The Massachusetts Division of Insurance (DOI) has reduced or rejected proposed health insurance rate hikes from several carriers, curbing cost increases for thousands of individual and small group policyholders in the state.
The regulator said the action would result in $54 million in premium savings for the 2026 policy year.
The DOI approved reduced rate increases for six insurers and denied requests from two others, citing affordability concerns and pressure on rate adequacy driven by rising medical and pharmaceutical costs.
Revised rate filings showed approved increases ranged from 1% to 3.3% lower than originally proposed. For instance, Fallon Community Health’s requested 9.9% hike was trimmed to 7.1%, Health New England’s 10.4% request was reduced to 9.4%, and Harvard Pilgrim Health Care’s proposed 14.8% increase was cut to 12.2%, according to a Best Wire report.
However, filings from Blue Cross Blue Shield of Massachusetts HMO Blue, Inc. (BCBSMA) and WellSense Health Plan were rejected outright. The DOI said their requests were excessive and inconsistent with state law, though both carriers have the option to appeal the decision.
Massachusetts Gov. Maura Healey (pictured above) linked the reductions to recent policy changes that expanded the DOI’s ability to challenge rate hikes based on affordability. “While there is more work to be done, this is another important step that will better control costs for thousands of people and businesses,” Healey said in a statement.
State guidance issued under the new framework also required carriers to limit increases in deductibles and co-pays to match medical inflation, further addressing cost burdens.
Despite the pushback, insurers argued that they are under growing financial pressure. Carriers cited accelerating costs for medical services and pharmaceuticals, along with increased utilization of both physical and behavioral health services. Some expect those trends to intensify.
WellSense, for example, said it anticipated a surge in utilization in 2026, especially among new members who joined during or after 2024 and are now expected to increase their use of services to normal levels.
BCBSMA reported that medical and medication trends were rising at their fastest pace in over a decade, in part due to growing demand for GLP-1 weight-loss medications. The carrier said it spent over $300 million on five GLP-1 drugs in 2024 alone and described those prices as "unsustainable". As a cost-containment measure, BCBSMA plans to stop covering GLP-1s for weight loss in 2026, reducing its merged market rate request by 3%.
Insurers also pointed to increasing costs for inpatient and outpatient services and the impact of an aging population as long-term drivers of rising premiums.
Separately, the DOI, in May, denied a proposed 7.1% increase to workers’ compensation rates. That decision, which also rejected calls for a rate cut from the attorney general and industry stakeholders, kept rates flat and avoided $80 million in additional premiums for Massachusetts businesses.
