The Blue Cross and Blue Shield of Texas health plan rates may change in the coming year. These changes are based on a number of factors, like your zip code and family size. Please note that the rate change average may not apply to you and your family.
2025 Rate Changes
Download a PDF explaining the 2025 rate change justification:
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Scope, Range, and Best Estimate of the Rate Increase
BCBSTX filed rates to be effective January 1, 2025, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate changes for these plans is a decrease of 3.4% to an increase of 15.1%. The following are the average rate increases by product:
- Blue Advantage: 6.7%
- Blue Advantage Plus: 5.9%
- MyBlue Health: 6.7%
Changes in allowable rating factors, such as age, geographical area, or tobacco use, may also impact the premium amount for the coverage. There are currently 1,316,049 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.1
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Financial Experience of the Product
Consistent with the filed URRT, earned premiums for Individual plans during calendar year 2023 were $4,814,938,937 and total claims incurred were $4,590,926,548.
The proposed rates effective January 1, 2025, are expected to achieve the loss ratio assumed in the rate development.
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Changes in Medical Service Costs
The proposed rates reflect expected change in year over year medical service and prescription drug costs, which includes changes in reimbursement rates to providers, changes in expected utilization of services, the mix and intensity of services, and the introduction of new procedures and technologies.
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Changes in Benefits
There are no legally required changes to covered benefits and no significant changes to the benefit structure. Cost-sharing changes were made within these products allowing plans to maintain their metal status, which can contribute to the change in rates.
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State Mandated Changes
The proposed rates reflect the impact of the passage of Texas Senate Bill 1296 as well as the Texas Department of Insurance (TDI)’s requirement for issuers to use a 35% CSR adjustment factor for Silver plans sold on the Exchange.
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Administrative Costs and Anticipated Margins
The Affordable Care Act expects health plans in the individual market to spend at least 80% of each premium dollar they collect to pay for medical care and activities that improve health care quality for members. If health plans fail to spend at least 80% on medical claims and health care quality initiatives, they are required to give back money to consumers through a premium rebate. These rates assume BCBSTX will once again exceed the 80% threshold.
1 Member count reflects the accurate count at the time the rate increase notice was created.