This is the first of a two-part series. I drafted the analysis from more than 30 years as a payer relations executive, and used Claude.ai to compile and document the underlying rate-filing and enrollment data. Sources are linked throughout and I encourage you to check the work yourself.
The Big Picture
Texas insurers filed individual market rate increases ahead of 2026 that landed far above recent norms. Carriers initially requested an average near 24 percent, but the Texas Department of Insurance later described the figure as roughly 33 percent, and the final approved weighted average came in near 34.7 percent before subsidies are applied. [1][2][3]
To put that in perspective, average individual market increases in Texas had not topped 4 percent in any year since 2018. [4] The small group fully insured market told a calmer story, with an unweighted average increase near 10.3 percent. [3]
The single largest driver, named in filing after filing, is the expiration of the enhanced federal premium tax credits at the end of 2025. Because those credits are ending, the net premium increase for most subsidized enrollees will be much steeper than the pre-subsidy averages suggest. [5]
Individual and small group ACA plans in Texas are filed as statewide single risk pools. The premium a family actually sees in San Antonio is the carrier's statewide filed increase, adjusted by the geographic factor for Texas Rating Area 7, which covers Bexar along with Atascosa, Bandera, Comal, Guadalupe, Kendall, Medina, and Wilson counties. [6] I live and work in Bexar County, so that's what I will focus on today.
The Department of Insurance has handled individual and family rate review since the 2023 plan year under 28 TAC Chapter 3, Subchapter F. Filings move through SERFF and are mirrored in the federal Rate Review database. Texas uses 26 rating areas and runs entirely through HealthCare.gov, with no state based exchange. [7][8]
The Carriers in Texas Rating Area 7
For 2026 the Texas individual marketplace has 16 participating insurers statewide. Aetna, a CVS Health Company exited at the end of 2025, and Harbor Health entered. [9]
The figures below are statewide single risk pool averages, as filed, effective January 1, 2026. The final approved statewide weighted average moved to 34.7 percent, though not every carrier's final approved figure was individually restated in the public record. [3][10]
Confirmed available in Rating Area 7 (San Antonio / Bexar):
Blue Cross and Blue Shield of Texas: 39.4 percent on Blue Advantage HMO and 38.4 percent on Blue Advantage Plus POS, with a filed range of 8.9 to 64.7 percent. BCBSTX sells in all 254 counties. [10][11]
Superior HealthPlan (Ambetter Health): 36.0 percent. [10][12]
UnitedHealthcare of Texas: 23.02 percent, range 13.5 to 31.1 percent, covering 580,871 individuals statewide. [10][13]
Community First Insurance Plans, sold by the Community First Health Plans, 17.58 percent, range 12.28 to 18.77 percent. [10][14]
Wellpoint Insurance Company: filed range of 16.2 to 32.0 percent, with San Antonio in its service area. [10][15]
Metro presence in San Antonio, plan and network worth verifying:
Cigna Healthcare of Texas: 42.3 percent, range 23.0 to 56.5 percent. [10]
Molina Healthcare of Texas: 29.3 percent, range negative 4.9 to 31.6 percent. [10]
Oscar Health Insurance Company: 26.1 percent. [10]
CHRISTUS Health Plan: average not cleanly stated in the public filing, San Antonio based. [10]
Statewide filers, Rating Area 7 availability not confirmed here:
Celtic Insurance Company (Ambetter / Centene): 41.5 percent. [10]
Baylor Scott & White Health Plan, HMO: 23.71 percent. [10]
Baylor Scott & White Health Insurance Company, EPO: 19.55 percent. [10]
Sendero Health Plans: 16.2 percent, range 8.7 to 19.4 percent. [10]
Moda Health Plan: 14.74 percent. [10]
Community Health Choice, Access to Care , and Imperial Health Plan of California, Inc.: actuarial memos heavily redacted. [10]
What this means for our market
Three takeaways were worth holding onto.
First, the spread is enormous. Within a single market, filed increases ran from the high teens to the low forties, and within a single carrier the range can swing from below zero to above 60 percent depending on plan, age, and rating area. A market average is a starting point for a conversation, never the end of one.
Second, the subsidy cliff did more to shape enrollment behavior in 2026 than any single carrier's filed percentage. Generally speaking, healthier members tend to leave first when net premiums jump, which raises average morbidity and feeds the following year's increases. Several carriers priced exactly that effect into these filings for 2026.
Third, the local nonprofit posture stood out. Community First Health Plans filed the lowest increase among the carriers confirmed for our rating area. That is worth noting in a market where affordability and access carry real community weight.
A Critical Note on Accuracy of Data
I want to be transparent about the limits of this AI-enabled analysis. The plan level Rating Area 7 roster, with applied geographic factors, lives in the Centers for Medicare & Medicaid Services (CMS) Qualified Health Plan Landscape and Rate data files for Texas. That is the authoritative source for a definitive Bexar carrier list, and I would pull it directly before putting any of these figures into a board deck or a negotiation. The percentages here are statewide, as filed, and drawn from SERFF, the Texas Department of Insurance, and the federal Rate Review database as compiled in the public record.
If you work in this market and you are reading these filings differently, I would value your feedback and an exchange of perspectives. My sources are linked below for convenience. Getting it right serves all of us.
[1] Texas insurers initially requested an average near 24 percent. Texas Tribune, August 21, 2025.https://www.texastribune.org/2025/08/21/texas-health-insurance-premiums-aca-tax-credit-expiration
[2] Texas Department of Insurance described the figure as roughly 33 percent. Newsweek, August 2025.https://www.newsweek.com/texas-health-insurance-cost-rise-2026-2113912
[3] Final approved statewide weighted average near 34.7 percent; small group unweighted average near 10.3 percent. ACA Signups, compiling SERFF, TDI, and the federal Rate Review database. https://acasignups.net/rate_changes/2026/tx
[4] Texas individual market increases had not exceeded 4 percent since 2018. Texas Tribune, August 21, 2025.https://www.texastribune.org/2025/08/21/texas-health-insurance-premiums-aca-tax-credit-expiration
[5] Expiration of enhanced premium tax credits as the leading driver. ACA Signups, carrier actuarial memos.https://acasignups.net/rate_changes/2026/tx
[6] Texas rating areas and statewide single risk pool structure. forhealthinsurance.com, Texas Health Insurance 2026.https://www.forhealthinsurance.com/texas-health-insurance/
[7] Texas Department of Insurance rate review authority, 28 TAC Section 3.506. Texas Administrative Code via Justia.https://regulations.justia.com/states/texas/title-28/part-1/chapter-3/subchapter-f/section-3-506
[8] TDI has handled individual and family rate review since the 2023 plan year. healthinsurance.org, Texas ACA Marketplace. https://www.healthinsurance.org/aca-marketplace/texas/
[9] 16 participating insurers for 2026, Aetna exit and Harbor Health entry. healthinsurance.org.https://www.healthinsurance.org/aca-marketplace/texas/
[10] Per carrier filed figures and ranges. ACA Signups, compiling SERFF, TDI, and the federal Rate Review database.https://acasignups.net/rate_changes/2026/tx
[11] BCBSTX coverage in all 254 counties. Texas Tribune, August 21, 2025.https://www.texastribune.org/2025/08/21/texas-health-insurance-premiums-aca-tax-credit-expiration
[12] Ambetter availability in San Antonio. healthcareinsider.com, Best Health Insurance in Texas 2026.https://healthcareinsider.com/best-health-insurance-in-texas-2026
[13] UnitedHealthcare filing covering 580,871 Texans; BCBSTX refiled higher than its initial request. San Antonio Current, August 24, 2025. https://www.sacurrent.com/news/health-insurance-carriers-request-raising-aca-premiums-by-more-than-20-on-average-in-texas-38331688
[14] Community First Health Plans, the only local nonprofit health plan in Bexar County, and University Community Care Plan. Community First Health Plans. https://communityfirsthealthplans.com/blog/your-guide-to-the-health-insurance-marketplace-what-it-is-and-how-to-apply/
[15] Wellpoint San Antonio service area. Wellpoint. https://www.wellpoint.com/tx/individual-family/aca-marketplace
[16] Authoritative plan level data for Texas rating areas. CMS Qualified Health Plan Landscape and Rate data files, available through the CMS Health Insurance Exchange Public Use Files. https://www.cms.gov/CCIIO/Resources/Data-Resources/marketplace-puf
About the Author
Kevin W. Barron, MBA, FHFMA, FACHE is a nationally recognized healthcare contracting and payer relations executive with over 30 years of experience in healthcare finance. He is an author, speaker, and mentor to emerging leaders in healthcare finance. Follow Kevin on LinkedIn or subscribe to his weekly newsletter at https://www.KevinWatsonBarron.com
Disclaimer: This article is provided for general informational and educational purposes only. It reflects my personal views and observations based on professional experience in healthcare finance, managed care, payer relations, and revenue cycle operations. It should not be interpreted as legal, financial, regulatory, actuarial, or reimbursement advice. The content is not intended to represent the official position of my employer, any payer, provider, professional association, or other organization with which I may be affiliated. Readers should consult their own legal, financial, compliance, actuarial, or operational advisors before making decisions based on the issues discussed. Any references to payers, providers, regulations, market trends, or reimbursement practices are intended for discussion and education only and should not be construed as a statement about any specific contract, negotiation, patient matter, or confidential business arrangement.