NJ DEPARTMENT OF BANKING AND INSURANCE RELEASES INITIAL HEALTH INSURANCE RATES FOR THE INDIVIDUAL MARKET FOR PLAN YEAR 2026 – Insurance News

The following information was released by the New Jersey Department of Banking and Insurance:

The New Jersey Department of Banking and Insurance today announced that plan year 2026 health insurance initial rates have been submitted by insurance carriers operating in the individual market, which includes Get Covered New Jersey, the State’s Official Health Insurance Marketplace.

Based on plan rates submitted by carriers, rates will increase on average by 15.9% over 2025 in the individual market, which includes on-exchange and off-exchange plans (sold directly by insurance companies). Carriers identified the underlying reasons for the rate increases as increased costs and utilization, including increases in both medical and pharmacy costs. Rates are also expected to increase due to the anticipated expiration of federal enhanced premium tax credits. The expiration of the enhanced premium tax credits will also have a significant direct impact on the monthly costs for consumers who purchase plans on the marketplace. Currently, 88% of consumers enrolled in a plan through Get Covered New Jersey approximately 454,016 New Jerseyans receive the enhanced financial help that is slated to lapse for plan year 2026.

“Health insurance plans and prices change every year, so we encourage New Jerseyans to shop around to find the right coverage for them for 2026,” said New Jersey Department of Banking and Insurance Commissioner Justin Zimmerman. “Particularly given the anticipated loss of enhanced financial help made available by the federal government that resulted in lower costs for so many in past years, it will be important for consumers to look closely at their options and choose the plan that best fits their needs and budget. Get Covered New Jersey, the State’s Official Health Insurance Marketplace, will remain a source of quality, affordable coverage with financial help still available. We will also continue to have local help available from Navigators in the community to assist consumers in reviewing their options, as well as certified licensed brokers.”

If Congress continues to not act, health carriers reported to the Department an average rate increase of 15.9%. If federal action is taken this fall to continue enhanced premium tax credits in the 2026 plan year, carriers reported that the average rate increase for consumers would be 12.8%.

Nationwide, health insurers for Affordable Care Act-regulated plans reported a median 18% premium increase in a recent Kaiser Family Foundation (KFF) survey.

The rate increases are in addition to the premium increase consumers will experience due to the loss of federal financial help from expiring enhanced premium tax credits.

The enhanced premium tax credits, initially provided through the American Rescue Plan Act of 2021 and continued through the Inflation Reduction Act of 2022, have been instrumental in lowering the cost of quality health insurance plans through Get Covered New Jersey. Nine in 10 New Jerseyans currently enrolled through Get Covered New Jersey received financial assistance. Nearly half of those currently receiving financial help pay $10 a month or less for coverage, compared to just 13% before the expansion of tax credits.

The Department had previously warned of significant health insurance premium increases if the enhanced premium tax credits were allowed to expire without Congressional action. In May, Commissioner Zimmerman sent a letter and fact sheets to New Jersey’s Congressional delegation on the potential loss of enhanced premium tax credits and the resulting devastating impact it would have on individuals and families. New Jersey would lose more than half a billion dollars in direct federal support to consumers. The average person receiving tax credits would see their costs go up by 110% by the loss of the enhanced tax credits, more than doubling their current premium, with costs increasing by $1,260 per person, per year on average, or $4,168 for a family of four.

Get Covered New Jersey provides residents quality, affordable health coverage, enabling them to access a wide range of health care services to keep themselves and their families healthy. Get Covered New Jersey offers federal and state financial help to qualifying residents to help lower their monthly premiums and out-of-pocket expenses. The state marketplace launched in 2020 with a state subsidy called New Jersey Health Plan Savings to further lower monthly premiums for consumers, beyond the tax credits offered by the federal government. The Department is estimated to provide $215 million this year to support state subsidies, New Jersey Health Plan Savings, providing greater affordability in the market by lowering premiums for hundreds of thousands of New Jerseyans.

Through this effort, New Jerseyans have experienced greater affordability, which has resulted in enrollment increasing annually. For plan year 2025, a record 513,217 residents have enrolled in a health plan through Get Covered New Jersey a 108% increase in enrollment since the State first launched its marketplace.

Five insurance companies are offering health plans in 2026 through the marketplace: Ambetter from WellCare of New Jersey, AmeriHealth, Horizon Blue Cross Blue Shield of New Jersey, Oscar, and UnitedHealthcare.

Aetna recently announced its intent to withdraw from marketplaces nationwide, and recently notified New Jersey consumers that it will no longer offer plans on the marketplace in 2026.

The submitted rates for the Individual Market (on-exchange and off-exchange) if enhanced premium tax credits expire are below. By law, rate filings in the individual and small employer markets are informational and not subject to prior approval; the Department may only disapprove an informational filing if the Department finds that the filing is incomplete and not in compliance with relevant laws or that the rates are inadequate or unfairly discriminatory.