Individual health plans will have a maximum adjustment of 5.11%; understand who is included in the rule

The National Supplementary Health Agency (ANS) approved this Friday (29) the ceiling of 5.11% for the annual adjustment of individual and family health plans.
Reproduction/TV Globo
Maintaining a health plan will weigh a little less on the pockets of Brazilians who have individual and family contracts. The National Supplementary Health Agency (ANS) defined this Friday (29) that the annual adjustment of these plans could be a maximum of 5.11%. The percentage is the lowest authorized by the agency since 2021, when there was a negative adjustment due to the effects of the Covid-19 pandemic.
The measure affects around 7.7 million beneficiaries, equivalent to 14.5% of users of medical assistance plans in the country. The new ceiling applies to individual and family contracts signed from January 1999 or adapted to the Health Plans Law.
The decision takes place in a scenario in which health spending continues to grow. Data from ANS itself shows that assistance expenses per beneficiary of these plans increased by 8.32% in 2025 compared to the previous year. According to the agency, the increase reflects both the increase in the cost of medical services and supplies as well as changes in the profile of patients and the incorporation of new mandatory procedures in plan coverage.
See the rights and duties after contracting health plans
Who will be affected by the adjustment
The limit of 5.11% applies only to individual and family plans, those contracted directly by the consumer with the operator.
The rule does not apply to corporate collective plans, offered by companies to employees, nor to plans collectives by membership, contracted through associations and class entities. In these cases, the adjustments are negotiated between operators and contractors, without a ceiling defined by the ANS.
The agency estimates that individual plans represent an increasingly smaller portion of the market. Today, most beneficiaries are linked to collective contracts.
Why the adjustment was below the increase in costs
The authorized percentage does not correspond only to inflation nor does it automatically follow the variation in operators' expenses.
Since 2019, ANS has used a methodology that combines the evolution of plans' assistance expenses with the economy's official inflation. The calculation considers not only the prices of health services, but also the frequency with which beneficiaries use consultations, exams, hospitalizations and treatments.
According to the agency, the objective is to avoid automatic transfers of costs to consumers and incorporate efficiency gains obtained by operators.
In announcing the index, the director-president of ANS, Wadih Damous, stated that the adjustment seeks to balance the sector's financial sustainability and families' ability to pay.
When will the new value begin to be paid? be charged
The adjustment does not come into force immediately for all consumers.
The charge can only be applied in the anniversary month of the contract, that is, in the month in which the plan was contracted.
For contracts with anniversaries in May and June, the charge may begin in July or, at the latest, in August, retroactively to the anniversary month of the plan.
After the announcement, consumers must check whether the percentage applied by the operator does not exceed the limit of 5.11% and whether the charge was carried out within the rules established by the agency.
Which explains the rise in health spending
Even with a smaller adjustment for consumers, the costs of medical assistance continue to put pressure on the sector.
According to the ANS, the increase in expenses is related to the increase in the cost of medical services and equipment, the greater use of health plans and the aging of the population, which tends to demand more consultations, exams and treatments. The incorporation of new procedures and technologies into the list of mandatory supplementary health coverage also contributes to this account.

Source: G1