Nearly 700,000 Bay Staters are facing the prospect of double-digit premium increases next year as insurers struggle to handle cost pressures across the healthcare landscape, possibly exacerbating affordability woes for patients.<\/p>\n
Insurers in the merged market, where many individuals and small businesses get coverage, have proposed an average rate hike of 12.9 percent for 2027, according to plans posted online by the Division of Insurance. Insurers last year sought an average rate hike of 13.4 percent.<\/p>\n
\u201cThis is just absolutely unaffordable \u2014 you know, four times the benchmark, more like five times the rate of inflation,\u201d Retailers Association of Massachusetts President Jon Hurst said, referring to the statewide healthcare cost growth benchmark. \u201cI am continuing to get more and more frustrated that there is just a lack of concern, not only within the healthcare industry but amongst our elected leaders, about what is happening to small businesses, to small employers on Main Street. Everybody\u2019s seeing high increases, but small businesses have been getting far higher increases than big business or big government.\u201d<\/p>\n
Last week, Gov. Maura Healey announced she\u2019d instructed insurers in the merged market to limit cost-sharing increases to 3.6 percent, a move her office said would result in average annual savings of more than $230 as residents increasingly struggle to afford care and incur hefty medical debt. Insurance Commissioner Michael Caljouw also recently said that coverage is \u201cincreasingly out of reach and unsustainable\u201d across the market. <\/p>\n
Lora Pellegrini, CEO of the Massachusetts Association of Health Plans, said the 2027 rate proposals reflect the continued \u201cacceleration in health care costs across Massachusetts,\u201d as she pointed to \u201csharp growth\u201d in hospital outpatient care, physician services and prescription drugs. The governor\u2019s Health Care Affordability Work Group is expected to produce initial recommendations in June, and Pellegrini she\u2019s hopeful that proposed changes \u201cwill rein in the underlying cost drivers in our marketplace.\u201d<\/p>\n
Blue Cross Cross Blue Shield of Massachusetts \u2014 which has the largest volume of enrollees at 166,384 \u2014 plans to increase premiums by an average of 15.3 percent. Tufts Health Public Plans, which trails closely behind at 160,566 members, wants to bump premiums by 11.8 percent.<\/p>\n
Fallon Community Health Plan proposed the largest increase of 25.7 percent for its 29,641 members. Harvard Pilgrim Health Care pitched the smallest increase of 6.7 percent for its 79,318 members.<\/p>\n
In its filing with the state, Blue Cross Blue Shield said costs for medical care and medications for members have \u201cescalated rapidly,\u201d with spending growing at the \u201cfastest rate in more than a decade.\u201d<\/p>\n
\u201cWe are experiencing persistent utilization pressures across multiple service categories, most notably in outpatient surgeries (including digestive and cardiovascular surgeries), rising behavioral health visit volumes, and increased medical pharmacy use,\u201d Blue Cross Blue Shield said. The insurer called out other cost pressures such as \u201cblockbuster high-cost biologics,\u201d emerging therapies, the state\u2019s aging population and heightened use of \u201cexpensive specialty drugs.\u201d<\/p>\n
Fallon Health said its cost drivers include increased risk adjustment transfer payments and claim costs amid \u201canticipated morbidity changes due to federal and state policy, such as the expiration of enhanced premium subsidies.\u201d The insurer said it \u201ccontinually works to manage the cost of care\u201d by managing medications through prior authorizations and \u201celiminating or minimizing duplicative, unnecessary, or inappropriate care.\u201d<\/p>\n
Under the proposed rate increases, Hurst estimates the average family plan will feature premiums topping $50,000 by next January. Hurst said he appreciates the governor\u2019s effort to curb cost-sharing, but he said the strategy \u201cdoesn\u2019t work unless you also say that the premiums can\u2019t increase.\u201d<\/p>\n
\u201cFrom our members\u2019 perspective, it\u2019s the total premium that\u2019s killing them,\u201d Hurst said. \u201cYou\u2019ve got to cap out the premiums.\u201d<\/p>\n
Eileen McAnneny, president of the Employer Coalition on Health, said residents on fixed incomes who are hit with double-digit premium increases will struggle to afford other basic necessities like rent, food and energy.<\/p>\n
\u201cI mean, we can regulate the health insurance rates, which they did last year and probably will do again this year. But the problem is, until we actually get at the underlying cost of care, which are reflected in the ever-increasing premiums, then we\u2019re not really going to solve this problem,\u201d McAnneny said. \u201cWe have to find ways to deliver more efficient and more value-based care.\u201d<\/p>\n
The Division of Insurance last year rejected initial proposals from Blue Cross Blue Shield and WellSense Health Plan (also known as Boston Medical Center Health Plan) after regulators deemed hikes excessive. <\/p>\n
Insurers will present their 2027 plans at a public information session on June 16, and rates will be finalized in August. <\/p>\n","protected":false},"excerpt":{"rendered":"Nearly 700,000 Bay Staters are facing the prospect of double-digit premium increases next year as insurers struggle to…\n","protected":false},"author":3,"featured_media":826832,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_share_on_mastodon":"0"},"categories":[35],"tags":[3992,8015,81,23265,525,18217,339555,210,1141,339556,198379,223648,1142,339557,94797,3584,62224,47585,881,1439,47589,67,586,132,68,2969],"class_list":["post-826831","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-americas","tag-american","tag-business-news","tag-clinics","tag-finance","tag-financial","tag-general-health","tag-health","tag-health-care","tag-health-care-facilities","tag-health-care-healthcare","tag-health-treatment","tag-healthcare","tag-healthcare-clinic","tag-healthcare-providers","tag-hospitals","tag-industries","tag-north-american","tag-public-health","tag-u-s","tag-u-s-a","tag-united-states","tag-united-states-of-america","tag-unitedstates","tag-us","tag-usa"],"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/116649838921765410","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/826831","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=826831"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/826831\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/826832"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=826831"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=826831"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=826831"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}