Division of Insurance Information Sessions to Examine Cost Drivers Underlying the Health Premium Environment

The Division of Insurance is launching a series of information sessions over the next two months to examine the health cost factors driving the premium environment.

The Current Environment

In August 2024, after a thorough review and public information session, the Division concluded its review of carrier’s merged market (individual and small group) rate filings for calendar year 2025.  As identified at 2025 Health Insurance Rates | Mass.gov, the final weighted average premium rates for the merged market is increasing by 7.9% over calendar year 2024 .  During its detailed review, the Division identified a number of health cost factors contributing to the 7.9% average weighted increase, including weighted increases of medical costs by 6.6%, pharmacy costs by 11.8% and administrative costs by 0.6%.   While this premium rate data is specific to the individual/small group market, the Division understands that the same cost pressures apply to the large group market.

With this environment in mind, and in advance of the submission of the future rate increase filings in Mary 2025, the Division is interested to understand more about the current landscape of cost pressures in a more detailed manner.  Accordingly, the Commissioner of Insurance is launching a series of information sessions over the next two months to examine the health cost factors driving the premium environment.

Session Schedule

The Division will hold these sessions at the following dates and times. To register for a particular session, please click the registration link under that specific date. 

December 3             1-2 PM                Introduction and Discussion of Environment   

To register: https://events.gcc.teams.microsoft.com/event/89943c7e-4947-4c52-80a8-6939f1932d72@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

December 5              1-3 PM               Hospital Reimbursement

To register: https://events.gcc.teams.microsoft.com/event/cd23880a-2f36-44d2-83ee-fedee7886a2f@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

December 10            1-3 PM               Provider Reimbursement

To register: https://events.gcc.teams.microsoft.com/event/b09cae8f-a37a-44da-9973-924584f5cd65@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

December 13            1-3 PM               Medical\Behavioral Health Utilization  

To register: https://events.gcc.teams.microsoft.com/event/b931f4a9-042a-40b0-9b8b-9fea926314f9@3e861d16-48b7-4a0e-9806-8c04d81b7b2a         

December 17            1-3 PM                Pharmaceutical Reimbursement

To register: https://events.gcc.teams.microsoft.com/event/be7b36aa-9fab-4a51-b22a-45693635be01@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

December 19            1-3 PM                Pharmaceutical Utilization

To register: https://events.gcc.teams.microsoft.com/event/18e59449-eb69-4421-8352-17021aa0b5ef@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

January 7                    1-3 PM                Administrative Costs

To register: https://events.gcc.teams.microsoft.com/event/566a079b-7074-42ca-8521-67806ee91ff2@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

POSTPONED January 9                    1-3 PM                Discussion of Policy Options and Concluding Discussion

To register: https://events.gcc.teams.microsoft.com/event/8a3739ca-53ca-4c0a-bde0-1485146df40e@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

January 14                  1-3 PM                   Presentation about Trends by the Center for Health Information and Analysis and the Group Insurance Commission. 

To register: https://events.gcc.teams.microsoft.com/event/c321d739-b61c-4cf1-82c5-efa0d04e49cd@3e861d16-48b7-4a0e-9806-8c04d81b7b2a.

January 23                   1-3 PM                   Pharmacy Benefit Managers (PBMs)

To register: https://events.gcc.teams.microsoft.com/event/d0c76598-85fa-473a-959e-8b164c786c2c@3e861d16-48b7-4a0e-9806-8c04d81b7b2a.

February 11                 1-3PM                    Policy Discussion about Addressing Pharmacy Costs and Utilization

To register: https://events.gcc.teams.microsoft.com/event/6cb7b2eb-7803-4a28-b6c1-27b5f1e80a8b@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

February 18                 2-4 PM                    Policy Discussion about Addressing Non-Hospital Costs and Utilization

To register: https://events.gcc.teams.microsoft.com/event/ccf29e7e-ee56-4b88-9e85-4f50b13df6fa@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

February 25                  1-3 PM                    Policy Discussion about Addressing Hospital Costs and Utilization

To register: https://events.gcc.teams.microsoft.com/event/9061e95a-2c14-45e6-b49c-429e1921a2da@3e861d16-48b7-4a0e-9806-8c04d81b7b2a

Presentations Shared at Individual Sessions

December 3 Health Session