The Massachusetts Division of Insurance has renegotiated lower rates — projecting $72 million in premium savings — with insurers in the state’s merged individual and small employer market.
The negotiations included Blue Cross Blue Shield of Massachusetts HMO Blue, Harvard Pilgrim Health Care, Health New England, Mass General Brigham Health Plan, Tufts Health Public Plans, UnitedHealthcare and WellSense Health Plan.
Fallon Community Health Plan had pitched the largest increase, 25.7%, which the state blocked. The insurer can pursue an administrative appeal process.
“We respect the Division of Insurance’s decision and look forward to continuing our discussions with them as the review process moves forward,” a Fallon spokesperson told Becker’s. “As a not-for-profit community health plan, Fallon Health has worked to limit premium increases, filing the lowest average premium increases for its Health Connector product in the market from 2024 through 2026.”
Based on the proposed rates, the annual weighted average base rate change was 12.9% across all eight carriers. Excluding Fallon, the approved weighted average base rate change is now 10.4%.
In 2021, Fallon said it was backing off commercial products but would still offer a few on the marketplace, Massachusetts Health Connector. Fallon is in the process of joining with Mass General Brigham Health Plan, as well.
A state law signed by Democratic Gov. Maura Healey in early 2025 established affordability considerations in rate reviews.
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