PROVIDENCE, R.I. (WPRI) — Commercial insurance premiums for nearly 175,000 people in Rhode Island are set to increase next year.
The state’s Office of the Health Insurance Commissioner (OHIC) approved rate hikes Monday of about 17.6% for the small group market, 19.3% for the large group market, and 21% for the individual market.
The rate changes do not affect the roughly 65% of Rhode Islanders with employer-sponsored coverage, since self-funded employers pay health care costs directly and are not subject to OHIC’s approval process. Many other residents are covered by government programs such as Medicare and Medicaid.
Health Insurance Commissioner Cory King warned that premiums in Rhode Island and nationwide will “rise more significantly” in 2026 than in recent memory.
“To guard against double-digit rate increases becoming the new normal, large health care provider organizations and health insurers need to bear more accountability for managing costs and providing access to affordable health care,” King said.
Driving factors
Commercial insurers first submitted rate change proposals in May. Since then, OHIC said it has reviewed assumptions about medical and pharmacy costs, administrative charges, and reserve margins before landing on the final rates.
While primarily tied to health care use and costs, there are several other contributing factors that lead to the double-digit increases.
A new annual state insurance fee of $50 per person — or $200 per family of four — takes effect in January. Because the Rhode Island General Assembly included the fee in the FY2026 budget after the initial filings, OHIC said it was required to be added on top of the requested rates.
Additionally, federal Enhanced Premium Tax Credits (EPTCs) under the Affordable Care Act are set to expire at the end of the year unless Congress extends them. Without the credits, HealthSource RI customers could see premiums jump by 85% — or about $1,250 more per household annually — before next year’s rate hikes even take effect.
Low-income and older Rhode Islanders are expected to be hit hardest, according to OHIC.
Still, the agency claims Rhode Island customers will save more than $59.3 million compared to the insurers’ original proposals. OHIC also rejected all administrative cost increases, instead limiting them to the rate of inflation to “reduce the financial burden” on residents.
The OHIC reportedly denied requests for extra charges tied to the impact of potential drug tariffs, citing “lack of concrete evidence.” In some cases, the agency also trimmed insurers’ reserve requests and adjusted assumptions about pharmacy and medical use, which helped lower rates from what was originally proposed.
Push for federal action
R.I. Gov. Dan McKee and Massachusetts Gov. Maura Healey have joined 15 other governors in pleading with Congress to extend the Affordable Care Act’s EPTCs.
“The timing couldn’t be more urgent,” the governors wrote. “If Congress acts quickly, states can lock in lower premiums and spare families a wave of sticker shock this fall. If not, the damage will be felt for years.”
The group clarified the issue is not partisan, but about providing stability and keeping health care affordable for those who need it most.
“It’s about protecting working people who are doing everything right but still struggling to get by. Extending these tax credits is one of the simplest, most effective steps Congress can take,” the letter read.
If the credits do expire, McKee said about 40,000 Rhode Islanders who rely on marketplace coverage would face major cost hikes. He called for “immediate federal action” to prevent further strain on families already facing higher expenses.
HealthSource RI Director Lindsay Lang reiterated that same concern, acknowledging thousands could lose their coverage altogether.
“We worry about our neighbors facing insurmountable medical costs or suffering serious health impacts from avoiding or delaying care as a result,” Lang said. “When fewer Rhode Islanders have health insurance, the rate of uncompensated care will go up, exacerbating the strain our hospitals and providers already feel.”
Meanwhile, McKee said he has directed the OHIC to begin an “aggressive review” and draft a legislative proposal aimed at containing health insurance costs. He described rising premiums as a “real strain for families across Rhode Island” and said it’s crucial to create “additional tools to strengthen the office’s regulatory authority.”
In a letter to King on Monday, McKee highlighted several priorities such as capping certain cost drivers like administrative charges, expanding OHIC’s authority to control premiums, and temporarily pausing new unfunded health insurance mandates while their impact is assessed.
Read the OHIC’s full release on the approved rate increases below.
RI OHIC Rate Review Process Press Release – Approved Rates September 2025Download
NEXT: Over 50K Rhode Islanders to lose health insurance by 2034, per new estimates
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