By Brazil Stock Guide – Annual premium adjustments for individual health insurance plans in Brazil for the 2026–27 cycle may vary significantly depending on a single regulatory decision: how the National Supplementary Health Agency (ANS) treats Hapvida in its calculation. The base-case estimate points to a 5.4% increase, but the figure could rise to as much as 7.8% if the operator is included, according to calculations by BTG Pactual’s research team.
The projection incorporates consolidated 2025 data and suggests a slowdown compared with the 6.06% increase applied in the previous cycle. The ANS methodology combines 80% of medical inflation — measured by cost per beneficiary — and 20% of general inflation (IPCA excluding healthcare), adjusted by an efficiency factor. With overall costs showing moderation, the ceiling for adjustments is expected to decline, limiting room for margin recovery across the sector.
The main distortion comes from Hapvida, which reported an approximately 36% increase in medical costs per beneficiary in 2025 — far above the roughly 6% seen across the rest of the industry. If ANS treats the company as an outlier and excludes it from the sample, the adjustment should remain close to 5.4%, according to BTG Pactual estimates. If included, however, its weight could add around 2.4 percentage points to the final result.
For Hapvida itself, the outlook is challenging. A more limited adjustment would further pressure margins already strained by higher utilization rates, low operating leverage, and cash consumption. The difficulty in passing through costs highlights a structural mismatch between medical inflation and pricing power, particularly in the individual plans segment.
ANS typically sets annual adjustments only for individual and family health plans, the most regulated segment in Brazil’s private healthcare system. In the previous cycle, the agency capped increases at 6.06% for contracts renewing between May 2025 and April 2026. If confirmed, the projected 5.4% adjustment for 2026–27 would be the lowest since the pandemic period, when adjustments were frozen and even turned negative — including a roughly 8% reduction in 2021 — followed by a sharp 15% rebound the following year.
Operators with lower exposure to this segment are likely to navigate the environment more effectively. Highly regulated and offering limited pricing flexibility, the individual plans market has been gradually abandoned by players such as SulAmérica and Bradesco Saúde, which now maintain only legacy portfolios. In this context, the 2026–27 adjustment is more than just a number — it underscores the limits of a model increasingly pressured by rising costs and price controls.
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