Note: Mike updated his original post from 2024 to show that where you go for care STILL makes a big difference in what you pay.
One of the most amazing things I learned at my Dad’s feet was how to forecast the weather.
Yep, that sounds funny to say out loud, but I spent many days on the water with him hunting, fishing, crabbing, crawfishing, skiing or just enjoying our beautiful state. When we were out, especially in the summer, we had to be acutely aware of the weather. The last thing you wanted was to get caught 45 minutes from the landing in a small metal boat during pouring rain or a lightning storm. But of course, that happened to us. We hated to go home once we were out.
Pops would look at the horizon, gauge the clouds for color, motion and electrical activity, and pronounce us “ok” or “in trouble!” Sometimes we would pack up and head for home. Sometimes he would park under a thick tree and wait it out (never the tallest tree, because he believed lightning always struck the tallest tree, which turns out NOT to be true). As a youngster, I can tell you I was often plenty scared. Not so much of what was right in front of me, but of the unknown.
It was always the things you COULDN’T see coming that caused the most anxiety. Like the time lightning struck a tree about 50 yards from us out of a relatively clear, blue sky. It popped, sizzled, burned and scared the heck out of me!
Like the time a huge wind popped up, blowing 50 mph or more, and nearly flipped our boat! Like the time I bent over to pull up a crab trap, and a leaping mullet hit me so hard under the nose that I blacked out. The unknown can be so scary.
My friends who run their own businesses tell me the same thing: “Mike, it’s the surprises I can’t stand. If I know bad times are on the way, I can prepare for them. I have time to figure out a plan, or just pack it in. But at least I don’t get ambushed!”
Amen to that. Which is why I’m giving you the Straight Talk today on what’s happening to your health insurance rates in 2026 and beyond.
It’s Not Just What You Get, It’s WHERE You Go
The healthcare market is changing quickly, and not for the better cost-wise. Louisiana Blue spends at least 85% of the money you send us to pay for your healthcare services (and we spent a much higher percentage in 2025). Since care costs are going up, your premium costs are likely to go up. The care people needed that was covered through their health insurance in 2025 and now in 2026, especially the increases in prescription drugs and hospital stays, drove significant rate increases in 2026. They will likely do so again, perhaps not as much, in 2027.
Why is it costing more for people to get care? Well, let’s start with something called “site of service.”
It turns out that when you need a medical procedure, like chemotherapy or knee replacement or hip replacement or a hysterectomy, WHERE you have that done has a huge bearing on the cost.
We saw three trends that accelerated in 2025-26 and are causing us worry now:
- An increased demand for procedures like knee and hip replacements, which was not unexpected. A lot of people delayed a lot of procedures during the COVID-19 pandemic and are getting them now.
- What is unexpected is that patients are heading in droves (or being referred by their doctors) to the highest-cost places to have these medical services. That’s driving claims cost increases that are double our expectation.
- Once patients go to a high-cost setting to get care, they don’t only pay more for the procedure. They also are charged huge amounts of money for the drugs they are given. These drug costs are now 34% of the total premiums our members paid in 2025. More than one-third of your premiums were driven STRICTLY by the cost of the drugs you received at the pharmacy, the hospital and the doctor’s office. These are the same drugs that lower-cost sites give patients having the same procedures, but the costs are significantly higher at the more-expensive care sites.
What Louisiana Blue has to pay to cover healthcare services for folks directly affects what you pay in premiums. And these three trends increased the cost of care, causing much of the premium increases you will see in 2027.
When we look at sites of service across the state, we see mammograms that cost four times as much in some settings as in others. Those most-expensive sites are typically hospital based or owned. And we are seeing similar trends, HUGE differences in pricing, in other services like lab work, radiology and colonoscopies. The “where” is often more important in pricing than the “what” or the “why.”
The National Picture
This massive discrepancy in prices between different locations has led to a national call for a new rule called “site-neutral payments.” Congress is debating this, and U.S. Centers for Medicare & Medicaid Services (CMS) is studying it right now.
The concept is very simple: big third-party payers (think Medicare or Medicaid) would set a single price for a single procedure and then pay that same amount no matter WHERE you have it done. I would expect health insurance companies to quickly follow suit once site-neutral payments for government health programs are in place. Since cost sharing for the average person is now higher every year, the actual cost of those procedures, especially when you have them early in the year, often comes right out of your pocket. Wouldn’t you like to save a few bucks?
Shop Before You Schedule
The good news is that if you need to have a procedure, we’ve made it even easier for you to shop around ahead of time and find the lowest-cost option. Just use our Louisiana Blue app and digital platform, MyLABlue, powered through MyChart. (Sign up here!) In MyLABlue, click the three-line menu on the left side of your phone screen, scroll down to “Find Care: Estimate Cost of Care,” and you can get a strong vision of how much different healthcare sites charge for the exact same care. The app even knows, if you are a Louisiana Blue member, how much YOU would pay based on your current deductible and coinsurance status. Since the app knows you, it knows what your financial exposure would be based on which facility you use.
The differences in pricing can be pretty staggering, especially before you hit your deductible.
You can also access that information from our www.lablue.com website. Just look for the menu item “Save!” and you’ll see the same cost-estimator tool. Taking some time to shop before you schedule can go a long way toward making sure you are getting the best value for your investment.
You can look up most procedures that you’d need to schedule in advance (colonoscopy, mammogram, MRI, etc.) to compare costs before you go. Keep in mind you don’t have to go to the site of service that your doctor referred you to if you find a cheaper option you want to use. As long as the lower-cost site is in your network, you can ask your doctor to refer you there.
Use these shopping tips to save on your out-of-pocket costs like your deductible and coinsurance. In addition to saving money when you get care, you can help protect your health insurance rates by choosing wisely.
The Unknown Unknowns
We work hard every year to project how much more healthcare is going to cost in the next year, and the year after that. We expected increased costs from factors like inflation, labor shortages in healthcare and higher and higher prescription drug prices. What we didn’t expect was for patients to suddenly start seeking treatment—in larger numbers—in the absolute most-expensive settings. So, taking a few minutes to compare prices online is the best thing we, as patients, can do to make a difference.
Keep in mind that spending more money does not always equal better care or more value! It’s often just more money out of your pocket.
It’s not unusual for a treatment like a colonoscopy (for example) to vary in price from around $1,500 to $7,000 or more!
What do you think would happen to your health insurance rates if everyone started getting the $7,000 colonoscopy and ignoring the other location where it’s just $1,500? Yeah, we sure couldn’t afford that. Now extend that practice to EVERY procedure a person could get, including knee replacements, hip replacements, chemotherapy treatments and hysterectomies, to name a few. The potential cost increases are staggering.
Like storm clouds on the horizon, we’re trying hard to read the signs and let you know as soon as we know how costs are changing. That doesn’t mean we won’t get a stray lightning strike or gust of wind or get hit in the face by a fish (yech!), but we have an obligation to point out when costs are going up too quickly and why, especially when you can affect the costs yourself. And this is happening now.
The Straight Talk is, if doctors keep sending their patients to the absolute most-expensive settings for their treatments and surgeries—whether or not patients realize that’s where they’re going—they’ll be charged many times more than what the cost should be. And rate increases will continue.
A bad moon rising? Trouble on the way? You heard it here first.
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