Where does your plan cost sit against the market?

Filed small group rate submissions for plan year 2026.

• From the Unified Rate Review file every issuer submits to CMS.
• All 50 states plus DC. Posted March 2026, after final approval.
• Weighted by projected member months, so a plan covering 40,000 members counts more than one covering 40.
• It reflects the market as filed. It isn't a survey.

Employer share plus employee share, medical and pharmacy only.

• Leave out dental, vision, life, disability and EAP.
• Fully insured: your gross premium.
• Level funded: the maximum funding rate, not expected cost after surplus. The max is contractual and it's the only figure that compares like for like against a premium.
• Self-funded: admin plus stop-loss plus expected claims.

The moment dental and vision enter the number, no two employers are computing the same thing.

Because per employee can be moved without changing anything real.

• Shift an 80/20 contribution split to 70/30 and your employer cost per employee drops 10%.
• Nothing about what the plan costs has changed. That isn't a saving.
• Cost per member is the basis filed rates use, so it's the only figure that compares against the market.
• Your per-employee number sits next to it because that's the line your CFO manages.

Not necessarily, and anyone who says otherwise is guessing about your group.

Three things push a correctly priced group high:

• An older average age.
• A high share of employees taking family coverage.
• An active high-cost claimant.

None of those is a pricing error, and none gets fixed by shopping the same plan design to another carrier.

What a high percentile does tell you is that the question is worth asking. If the answer is none of those three, something else is driving it.

Yes, as a reference point.

• Small group filings reflect the fully insured market for groups generally under 50 to 100 employees, depending on your state's definition.
• Self-funded or level funded? It tells you what the insured market would charge for a comparable population in your state. That's the number you're implicitly beating, or not.
• Large self-funded employer? Treat it as directional. Your own claims experience is the better benchmark, and you already own it.

State medians vary far more than most people expect.

• National median: roughly $733 per member per month for 2026.
• Individual states run from under $500 to over $1,200.
• Some of that is real cost of care. Some reflects which issuers filed and how much volume sits behind each filing.
• A state with few filings can look unusual for that reason alone.

That's why you get a national percentile alongside your state one. If the two disagree sharply, the state distribution is thin and the national figure is the steadier read.