Health care costs continue to rise at unsustainable rates, adversely affecting other critical state needs, such as education and local aid. The GIC has been trying to change the way care is provided and paid through the Centered Care Initiative. Our five-year contracts with the health plans begin a shift from fee-for-service provider contracts to global budgets. Plans are subject to penalties for missed targets and receive shared savings if they beat targets.
However, the elephant in the room remains tackling provider charges. Recent Health Policy Commission and a study commissioned by the Massachusetts Association of Health Plans shows large gaps between the prices of high-price and low-price providers, that high price providers charge more due to their market clout, and that too many patients are getting routine care at very expensive providers. Adding to this challenge are the skyrocketing costs of drugs – not only of specialty drugs, but also of brand name and generic medications.
For this year, the Commission elected not to make major benefit changes, especially since last year they did make copay and deductible changes. The Commission wants to see how some of last year’s changes play out – especially the implementation of the Employer Group Waiver Plan for the prescription drug portion of UniCare State Indemnity Plan/Medicare Extension (OME) and the switch of the two Preferred Provider Organization (PPO) plans for Harvard and Tufts to Point of Service (POS) plans.
The Commission is also evaluating some longer-range changes that it may want to consider in the future. For now, most of the benefit changes have to do with improving parity across the plans and most of these are benefit enhancements. These are outlined on the health plan benefit changes page.
The initial proposed weighted rate increase from the plans was substantial at 7.1%. After our annual rate renewal negotiation process, the final weighted average rate increase is 3.6%, in keeping with the state’s benchmark and better than the national average.
Some plans did better than this and some did worse. If you are in a plan with a high premium, it’s more important than ever to take the opportunity during Annual Enrollment to consider enrolling in a less expensive plan. See Consider a Less Expensive Plan for additional information.
However, due to the Harvard Pilgrim Independence Plan’s significant premium increases and spending beyond its premium rates, the plan will be closed to new members. See the health plan benefit changes page for additional information.
The calendar year deductible is transitioning to a fiscal year, so there’s no longer a deductible barrier for changing carriers. See the Fiscal Year Deductible Change page for additional information.
In addition to deciding which health plan best suits your needs during Annual Enrollment, take charge of your health and take advantage of ways to lower your out of pocket costs all year long.
- Work with your Primary Care Provider (PCP) to navigate the health care system.
- Seek care from Tier 1 and Tier 2 specialists. Over 150 million de-identified claims have been analyzed for differences in how physicians perform on nationally recognized measures of quality and/or cost efficiency. You pay the lowest copay for the highest-performing doctors:
*** Tier 1 (excellent)
** Tier 2 (good)
* Tier 3 (standard)
- If you are in a tiered hospital plan and have a planned hospital admission, talk with your doctor about whether a Tier 1 hospital would make sense.
- Use urgent care facilities and retail minute clinics instead of the emergency room for urgent (non-emergency) care.
- Make copies and bring the prescription drug formulary from your plan’s website with you to all doctor visits.
- Use your health plan’s online cost comparison tool to shop for health care services in advance.
- Consider enrolling in a Limited Network Plan to save money on your monthly premium.
- Read about ways to take charge of your health; the GIC’s website has a wealth of articles and links to additional resources.
- Eat healthy, exercise regularly, don’t smoke, and find ways to de-stress.
This information provided by the Group Insurance Commission .