Health insurers double down
US health carriers are pivoting to tighter underwriting and operational efficiency for 2026 — AM Best says insurers are investing in granular risk selection, advanced analytics and AI to protect loss ratios and meet regulatory scrutiny. The shift puts claims, SIU and underwriting teams under pressure to deliver faster, auditable workflows. (drmattlynch.com)
AM Best’s Review & Preview Market Segment Report, published March 5, 2026, identifies escalating medical cost inflation, higher utilization and sharply rising drug costs—specifically GLP‑1 obesity drugs and high‑cost cancer, autoimmune and gene therapies—as primary drivers depressing underwriting results. (news.ambest.com ) AM Best lists the corrective playbook insurers used in 2025—more conservative underwriting/pricing models, market exits, greater use of value‑based care arrangements and substantive premium rate increases—and expects those measures to continue into 2026. (secure.businesswire.com ) Major carriers have already tightened market footprints for 2026: UnitedHealth announced it will stop offering Medicare Advantage in 109 counties (affecting roughly 180,000 people), CVS/Aetna cut Part D and MA availability in multiple counties, and Humana reduced its MA county footprint to about 85% of U.S. counties. (foxbusiness.com ) Vendors and consulting firms report insurers are funding granular risk‑selection tools and AI for pre‑bind screening; Shift Technology’s case studies show AI models used to detect misrepresentation and reduce exposure at underwriting intake. (shift-technology.com ) Consulting surveys show the underwriting modernization agenda centers on quality, ease of doing business and talent development, while large integrators warn that siloed AI pilots (submission intake or narrow fraud checks) limit scale and ROI unless integrated into end‑to‑end workflows. (accenture.com ) (scnsoft.com ) Claims and Special Investigations Units face quantifiable workload pressure: publishers tracking AI adoption say fraud detection and SIU workflows must become faster and auditable to sustain tighter underwriting standards and regulator exams, driving demand for case‑management automation. (riskandinsurance.com ) (shift-technology.com ) Federal and state policy shifts are compounding margin pressure—enhanced ACA premium tax credits expired Dec. 31, 2025, increasing expected marketplace premiums for 2026 and adding urgency to insurers’ underwriting and rate‑setting moves. (beckerspayer.com )
