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Yes—usually. In the United States, an insurer may propose higher premiums when it expects medical prices, use of care, prescription-drug spending, claims severity, or the risk pool’s health to increase. Large proposed increases in ACA individual and small-group plans generally undergo state or federal rate review, but review is not always an approval process and the rules differ by market and state.
What “medical costs increased” means in a premium filing
Insurers usually describe the change as medical trend. It is a forecast of how much the cost of covered care and the amount of care members use will change during the rating period. A filing may include several separate trends rather than one blanket adjustment.
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Provider prices
Hospitals, physicians, laboratories and other providers may negotiate higher payment rates. An insurer can project those contract changes into the premiums needed for the next plan year.
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Members may have more visits, procedures, admissions, imaging studies or behavioral-health services. Even if the price of each service is unchanged, higher use raises total claims. A shift toward more complex or intensive treatment can also increase spending.
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Prescription drugs
Drug spending can rise because list or negotiated prices increase, because members use more medicines, or because treatment shifts toward higher-cost products. Filings can also account for specialty-drug claims and changes in the mix of prescriptions.
Claims severity and the risk pool
A small number of very expensive claims can materially change average costs. The insurer may also forecast a different health mix among people enrolled in the plan. These assumptions must be supported in the filing; saying only that “health-care costs went up” is not the same as documenting the expected change.
When a proposed increase is subject to rate review
The Affordable Care Act (ACA) rate-review framework focuses on significant increases in the individual and small-group markets. Healthcare.gov explains that insurers planning significant increases must submit rates to either the state or federal government for review, and consumers may be able to comment. The exact percentage that triggers review and the regulator’s authority depend on the state and the product.
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Typical review sequence
- Actuarial projection: The insurer estimates claims, administrative costs, taxes, risk-adjustment effects and other expenses for the coming period.
- Rate filing: The issuer submits the proposed premium, supporting data and an explanation of the assumptions, including medical trend.
- Regulatory analysis: State or federal reviewers test the data, methodology and evidence. They may ask questions or require revised assumptions.
- Public disclosure: For covered ACA filings, the proposed increase and justification are generally posted through the applicable rate-review system.
- Comment or challenge: Consumers and other interested parties may submit comments where the process allows.
- Final implementation: The rate takes effect only after the applicable filing and notice requirements are satisfied. In some states the regulator can approve or reject it; in others the department reviews and publishes the filing without having power to deny the rate.
What regulators look at besides medical trend
Medical costs are important, but they are not the only line in a rate review. Pennsylvania’s consumer rate-decision materials describe review of medical claims, administrative expenses and projected profit or loss. A reviewer can therefore question whether a premium increase is being driven by supported claims growth or by an unsupported expense or margin assumption.
Claims experience and credibility
Reviewers compare recent claims with the data used in the projection and consider whether the experience is credible for the size of the pool. They may examine unusual one-time claims, enrollment changes and whether the insurer’s prior forecasts were consistently high or low.
Administrative expenses and taxes
Premiums also fund customer service, billing, technology, broker compensation, assessments and taxes. Those costs can be reviewed separately from medical trend. A higher administrative assumption does not become a medical-cost justification merely because it appears in the same filing.
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Regulators can evaluate the margin the insurer expects to earn or the losses it forecasts. The review asks whether the overall rate is reasonable in light of the insurer’s financial position and evidence, not simply whether health-care prices rose somewhere in the market.
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Medical-loss-ratio compliance
Medical-loss-ratio (MLR) rules limit how premium dollars may be allocated between clinical care and quality improvement versus administration, marketing and profit. Pennsylvania’s 2024 rate-decision summary cites the federal 80% MLR requirement for applicable individual-market plans. An MLR rule does not create a fixed premium cap, but it is a guardrail reviewers can use when assessing the filing and whether rebates may be owed.
Why a review does not always mean the state can stop the increase
“Reviewed” and “approved” are not interchangeable. Some insurance departments have authority to approve, modify or deny rates. Others conduct a public examination, publish their findings and enforce filing or MLR requirements without having statutory power to reject a rate solely because it is high.
The California Department of Managed Health Care, for example, states that it does not have authority to approve or deny rate increases. Its review is intended to promote accountability and check compliance, but the department’s publication of an increase is not an approval in the sense of setting the insurer’s price. Your state’s insurance department or, for some health maintenance organizations, another state regulator will identify the authority that applies to your plan.
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How the increase reaches your bill
The percentage in a public filing is not necessarily the percentage on your invoice. Premium impact depends on the market, state, rating area, plan design, risk pool and financial assistance.
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| Factor | How it changes what you pay |
|---|---|
| Individual versus employer or small-group coverage | Each market has different rating, filing and contribution rules. An employer may absorb part of an increase or change its contribution. |
| State and rating area | Approved or filed rates can differ by state, county, provider market and permitted rating factors. |
| Plan design | A plan with a different deductible, copay structure, out-of-pocket maximum or network may have a different premium even within the same insurer. |
| Risk pool | Community-rated individual and small-group plans generally reflect the claims experience and rules for the pool, not one member’s personal claims history. |
| Subsidy eligibility | Marketplace tax credits can offset some or all of a gross premium increase for eligible households. Changes in income, household size or benchmark premiums can alter the credit. |
| Employer contribution | For job-based coverage, the employee’s payroll deduction depends on the employer’s contribution policy as well as the insurer’s rate. |
An insurer generally cannot raise an ACA community-rated premium simply because you personally filed many claims. It can, however, change the filed rate for the rating factors and pool permitted by law. Ask whether the proposed change applies to the entire risk pool or reflects a permitted individual rating factor.
What the historical numbers show—and what they do not
Premium increases have accumulated over time, but historical averages are not a legal ceiling or a forecast for your renewal. The Congressional Budget Office reported that, from 2014 through 2024, enrollment-weighted average premiums for small-business health plans rose 43% overall: 46% for ACA community-rated plans and 35% for experience-rated plans. Those figures describe national historical averages for the stated period, not every employer or state.
A Peterson Center on Healthcare and KFF analysis of ACA filings found a 6% median proposed increase for 2024 in its reviewed sample. “Median” means half the reviewed proposals were lower and half higher; it does not predict your plan’s final rate. The analysis identified medical trend—the growth in the cost and utilization of health-care services and medication—as a prominent driver of proposed ACA premium changes.
What to do when your renewal notice cites medical costs
- Read the notice carefully. Identify the effective date, the current and proposed premium, the plan name, the market (individual, small group or employer), and any change to deductibles, copayments or the out-of-pocket maximum.
- Find the filing explanation. Use your state insurance department’s rate-review page or the federal rate-review information for your state. Check the proposed percentage, the medical-trend assumptions and the regulator’s status or decision.
- Separate gross premium from your net cost. If you buy Marketplace coverage, update your household income and compare the tax credit and benchmark plan during the applicable enrollment period. A larger gross rate can have a smaller net effect if the credit changes.
- Compare replacement plans on total exposure. Check the annual premium, deductible, copays, coinsurance, out-of-pocket maximum, provider network, hospital access and prescription formulary. The cheapest premium can be costly if your doctors or medicines are out of network.
- Ask focused questions. Request the main price and utilization assumptions, whether prior-year trend was over- or underestimated, and whether the change applies to the whole pool or a permitted rating factor. Ask for the filing or public explanation in writing.
- Comment or complain when available. Follow the state or federal instructions and meet the deadline. Include the plan, effective date, proposed change and the specific assumption or disclosure you believe is unsupported.
- Get regulated enrollment help. A licensed, state-authorized assister or broker can explain available plans. Verify the person’s license, authorization and compensation before sharing financial or medical information.
Can a state insurance department stop your increase?
Sometimes, but not universally. The answer turns on the state statute, the type of insurer and the market. In a prior-approval state, the department may negotiate a lower rate or refuse a filing that fails legal standards. In a file-and-use or review-without-denial system, the department may publish criticism or require corrections while lacking authority to set the final price.
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Even where a regulator cannot veto the rate, a filing can still be changed if assumptions are unsupported, disclosures are incomplete or the issuer fails applicable MLR and filing requirements. Contact the department listed on your policy or renewal notice and ask what authority applies to your exact product.
Markets that follow different rules
The general explanation above is centered on U.S. ACA individual and small-group coverage. Employer plans governed by ERISA, Medicare, Medicaid managed care, large-group policies and state-based products can follow different rating, filing, appeal and subsidy rules. Medicare premiums may be set through federal programs rather than a state commercial rate filing; Medicaid managed-care payments follow contracts and public-program rules. Do not assume an ACA review threshold or consumer-comment process applies to those products.
There is no single nationwide percentage cap covering every health-insurance market. A lawful increase in one state or product may be handled differently in another, and the same insurer can face different procedures for its individual, small-group and large-group books of business.
Questions to use when evaluating the explanation
- What portion of the proposed rate is attributed to provider prices, utilization, prescription drugs, claims severity and risk-pool changes?
- Which assumptions changed from last year, and how accurate were the previous projections?
- Does the filing include administrative expenses, taxes or projected profit changes in addition to medical trend?
- What is the filing number, review status and public-comment deadline?
- Does the regulator have authority to approve or deny this specific rate?
- What will the premium, deductible and out-of-pocket maximum be after subsidies or employer contributions?
The practical answer is therefore conditional: medical-cost growth is a recognized and potentially lawful reason to seek a higher premium, but it is not a blank check. Evidence, market rules, state authority, MLR requirements and your financial assistance determine whether the proposed rate is implemented and what you ultimately pay.
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