Insurance coverage exec says regulatory transfer will simply shift prices into plan premiums
STATE HOUSE, BOSTON, MAY 15, 2025…..Well being insurers in Massachusetts should curb will increase to deductibles and copays beginning subsequent yr, because the Division of Insurance coverage flexes its new authority underneath a 2025 legislation that offers officers heightened scrutiny over well being care prices.
The insurance coverage division issued regulatory guidance on March 12 that requires insurance coverage corporations to limit the expansion of deductibles and copays to the speed of medical inflation, which is roughly 4.8%.
Gov. Maura Healey’s workplace highlighted the steerage Thursday, which marked the deadline for insurers to file price proposals with the insurance coverage division for calendar yr 2026.
“Deductibles and co-pays have been rising too quick – now outpacing wages and wage progress for our residents,” Insurance coverage Commissioner Michael Caljouw stated in an announcement. “Right this moment’s announcement is a crucial first step to defending our residents from these troublesome prices.”
The top of a commerce group representing well being insurers stated DOI’s caps will “not make care extra inexpensive.”
“[I]t will merely shift prices into premiums, elevating month-to-month bills for everybody,” Lora Pellegrini, CEO of the Massachusetts Affiliation of Well being Plans, stated in an announcement to the Information Service.
She attributed rising prices to escalating costs charged by hospitals, suppliers and pharmaceutical corporations.
“Whereas efforts to restrict deductibles and copays could present short-term reduction on the level of service, they do nothing to deal with the basis causes of rising well being care spending,” Pellegrini stated. “Actually, they threat exacerbating the issue by pushing extra prices onto people and small companies via increased premiums. If we’re critical about enhancing affordability, we want structural reforms that maintain all components of the well being care system accountable, together with suppliers, hospitals and drug producers whose unchecked value progress is driving this disaster.”
Caljouw in February had warned the Well being Connector Board that rising deductibles could immediate sufferers to forgo or self-ration care. Larger deductible limits can translate into policyholders paying extra out of pocket for his or her well being care, a pressure that’s exacerbated by rising premiums.
Connector Board members in February voted to raise the minimum creditable coverage deductible limit for people to $3,200 in 2026, up from $2,950. Regulators set deductible limits annually that make clear what kind of plan protection is ample to satisfy the state’s insurance coverage protection mandate.
The market evaluation legislation, which Healey signed in January, updates the charges evaluation course of the insurance coverage division. Regulators are tasked with gauging whether or not proposed charges are “extreme” by making an allowance for “affordability for customers and purchasers of medical insurance merchandise.”
The speed filings due Thursday observe a request from the insurance coverage division for insurers to clarify how the proposals deal with affordability. Insurers additionally needed to define how common price sharing, together with deductibles, for eligible people and small employers “has not elevated on a year-over-year foundation by greater than the New England Client Worth Index for well being take care of November 2024, besides as needed to satisfy federal Actuarial Worth (AV) calculator necessities,” in line with the bulletin.
DOI this summer time stated it plans to work on rules that “outline and deal with affordability requirements.”
