What do Alabama's 2027 health insurance rate filings mean for your renewal?

What a rate filing is

A rate filing is a health insurance carrier’s proposal for next year’s premiums, submitted with a written justification. Carriers file every year for ACA-compliant coverage, and the federal rate review rules apply to the individual and small-group markets only (45 CFR 154.103).

Each filing reports a requested rate change. That figure is one average for the carrier, weighted by how the carrier projects its enrollment will spread across its products (Peterson-KFF Health System Tracker). Public summaries and redacted actuarial memoranda for each filing are posted at ratereview.healthcare.gov.

Who reviews rate filings in Alabama

• The Alabama Department of Insurance (ALDOI). For 2027 coverage, carriers in states with an effective rate review program had to submit proposed filings to both CMS and the state by a date the state set, no later than July 15, 2026 (CMS timeline bulletin). On September 3, 2026, ALDOI announced that it had approved the 2027 individual-market rates (ALDOI).
• CMS, the federal agency that runs HealthCare.gov and the rate review site. A rate increase of 15% or more is subject to review (45 CFR 154.200). CMS conducts reviews itself only in states without an effective rate review program. As of its April 23, 2024 update, that list named Oklahoma, Tennessee, and Wyoming (CMS).

Which market does your renewal belong to?

Federal law defines a small employer as generally having 1 to 50 employees and lets each state expand that to 100. CMS’s table of state rating variations shows no expansion for Alabama, so the federal default applies (CMS). KFF describes the small-group market as covering businesses with 50 or fewer full-time equivalent employees (Peterson-KFF).

	Small group	Individual	Large group
Who buys it	Employers with generally 1 to 50 employees	People buying their own policies	Employers with more than 50 employees
In the 2027 rate filings?	Yes	Yes	No
What can change the price	Individual or family coverage, rating area (your principal business address), age (up to 3:1 for adults), tobacco use (up to 1.5:1)	The same factors, using the policyholder’s address	Priced outside the small-group rating limits, so the group’s claims history can count
2027 status in Alabama	Proposed figures posted	Approved by ALDOI	Set group by group at renewal

Sources for the table: 45 CFR 147.102 sets the small-group and individual rating factors, and the rate review and single risk pool rules cover the individual and small-group markets only (45 CFR 154.103, 45 CFR 156.80). The NAIC describes a group’s claims experience at renewal as one of the most direct ways an insurer can tie premiums to expected costs (NAIC).

The small-group rating limits in this table apply to ACA-compliant coverage. A grandfathered plan can be exempt from them (45 CFR 147.140(c)), and so can a transitional policy still in force under CMS’s extended non-enforcement policy, where a state allows it (CMS bulletin, March 23, 2022). If your company has kept the same policy for many years, ask your carrier which status it has.

Federal law lets a state merge its individual and small-group markets into a single risk pool (45 CFR 156.80(c)). Alabama keeps them separate: carriers file small-group rates as their own market, and Blue Cross and Blue Shield of Alabama’s small-group memorandum describes a single risk pool made up of its small-group plans (Section 3 of the BCBSAL small-group memorandum). An individual-market increase applies to individual policies only.

Alabama’s 2027 small-group filings, carrier by carrier

The table shows each filing as displayed on the federal Rate Review site on September 15, 2026. To find them, go to ratereview.healthcare.gov, choose Search ACA-Compliant Products, and select Alabama, Small group, and 2027. The same records appear in the site’s public data feed for Alabama small-group 2027 submissions.

Carrier	Proposed average change	Range across its products	Submission ID	Filing document
Blue Cross and Blue Shield of Alabama	7.22%	4.20% to 8.00%	469447111	Actuarial memorandum
VIVA Health	10.70%	10.70%	930187111	Actuarial memorandum
UnitedHealthcare of Alabama, Inc.	17.29%	15.99% to 17.57%	682597111	Actuarial memorandum
UnitedHealthcare Insurance Company	17.79%	15.22% to 17.92%	694617111	Actuarial memorandum

All four filings list an effective date of January 1, 2027, a status of “Submission Filed,” and a final rate change of “N/A.” These are proposed figures. CMS refreshes its posted rate data when it publishes final rates, which it intends to do no later than October 30, 2026 (CMS timeline bulletin, pages 2 to 4), so the status shown can lag a state decision, and final numbers can differ from these proposals.

Both UnitedHealthcare filings request increases above 15%, the federal level at which an increase is subject to review.

One carrier dominates this market. KFF’s analysis of federal medical loss ratio data found that the largest insurer held 98% of Alabama’s small-group market in 2024, and no other insurer held more than 5% (KFF). Blue Cross and Blue Shield of Alabama describes itself as the largest provider of healthcare benefits in Alabama (BCBSAL). In the NAIC’s 2024 market share report, the BCBS of Alabama insurance group ranked first among accident and health insurers in the state, with 39.53% of all accident and health premium written in Alabama, a broader measure than small group alone (NAIC, Alabama table, PDF page 16).

Each carrier’s average applies only to its own policyholders. A simple average of these four filings gives every carrier equal weight, so it says little about what a typical Alabama small employer will see.

Alabama’s approved 2027 individual-market rates

For comparison, ALDOI approved these average increases for individual policies, effective January 1, 2027 (ALDOI):

• Blue Cross and Blue Shield of Alabama: 19.9%
• UnitedHealthcare Insurance Company: 27.5%
• Celtic Insurance Company: 11.4%
• Oscar Insurance Company: 33.8%

Why premiums are rising

Nationally, 295 small-group insurers proposed a median 2027 increase of 14%. The 25th percentile was 10% and the 75th percentile was 18% (Peterson-KFF). That median is unweighted by enrollment.

KFF read 82 insurer filings from 14 states and Washington, D.C. in detail. Alabama was outside that group, so these are national patterns:

• Medical prices and use of care. The median insurer estimate of underlying medical cost growth was 10.8%, driven by prices for hospital stays, physician care, and prescription drugs, plus more use of services.
• High-cost specialty drugs. Insurers point to new expensive drugs, many without lower-cost alternatives.
• GLP-1 medications. Some insurers dropped coverage for weight loss and still see rising costs as use among diabetes patients grows.
• Behavioral health. More use of mental health and substance use services.
• A shrinking, less healthy risk pool. Some insurers link falling small-group enrollment to healthier groups leaving for level-funded plans.

Closer to home, Blue Cross and Blue Shield of Alabama’s 2027 small-group memorandum names projected medical inflation and utilization, along with changed retention loads, as the main considerations for its proposed rate changes (BCBSAL small-group memorandum, PDF page 5).

What a filed average does and does not tell you

• It is a carrier-wide average. Blue Cross and Blue Shield of Alabama’s small-group products range from 4.20% to 8.00% around its 7.22% average.
• Your renewal quarter can matter. Blue Cross and Blue Shield of Alabama’s memorandum shows its proposed average rate change by renewal quarter and applies quarterly trend factors for groups renewing in each quarter of 2027 (PDF pages 5 and 28). VIVA Health’s memorandum measures its 10.7% change as of January 1, 2027 and schedules quarterly trend increases for the second through fourth quarters (PDF pages 4 and 13).
• Your premium is built person by person. In the small-group market, the total is generally the sum of each enrolled person’s rate, set by age, tobacco use, rating area, and individual or family coverage (45 CFR 147.102).
• Aging counts at issue or renewal. Each person’s age is taken as of the date the policy is issued or renewed (45 CFR 147.102(a)(1)(iii)), so a workforce that has aged since last year shows up in the renewal. Adding or dropping employees and dependents can change the billed total during the year.
• Averages can leave out aging. Oscar’s 2027 Alabama individual filing, for example, states that its proposed average rate change “is absent of rate changes due to attained age” (Oscar memorandum via ALDOI, page 2).
• Plan designs shift too. Blue Cross and Blue Shield of Alabama’s 2027 individual memorandum says its cost-sharing changes keep plans within required actuarial value ranges and keep up with the cost and use of care (BCBSAL individual memorandum via ALDOI). Compare deductibles and copays line by line.
• A small group’s claims are outside the rating factors. Large-group and level-funded pricing can reflect claims. Level-funded plans are generally exempt from ACA small-group rating rules and are not guaranteed renewable, so a bad claims year can raise the renewal or end it (Peterson-KFF).

When 2027 renewals arrive

Date	What happens
July 15, 2026	Latest date for carriers to submit proposed 2027 filings in states with an effective rate review program
July 31, 2026	CMS’s planned posting date for proposed filings
September 3, 2026	ALDOI announces approved 2027 individual-market rates
October 15, 2026	Deadline for final decisions on filings with only off-Marketplace plans
October 30, 2026	Latest date for CMS to post final 2027 rates
January 1, 2027	Effective date on Alabama’s posted small-group filings; 2027 rates begin applying to plan years that start on or after this date
April 1, July 1, October 1, 2027	Dates when small-group carriers may put quarterly rate changes into effect

Sources: CMS timeline bulletin, ALDOI, Rate Review data feed, 45 CFR 156.80.

Federal rules let a small-group carrier outside a merged market change rates no more often than quarterly. A new rate applies to coverage issued or renewed on or after its effective date and holds for the group’s entire plan year (45 CFR 156.80).

What to do before your renewal

1. Confirm your market. Check whether your company falls in the 1 to 50 employee small-group range or the large-group market.
2. Look up your carrier’s filing. On ratereview.healthcare.gov, select Alabama, small group, and 2027, then note the proposed average, the range, and the date you checked.
3. Check back for final numbers. CMS plans to post final 2027 rates by October 30, 2026, and they can differ from the proposals.
4. Know your renewal quarter. Ask whether your carrier’s rate for your renewal month includes a quarterly trend adjustment.
5. Clean up your census. Update dates of birth, tobacco status, and coverage tiers, because those drive small-group premiums.
6. Split the increase. Ask how much of your renewal is the carrier’s rate change and how much comes from your group’s ages and enrollment.
7. Compare plan designs line by line. Deductibles, copays, out-of-pocket maximums, and networks.
8. Price the alternatives. Other small-group carriers, and level-funded options if your group qualifies, weighing the renewal risk.
9. If you have more than 50 employees, request your claims reports early. Large-group pricing can reflect them.
10. Start 90 to 120 days before your plan year begins. That window gives every option a real look.

How My Advisor helps

We open renewal season early, on your calendar, and benchmark where your plan stands against your market. Every carrier and arrangement worth evaluating gets a look: contracts read line by line, claims analyzed, and actuarial counsel where the numbers need it. We broker across carriers and across fully insured, level-funded, and self-funded arrangements, so the recommendation follows your census and your claims history. Whichever way the numbers point, we show you the math we ran to get there.