Question 1

What does the state funding analysis show?

Accepted Answer

Each state page models how an employer with 10, 30, 70, 150, 250 or 500 employees would fare under five funding paths over five years: PEO-integrated, level-funded, self-funded, self-funded captive and Taft-Hartley, each compared with staying fully insured. It shows the chance of beating fully insured and the five-year median savings at your size.

Question 2

Are these results quotes?

Accepted Answer

No. They are illustrative simulations, 2,000 or more runs per scenario, built on state-adjusted 2027 small-group rates. Actual rates and underwriting can change the result.

Question 3

What does the card for each state mean by a path that leads?

Accepted Answer

Each state card names the funding path with the highest modeled five-year median savings versus staying fully insured, at 10 employees and at 500 employees. In most states PEO leads at 10 employees, while the leader at 500 employees varies by state between self-funded, self-funded captive and Taft-Hartley.

Question 4

What is the difference between final filed rates and requested rates?

Accepted Answer

Each state card says whether the 2027 rates behind it are final filed rates or are requested and not yet final. A requested rate can still change, so the results for those states are more provisional.

Question 5

How does the simulator produce a range instead of one number?

Accepted Answer

It runs your group's next five years thousands of times and prices each funding path under its own rating and renewal rules, so results are a range of likely costs rather than one forecast. The 2027 methodology page explains the rules, the data sources and the limitations.

Question 6

Where should I start if I do not know which funding path fits?

Accepted Answer

Read the side-by-side comparison of the seven funding paths, then open your state page for the modeled results at your employer size, and use the funding simulator to enter your own group's numbers.

Question 7

Why is ICHRA not one of the paths on the state pages?

Accepted Answer

The state pages compare five paths that the simulator models year by year under their own rating and renewal rules: PEO-integrated, level-funded, self-funded, self-funded captive and Taft-Hartley, each against staying fully insured. ICHRA works differently. In the funding simulator it appears as an employer cost benchmark against the individual market, added with a button, where you choose an employer contribution between 50% and 100%. Because it is a fixed comparison rather than a simulated path, it does not produce the same probability and median savings figures. If ICHRA is on your list, use the ICHRA calculator and check individual-market premiums in each rating area where your employees live, as the ICHRA page explains.

Question 8

Why can a healthy small group save by leaving community-rated coverage when a sicker group may not?

Accepted Answer

Fully insured small-group premiums are community rated. Federal rules let insurers vary small-group premiums only by age, within a 3 to 1 ratio for adults, tobacco use, family size and geography, so your group's claims do not set your price; New York and Vermont also bar age differences. Most states define small groups as 1 to 50 employees, while California, New York and Vermont use 1 to 100. A healthier-than-average group therefore pays the pool's average and may price lower by level funding or self-funding to its own risk. A sicker-than-average group is subsidized by the pool, so community-rated coverage works as a hedge while the group qualifies. The 2027 methodology explains how the model places your group on either side of that line.

Question 9

Why might self-funded options be missing for my state or group size?

Accepted Answer

The model follows each state's stop-loss law. If a state restricts small-group stop-loss coverage, and with it self-funding, those paths are removed from the comparison rather than shown as options you could not buy. New York is the clearest example: stop-loss insurance may be issued only to employers with 101 or more full-time-equivalent employees, so self-funded options are limited there to larger groups. Other states set minimum attachment points, which keep self-funding available but raise the risk a small employer must keep. The self-funded captive path is also withheld below its enrollment floor of 20 enrolled employees. See our summary of stop-loss rules by state for the rules behind each state result.

Question 10

Where do the renewal assumptions for staying fully insured come from?

Accepted Answer

For smaller groups the model starts with your state's history of filed small-group renewals, drawn from CMS rate review public files and state insurance department filings. It then applies the Benefitra Renewal Index for your planning horizon: a recent weighted trend for a one to three year view, and the longer state average for a five-year view. Where an insurer has already filed its rate for next year, the filed rate is used instead, and a rate that is only requested is treated as a read on the current year rather than a forecast for later years. Large-group fully insured plans renew on your own claims, weighted by how credible your group's experience is. In the funding simulator you can replace the default with your insurer's actual renewal.

Question 11

What can the state analysis not tell me?

Accepted Answer

It cannot predict individual claims, and one catastrophic claim could put a real group outside even the modeled bad-year range. Its incidence rates, cost distributions and renewal behavior are calibrated to population-level research and typical groups, so an unusual workforce, industry, location or claims history may not fit the defaults. Some 2027 rates are still proposed and may change before they are final. For Taft-Hartley trusts and MEWAs, the modeled range holds only while the arrangement stays financially healthy, and the model cannot see whether a particular trust is solvent. Its validation is preliminary and directional, not an accuracy rate for individual employers. Treat the pages as a way to frame the decision, as the limitations section of the 2027 methodology sets out.

Question 12

What do I need to move from the state analysis to an actual funding decision?

Accepted Answer

Real funding decisions need underwriting, actual stop-loss quotes and a review of plan documents, none of which a simulation can supply. Start by running the funding simulator with your own current premium, census and, if you have it, claims history; files are read in your browser, and only group-level inputs and claims summaries go to the pricing server. Then gather quotes for the paths that look workable at your size, along with your most recent renewal. For self-funded or level-funded options, request a claims experience report from your current carrier so the new carrier can price your group rather than its category. Enter each real quote into the simulator, which recalculates every chart on your number, and review the result with a licensed advisor before deciding.

2027 health insurance funding analysis by state

Northeast

Midwest

South

West

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