Final Merged Market Rates Effective for 2026
As of 7/25/25
| Carrier Initial Rate Filing % Final Approved Rate Filing % Members | |||
|---|---|---|---|
| Fallon Community Health 9.9 7.1 23,198 | |||
| Health New England 10.4 9.4 24,884 | |||
| Harvard Pilgrim Health Care 14.8 12.2 90,561 | |||
| MGB Health Plan 10.5 7.2 71,452 | |||
| Tufts Health Public Plans 13.2 11.1 187,126 | |||
| United Healthcare 12.3 9.3 24,031 | |||
| BCBSMA HMO Blue, Inc. 12.9 Notice of Disapproval issued 7/21/25* 166,777 | |||
| WellSense Health Plan 16.2 13.2 133,412 |
* Each carrier has the legal right to file an administrative appeal request with the Division of Insurance within ten (10) days of their receipt of a Notice of Disapproval. This website will be updated with information on these processes as they change.
Merged Market Summary for Proposed Rates Effective for 2026
The following tables depict the proposed overall weighted average premium increase and the key assumptions behind premium development for the merged (individual and small employer) market filed by insurance carriers as part of the Massachusetts Division of Insurance rate review process (for rates effective in 2026). This information is subject to change as the rate review process continues.
The Health Care Access Bureau within the Massachusetts Division of Insurance is currently reviewing these assumptions. This review process will culminate in a final decision in August 2025.
There are 711,563 consumers enrolled in merged (individual/small group) market plans (data as of December 2024).
- The Average Rate Change represents adjustments to reflect benefit changes in renewing plans and it reflects plans that have been terminated and mapped to existing plan offerings. This weighted average rate change represents the average rate change consumers will experience before changes due to age.
- The Medical Expense and Pharmacy Trend Assumptions are the annualized rate of increase due to increases in the unit cost of health care services and in the utilization of health care services.[1] These trend assumptions are generally applied to current claims experience to project 2026 required revenue rates.
- The Non-Medical Portion of Premium represents the percent of overall premium that is required to cover administrative expense, contribution to reserves and required taxes and fees, including premium tax, ACA fees.
- The Risk Adjustment Assumption is the Affordable Care Act’s (ACA) risk adjustment program which redistributes funds from carriers with lower-risk enrollees to plans with higher-risk enrollees.
[1] Provider mix and service mix are typically included within utilization trend assumptions. Cost sharing leverage may also be included in either the pricing AV or utilization assumptions.
Carrier Rate Filing Summaries (Explanations)
Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.
Public Summary
Exhibit for Public Release
Plan and Benefit Templates
- Plan and Benefit Template 1
- Plan and Benefit Template 2
- Plan and Benefit Template 3
- Plan and Benefit Template 4
Boston Medical Center Health Plan, Inc. (d/b/a WellSense Health Plan)
Public Summary
Exhibit for Public Release
Plan and Benefit Templates
Fallon Community Health Plan, Inc.
Public Summary (Narrative)
Exhibit for Public Release
Plan and Benefit Templates
- Plan and Benefit Template 1
- Plan and Benefit Template 2
- Plan and Benefit Template 3
- Plan and Benefit Template 4
Harvard Pilgrim Health Care, Inc.
Public Summary (Narrative)
Exhibit for Public Release
Plan and Benefit Templates
- Plan and Benefit Template 1
- Plan and Benefit Template 2
- Plan and Benefit Template 3
- Plan and Benefit Template 4
Health New England, Inc.
Public Summary (Narrative)
Exhibit for Public Release
Plan and Benefit Templates
- Plan and Benefit Template 1
- Plan and Benefit Template 2
- Plan and Benefit Template 3
- Plan and Benefit Template 4
Mass General Brigham Health Plan, Inc.
Public Summary (Narrative)
Exhibit for Public Release
Plan and Benefit Templates
- Plan and Benefit Template 1
- Plan and Benefit Template 2
- Plan and Benefit Template 3
- Plan and Benefit Template 4
Tufts Health Public Plans, Inc.
Public Summary (Narrative)
Exhibit for Public Release
Plan and Benefit Templates
UnitedHealthcare Insurance Company
Public Summary (Narrative)
Exhibit for Public Release
Plan and Benefit Templates
Prior Merged Market Rate Changes
Public Information Session
In accordance with the provisions of 211 CMR 66.08(3)(e), health insurance carriers presented their proposed merged market health insurance rates for 2026 at a public information session held on June 17, 2025. To watch the session, click the video link below. The relevant filing materials for each carrier can be reviewed in the section titled Carrier Rate Filing Summaries.
Public Information Session Video, 2025
Written Comments Submitted for Public Session on June 1, 2025
Ryan C. Kearney, General Counsel Retailers Association of Massachusetts
Karen Granoff, Senior Director, Managed Care, Massachusetts Health & Hospital Association
Travis Condon, Director of Public Affairs, North Central Massachusetts Chamber of Commerce
Alex Sheff, Senior Director, Policy and Government Relations, Health Care for All