Monday, September 15, 2025
PHOTO: File
Commercial health insurance premiums for 2026 have been approved by the State of Rhode Island’s Office of the Health Insurance Commissioner (OHIC), with modifications.
The 2026 premiums approved by OHIC are driven by significant increases in the cost of health care services and drugs, due to increasing unit prices and use of health care goods and services, impacting not just Rhode Island, but the nation.[While the sunset of Enhanced Premium Tax Credits will also have a national impact, in Rhode Island, new fees approved by the General Assembly will also drive up consumer costs.
Rhode Island’s Office of Health Insurance Commissioner (OHIC) has approved dramatic increases in health insurance premiums in Rhode Island.
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According to OHIC’s announcement, the “weighted average rate changes are 21.0% for the individual market, 17.6% for the small group market, and 19.3% for the large group market.”
“Premiums in Rhode Island and in many states across the country will rise more significantly next year than they have in recent memory,” said Health Insurance Commissioner Cory King. “To guard against double-digit rate increases becoming the new normal, large health care provider organizations and health insurers need to bear more accountability for managing costs and providing access to affordable health care.”
To reduce the financial burden on Rhode Islanders, OHIC rejected all insurer-proposed increases in administrative costs, per member per month. In the last two years, OHIC has limited administrative cost increases to the rate of inflation, which is lower than the state’s regulatory cap on hospital price increases and the cost growth target.
According to OHIC, in addition to increased usage and pricing considerations, individual market premiums are increasing due to the expiration of federal Enhanced Premium Tax Credits (EPTCs). Originally authorized by the American Rescue Plan Act of 2021 and extended by the Inflation Reduction Act of 2022, Enhanced Premium Tax Credits lower qualifying Rhode Islanders premiums when they purchase their coverage through HealthSource RI. Under current law the EPTCs are due to sunset after 2025 unless they are extended by Congress. Those currently using premium tax credits to enroll in coverage through HealthSource RI are expected to see an 85% increase (or nearly $1,250 per household annually) on average in the monthly cost of their plan after tax credits, even before 2026 rate increases are taken into account. Rhode Islanders with lower incomes or who are older will see the most significant percentage and dollar increases, respectively. If the EPTCs were not set to expire, then the approved rate increases for individual market would have been 16.4% (instead of 22.0%) for BCBSRI and 17.2% (instead of 20.5%) for NHPRI.
“Insurers project that fewer individuals will choose to purchase insurance after these tax credits expire. With healthier individuals leaving the insurance risk pool, those remaining in the risk pool will face higher premiums because there will be fewer healthy members to subsidize members with more health care needs,” states OHIC.
Also new this year, the General Assembly enacted a new health insurance fee as part of the FY 2026 state budget. The fee—approximately $50 per person per year–will fund recently enacted Medicaid rate increases for primary care and “other critical health care programs.” Based on current data, the General Assembly estimated the fee to total $4 per member per month, or approximately $50 per person per year or $200 per year for a family of four. Because the fee, which increases premiums by approximately 0.5% to 0.6%, was enacted after the rate filings were submitted in May, OHIC had to add the new fee to the requested rates.
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