Higher rates are driven by increasing cost of medical services, growing costs of prescription drugs, and instability of policies at the Federal Level
Read BOI Superintendent Bob Carey’s op-ed in the Press Herald on higher rates HERE.
The Maine Bureau of Insurance today announced the finalized 2026 health insurance rates for Maine’s individual and small group market to take effect on January 1, 2026. Following a careful review of proposals from Maine’s insurers and after a public hearing, the Bureau has approved an average rate increase of 23.9 percent for the individual market and 17.5 percent for the small employer market (those with 50 or fewer employees).
These average final rates are slightly lower than those initially requested by health insurers – which were 26 percent for individuals and 19 percent for small employers – and are consistent with increasing rates across the nation. A recent analysis by the Kaiser Family Foundation found that, nationally, rates are increasing by an average of 20 percent
The Bureau is limited in what it can do to control proposed rate increases. Under State law, the Bureau examines each insurer’s experience and projected costs and is charged with determining whether rates are excessive, inadequate, or unfairly discriminatory. In this context, “excessive” is measured by the amount of premium needed to cover the expected cost. Federal law requires insurers to spend at least 80 cents of every premium dollar on health care services to ensure that health insurer profits do not drive premium increases.
“These higher rates are being driven by the increasing cost of medical services, the growing cost of prescription drugs, and the instability of Federal policies – especially the potential expiration of enhanced premium tax credits at the end of this year,” said Bob Carey, Superintendent of the Maine Bureau of Insurance. “While the premium tax credits will continue in 2026, they will be greatly reduced unless Congress and the President act soon.”
Superintendent Carey published an op-ed in the Portland Press Herald today explaining in greater detail the driving factors behind the increases. His op-ed can be read HERE.
The individual market covers roughly 71,000 Maine residents who purchase health plans on their own, primarily through CoverME.Gov, the state’s online marketplace. At year-end 2024, the small group market covered over 45,000 people who obtain health insurance through a small employer. The vast majority of Maine people obtain health insurance coverage through their employer through the large group market. Rates in the large group market are not subject to review and approval by the BOI.
Health insurance premiums vary by health insurer and by health plan. The Bureau urges consumers to shop for a policy that best meets their needs.
To learn more about individual and small group health insurance options in Maine, please visit https://www.maine.gov/pfr/insurance/consumers/life-health-disability, and to enroll in coverage visit https://www.CoverME.gov.
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