Mark Farrah Associates’ Data Confirms Stop-Loss Rate Hike Trend
September 3, 2026
Rising numbers of high-cost claims are significantly affecting stop-loss coverage for insured and self-insured health plan sponsors. Prominent benefit consulting firms, including The Segal Group [1] and Mercer (now Marsh) [2], have reported that medical stop-loss premium rates are expected to rise sharply in 2026, reaching double-digit increases for many carriers. In this Business Strategy Report, Mark Farrah Associates (MFA) presents key findings from its analysis of 2022 to 2025 stop-loss coverage data filed by carriers with the National Association of Insurance Commissioners (NAIC) through the Accident and Health (A&H) Policy Experience Exhibit (AHPEE), part of annual financial statements. The A&H insurance exhibit data, available in MFA’s Health Coverage Portal™, allows insurers to analyze and benchmark premiums, claims, lives, member months, and number of policies nationally and by state.
Stop-loss insurance is a policy purchased by insurers and employers, who self-fund their employee health plans. It protects the business from catastrophic claims by reimbursing the insurer or employer sponsor once total medical costs exceed a certain agreed-upon financial threshold (the "attachment point"). Stop-loss insurance is crucial for the financial stability of self-funded plans. It mitigates the risk of catastrophic claims that could otherwise severely impact an employer’s finances. This insurance provides a safety net, ensuring that while employers benefit from the cost savings of a self-funded plan, they are not overly exposed to the financial volatility of high-cost claims.
- As of December 31, 2025, direct premiums earned totaled $45.1 Billion (B) by 103 carriers that offered stop-loss coverage; these carriers reported direct claims incurred of $40.9B from 92.8 Million (M) covered lives (members). On a Per Member Per Month (PMPM) basis this yielded a 91% Claims Loss Ratio (CLR), meaning for every $1 earned in premiums, the company paid out ninety-one cents for claims.
- As of December 31, 2023, direct premiums earned totaled $35.3B by 104 carriers that offered stop-loss coverage that year; these carriers reported direct claims incurred of $28.4B from 83.3M covered lives. On a PMPM basis this yielded a 79% CLR.
- From 2023 to 2024, premiums PMPM increased 9%, while claims PMPM increased 19%. The following year, 2024 to 2025 premiums PMPM increased 8%, while claims increased 14%. The 2025 to 2026 data will be available in April of 2027, but most indicators suggest that stop-loss premiums are still not keeping pace with claims increases.
Demand for stop-loss coverage is increasing, as more employers, both large and small, shift to self-insure their employees. In recent years, a complex funding option, often called level-funding, has become more widely available to small employers. Level-funded arrangements are nominally self-funded options that package together a self-funded plan with extensive stop-loss coverage that significantly reduces the risk retained by the employer. According to Kaiser Family Foundation’s 2025 Employer Health Benefits Survey, “Thirty‑seven percent of covered workers in firms with 10 to 199 workers are enrolled in a level‑funded plan in 2025”; 51% are in either a self-insured or level-funded plan. [3] When you combine the increased demand for stop-loss coverage with the rapidly rising cost of medical claims, more claims are reaching their attachment points. As a result, insurers are experiencing higher claims loss ratios, which ultimately leads to increased premium costs.
About the Data
The data used in this analysis brief was obtained from Mark Farrah Associates' (MFA’s) Health Coverage Portal™ database and sourced from insurance companies reporting through the NAIC (National Association of Insurance Commissioners) via the Accident and Health Policy Experience Exhibit (AHPEE). Within MFA’s Health Coverage Portal™, the A&H Policy Experience Exhibit by State table presents summary level data including premiums, claims, lives, member months, and number of policies for multiple health insurance segments, including stop-loss coverage. This table does not include data for plans regulated by the California Department of Managed Health Care (CA DMHC) and not all health insurers are required to file with the state insurance departments. This table presents data for NAIC plans licensed as Fraternal; Life, Accident & Health; & Health. MFA’s A&H tables exclude non-health related segments, such as life, property, or flood policies.
In 2021, the AHPEE was modified to provide state insurance regulators with added data and improved consistency across the annual financial statements. In 2022, all types of insurers were required to report data at the state level, based on the location of the contract. The state-level A&H insurance data first became available in 2022, and MFA’s Health Coverage Portal™ currently includes state-level data for 2022 through 2025. Historically, this information was only available based on the domicile of the insurer; the AHPEEs prior to 2022 are available but not directly comparable with more recent data.
About Mark Farrah Associates (MFA)
Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, 5500 Employer Health plus, ASO Employer Health plus, Medicare Business Online™, Medicare Benefits Analyzer™, and Health Plans USA™. For more information about these products, refer to the product pages and brochures available under the Our Products section of the website (www.markfarrah.com) or call 724-338-4100.
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[1] The Segal Group, Articles | July 1, 2026, “Q3 2026 Trends Focus: Stop‑Loss Insurance”: https://www.segalco.com/consulting-insights/q3-2026-trends-focus-stop-loss-insurance/
[2] Mercer June 3, 2026, “As the stop-loss market hardens, renewal protections matter more than ever”: https://www.mercer.com/en-us/insights/us-health-news/as-the-stop-loss-market-hardens-renewal-protections-matter-more-than-ever/; As of September 2026, Mercer rebranded to become Marsh
[3] Kaiser Family Foundation, Employer Health Benefits Survey 2025 Annual Survey: https://files.kff.org/attachment/Employer-Health-Benefits-Survey-2025-Annual-Survey.pdf