\u201cThis is the hardest health insurance market I\u2019ve seen in two decades, with no end in sight,\u201d said David Shore, executive vice president at Borislow Insurance, which helps companies across the East Coast, including in Massachusetts, navigate insurance and funding options. \u201cIt\u2019s only going to get worse.\u201d<\/p>\n
The costs aren\u2019t just growing \u2014 they are exacerbating an affordability crisis<\/a> for state residents and businesses, experts say. The Massachusetts Taxpayers Foundation, a business-backed policy group, recently cited health care costs as a top concern<\/a>, with Massachusetts having among the highest employer health care costs in the country. <\/p>\n Rising premiums, plus out-of-pocket health care costs, are all outpacing increases in household income, inflation, and other indicators of economic growth. As a result, Massachusetts is increasingly unaffordable to live in, <\/b>said David Seltz, executive director of the state Health Policy Commission, during a recent hearing.<\/p>\n Massachusetts had the highest insurance premiums in the US last year. And the years of consistent, rising premium costs in the state have long surpassed national trends. <\/p>\n Families in Massachusetts spent, on average, $28,151 for employer-based health insurance last year, according to data presented by the Health Policy Commission<\/a>, a state agency.<\/p>\n Nationally, that figure was $24,540. <\/p>\n And that\u2019s just premiums. Consumers face other health care costs, including co-pays and deductibles. All told, the average annual cost of health care coverage for a family in Massachusetts was $32,469 in 2024. <\/p>\n Since 2024, insurance costs have grown. Family premiums for employer-sponsored health insurance grew 6 percent nationally from 2024 to 2025, according to a Kaiser Family Foundation survey of employers.<\/p>\n Because official data sources lag, it\u2019s difficult to assess private insurance prices planned for 2026 in real time.<\/p>\n But regardless of how a person gets commercial insurance \u2014 whether purchasing for themselves on the state\u2019s insurance marketplace, going through a broker, getting it directly from an insurer, or receiving insurance through an employer \u2014 costs are seemingly on the rise for everyone next year. <\/p>\n The state\u2019s insurance exchange, where people and small businesses can buy their own insurance, has reported its premiums<\/a> will increase by 11.5 percent, on average, in 2026. <\/p>\n Those premium increases range from 7.2 percent by Fallon Health to <\/b>13.6 percent by Boston Medical Center Health Plan, which also goes by WellSense Health Plan. <\/p>\n These hikes and others mean small businesses are maxed out on health care costs, said Jon Hurst, president of the Retailers Association of Massachusetts. <\/p>\n \u201cWe\u2019re at a breaking point,\u201d Hurst said. <\/p>\n Beyond pending retirements, profitability is flat and health care and energy costs have skyrocketed, meaning about half of small businesses in Massachusetts predicted they would have to sell or close within five years, a UMass Donahue Institute study<\/a> showed in February. <\/p>\n For businesses, premium increases can depend on a number of factors, including an employer\u2019s size, health care usage trends, and how the employer purchases insurance. <\/p>\n Less than half of Massachusetts employers are considered \u201cfully insured,\u201d meaning they buy insurance in which the insurer takes on the financial responsibility for paying out medical claims. <\/p>\n Most of the employers in this group who have 50 to 100 employees are seeing whopping premium increases that range from 10 to 30 percent, said Mark Gaunya, principal at Borislow Insurance, which works with hundreds of companies of varying sizes. <\/b><\/p>\n Larger employers in this bucket are more likely to see smaller price increases, he said, though things vary. <\/p>\n Most employers in Massachusetts, however, are considered \u201cself-insured\u201d as they <\/b>pay for the health care claims of their employees more directly. These types of workplaces are also seeing premium increases, from low single digit to low double digits. <\/p>\n \u201cI haven\u2019t seen rate increases like this in a long, long time,\u201d Gaunya said of the industry at large. \u201cThe market is really, really hard right now for a lot of people.\u201d <\/p>\n The state\u2019s two largest insurers cited figures that were similar. At Blue Cross Blue Shield of Massachusetts, \u201cfully-insured\u201d employers are seeing high single to low double-digit increases on average, though numbers vary widely depending on other factors, the insurer said. For its own employees, Blue Cross passed on an average 20 percent premium increase. <\/p>\n At Point32Health, premiums for employers with over 50 employees are increasing by about 15 to 20 percent on average in 2026, again with considerable variability. <\/p>\n When confronted with ever-rising costs, employers have to get more creative with the way they offer insurance, or change what is covered. Beyond passing on the entirety of the increase to their employees as higher premiums, employers can redesign the plan, or shift more costs onto the employee. That can mean higher co-pays and deductibles, in addition to higher premiums. <\/b><\/p>\n \u201cWe\u2019re seeing more 20s- and 30-percent increases than we ever have before, in premiums. It\u2019s quite insane,\u201d said Gregory Puig, partner with Sentinel Group and the president of the Massachusetts chapter of the National Association of Benefits and Insurance Professionals. <\/p>\n Shifting costs onto employees is not a new strategy. <\/p>\n Nearly half of Massachusetts residents with commercial insurance had a high deductible health plan in 2023 \u2014 up from 19 percent in 2014, state data show. <\/p>\n Average deductibles are also on the rise \u2014 from about $2,300 in 2014 to over $3,100 in 2023.<\/p>\n Rob DiMase, a partner at Sentinel Group, an employee benefits administration and consulting firm, <\/b>said these strategies have helped some employers he works with mitigate a 20 percent cost increase for next year, so the employees only see their premiums rise by 10 to 12 percent. <\/b> <\/p>\n Still, some employers are seeing huge increases. In the large group business, which includes employers with 50 to 500 employees, the best initial increase DiMase saw was 7 percent. The worst was around 57 percent.<\/p>\n Escalating costs have patients worried about the future. <\/p>\n Joe D\u2019Eramo, 61, who has a broker, paid just over $615 monthly this year for coverage through WellSense. Beginning Jan. 1, that premium will increase by $90 per month and his deductible will rise by $500, to $3,500.<\/p>\n D\u2019Eramo works as a freelance copy editor and public relations specialist, and drives for Uber on the side. But a $1,000 settlement with the ride share company will be wiped out by his health insurance increase.<\/p>\n D\u2019Eramo, who lives in Millis, was recently diagnosed with diabetes. He is counting down the years until he qualifies for Medicare, the government insurer that generally serves people 65 and older, so that he can save more money.<\/p>\n \u201cI just want to be able to make it to that [while still] <\/b>healthy,\u201d he said. <\/p>\n Jessica Bartlett can be reached at jessica.bartlett@globe.com<\/a>. Follow her @ByJessBartlett<\/a>. Marin Wolf can be reached at marin.wolf@globe.com<\/a>.<\/p>\n![\"Joe](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/11\/5K5V7ZPH2Y4RURH5DPW6NYHHRA.jpg\")
Joe D\u2019Eramo, 61, who was recently diagnosed with diabetes, is looking forward to being on Medicare to save money.Jonathan Wiggs\/Globe Staff<\/p>\n