends for pharmacy claims.
• Premium loads for non-benefit expenses averaged 17.3% for individual market issuers and 14.7% for small group market issuers.
• Average loss ratios from 2022 to 2023 improved for the individual market to 82.4%, down from 84%, but worsened for the small group market, to 85.5%, up from 84.7%.
• The ACA rate filing cycle is fraught with uncertainties, particularly if enhanced premium subsidies are not extended or if the Market Integrity and Affordability Rule is implemented as proposed.