Skip Navigation
Centers for Medicare & Medicaid Services

CCIIO Home > Resources > Data Resources

Programs and Initiatives

Resources

Rate Review Data

Background

As of September 1, 2011, the Affordable Care Act and rate review regulation require review of rate increases of 10 percent or more.  A non-grandfathered health plan sold in the individual or small group market that increases its rates by 10 percent or more is subject to review to determine whether the increase is unreasonable. Most states and territories have an effective rate review program  and will review rate increases submitted by health insurance issuers in their states and territories.  CMS will review rate increases in the market(s) where states do not have an effective rate review program.

For each rate increase subject to review, a health insurance issuer must submit a Preliminary Justification for each product affected by the increase.  This Preliminary Justification consists of the following parts:

Part I, Rate Increase Summary: A form that summarizes the data used to determine the rate increase. This information is used to populate the user-friendly plan profile on HealthCare.gov.

Part II, Written Explanation of the Rate Increase: A simple and brief narrative describing the data provided in Part I and the assumptions used to develop the rate increase, including an explanation of the most significant factors causing the rate increase. This information is posted on HealthCare.gov.

Part III, Rate Filing Documentation: Rate filing documentation that CMS uses to determine whether the rate increase is unreasonable. This section of the Preliminary Justification is only required to be filed when CMS is conducting the rate review.  It is posted on the CCIIO website.

This page contains links to the rate review data posted on the CCIIO website.  Please email ratereview@hhs.gov with questions regarding the rate review information that is posted on this website or to submit comments on proposed increases.

Data