For brokers placing individual ACA and group health business in Florida, the number that matters most in AM Best's latest rating action isn't the letter grade. It's what sits behind it: a capital hit tied to the same subsidy cliff and utilization spike shaping renewal conversations right now, one AM Best doesn't expect to fully resolve until 2026.
AM Best affirmed the Financial Strength Rating (FSR) of A+ (Superior) and Long-Term Issuer Credit Rating (Long-Term ICR) of "aa-" (Superior) for Blue Cross and Blue Shield of Florida, Inc. (Florida Blue) and its affiliates, Health Options, Inc., Capital Health Plan, Inc. of Tallahassee, and Florida Health Care Plan, Inc. of Holly Hill.
Together, these companies are known as Blue Cross and Blue Shield of Florida Group, and all ratings carry a stable outlook. All the companies named are domiciled in Jacksonville, Florida, unless otherwise specified.
For brokers, the affirmation is the reassurance: the carrier can absorb the pressure without a downgrade. What it doesn't resolve is the pressure itself.
The group's Best's Capital Adequacy Ratio (BCAR) declined in 2025 to strong from very strong, a change AM Best attributes mainly to net losses recorded during the year, with a projected return to very strong in 2026 based on improved operating results.
Total earnings for the group declined significantly in 2025, since higher medical utilization and lower-than-expected premium volume tied to weaker enrollment weighed on results — a combination many brokers are likely fielding client questions about already.
An AM Best sector report on the wider health insurance industry found individual ACA marketplace plans nationwide saw sharp increases in utilization and medical costs through the 2025 open enrollment period, as risk pools deteriorated and new enrollees carried higher morbidity, partly from Medicaid disenrollment.
The report also flagged rising GLP-1 use as a cost driver. A different data point, from WTW, puts 2026 US health cost trend at 9.6%, still well above pre-2025 levels. For brokers, that's the underlying reason renewal increases aren't a one-time correction.
Florida Blue responded to the pressure with rate increases on its Affordable Care Act products, and the pattern isn't isolated to Florida.
Regulators in Delaware and New Mexico approved 2025 individual-market increases of 25% to 35%, with New Mexico citing higher-than-expected claims and rising medical costs, and Delaware pointing to federal budget activity and the expiration of enhanced premium tax credits.
Delaware's commissioner also warned that subsidy disruption would likely cut 2026 enrollment. A related regulatory data point: CMS's own 2027 marketplace rule anticipates benchmark silver plans rising an average of 30% for 2026 nationally.
Florida Blue's premiums slipped slightly in 2025, since a drop in membership outweighed the effect of rate increases, and the insurer continues to prioritize margin stability alongside restored profitability. That membership drop is the piece of this story most directly relevant to a broker's book, since it's a client retention problem as much as a pricing one.
KFF data show ACA marketplace enrollment nationally fell to about 23 million in 2026 from 24.2 million a year earlier, following the expiration of enhanced premium tax credits at the end of 2025, while average premiums for those no longer receiving subsidies climbed to $1,904 from $888.
Florida recorded 4,474,300 marketplace plan selections for 2026, per CMS's official Open Enrollment snapshot, making it the largest single state marketplace by enrollment; CMS has not yet published effectuated (premium-paid) figures showing how much of that total holds through the year.
For brokers, that gap between selections and paid coverage is worth watching through the next few renewal cycles.
Read more: Higher ACA costs drive coverage losses – KFF
A natural broker instinct after reading about a carrier's earnings decline is to wonder whether to place business elsewhere.
The data argues against that: Blue Cross and Blue Shield of Minnesota reported a $353 million operating loss in 2025, reversing $27.6 million in operating income the prior year, as Medicare Advantage and Medicaid costs climbed alongside rising GLP-1 and hospital inpatient spending. Different program lines, same underlying dynamic.
This is a market-wide cost and subsidy problem, not a carrier-specific one, which means switching carriers doesn't insulate a client's renewal from it.
Operating results through the first quarter of 2026 have been positive, and the projected turnaround will play out under new leadership. GuideWell named Brian D. Pieninck president and CEO effective October 1, 2025, succeeding Pat Geraghty, who retired after 14 years in which the enterprise grew from an $8 billion health insurer into a $32 billion Fortune 500 company.
Part of why AM Best expects Florida Blue to work through this without a downgrade is the financial flexibility available through GuideWell and GuideWell Group, Inc. (GGI), which maintains dedicated funds to supplement risk-adjusted capitalization at the insurance subsidiaries if needed.
Liquidity metrics remain favorable, with additional sources available, including a revolving credit facility at GuideWell, Federal Home Loan Bank of Atlanta facilities for Florida Blue and Health Options, Inc., and private placement options.
AM Best also affirmed the Long-Term ICR of "a-" (Excellent) for GuideWell Mutual Holding Corporation.
AM Best affirmed the FSR of A (Excellent) and Long-Term ICR of "a" (Excellent) for Florida Combined Life Insurance Company, Inc., which provides Blue Cross Blue Shield-branded dental, life, and disability products and holds strategic value for Florida Blue, despite a slight 2025 capital decline tied to a dividend payment to its parent. Its BCAR-measured capitalization stands at the strongest level.
AM Best also affirmed the FSR of A- (Excellent) and Long-Term ICR of "a-" (Excellent) for Triple-S Vida, Inc. (TSV) of San Juan, Puerto Rico. TSV's BCAR is very strong, and its operating results have improved over the past two years, contributing to capital growth.
The insurer has posted a consistent trend of premium growth and has remained profitable for five straight years, though operating earnings have fluctuated; both operating and net earnings rose in 2025, largely due to higher net investment income, and TSV continues to draw on the financial and operating support of its ultimate parent, GuideWell.
