Blog/ Healthcare regulations
ANS sets an adjustment cap of 5.11% for individual plans in 2026
The lowest cap since 2000 was approved by the ANS board on May 29, 2026. Understand the calculation methodology, who is affected and the impacts on hospital management
- By
- Rivio, Editorial team
- Published
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- 3 minutes
Brazil’s National Supplementary Health Agency (ANS) approved on May 29, 2026 an annual adjustment cap of 5.11% for individual and family health plans. The percentage applies to contracts with anniversaries between May 2026 and April 2027.
The index is the lowest authorized by the agency since 2000, when the cap was regulated, disregarding the exceptional reduction of 2021, driven by the drop in the use of services during the covid-19 pandemic. In the years following the pandemic, adjustments soared: 15.5% in 2022 and 9.63% in 2023. From 2024 on, the trend began to reverse, reaching 6.06% in 2025 and now 5.11%.
For hospital managers, the individual plan adjustment has direct implications for the sector’s regulatory environment and serves as a cost thermometer that also affects group contracts.
How the ANS calculated the 5.11% index
The methodology the ANS has applied since 2019 combines two indicators with defined weights:
| Indicator | Weight in the calculation | What it measures |
|---|---|---|
| IVDA — Care Expense Value Index | 80% | Change in spending on plan member care, including frequency of service use |
| IPCA (excluding the Health Plan subitem) | 20% | General inflation — a proxy for non-care costs, such as administrative expenses |
According to the ANS, per capita care expenses in individual plans rose 8.32% in 2025 compared with the previous year. Even so, the final index came to 5.11%, because the formula also takes into account payers’ efficiency gains and the portion of the change already recovered through age‑bracket adjustments.
The result came in above general inflation: the May 2026 IPCA-15 (Brazil’s mid-month consumer price index) accumulated 4.64% over 12 months. The difference reflects the specific cost pressure in private healthcare, which has historically outpaced the general price index.
Who is affected and who is left out
The 5.11% cap applies exclusively to individual and family plans contracted from January 1999 onward or adapted to Law No. 9,656/98, which regulates private health plans in Brazil. That is about 7.7 million plan members, or 14.5% of the 52.9 million medical plan users in the country.
Employer-sponsored and affinity group plans are not covered by this rule. In these contracts, adjustments are freely negotiated between payers and the contracting legal entities. A survey released by the ANS in May 2026 showed that these plans had an average change of 9.9% in the first two months of 2026, almost double the cap set for individual plans.
Group plans account for most of the private healthcare market and concentrate the largest share of hospital revenue. For this reason, the individual segment adjustment does not directly affect hospitals’ contracts with payers, but it signals the direction of negotiations.
What this adjustment signals for hospital management
For hospital managers, there are three important takeaways:
Care costs keep rising
The 8.32% increase in per capita care expenses in 2025 confirms that hospital operating costs remain under pressure: more use of services, more expensive medical supplies and greater case complexity. This scenario directly affects hospital billing and contract negotiations with payers.
The gap between individual and group plans widens the asymmetry
With group plans adjusted by 9.9% on average and individual plans capped at 5.11%, the market asymmetry deepens. Payers tend to offset the restraint on individual plans with greater pressure on group plans, which can translate into price table revisions, stricter denials and more contested contract negotiations.
The regulatory environment requires constant monitoring
Changes to the adjustment cap are part of the regulatory environment that hospitals need to follow closely. The impact of denials and contract revisions tends to be amplified in years of greater cost pressure. Financial management that monitors these movements in advance has more room to negotiate and less exposure to invisible losses.
A smaller adjustment does not mean less pressure on cash
The 5.11% cap approved by the ANS is good news for individual plan members, but it does not signal relief for hospitals. Care costs are growing faster than inflation, group plans still have no regulated cap and denial dynamics tend to intensify when payers are under financial pressure.
