The Massachusetts Division of Insurance (DOI) has finalized 2026 premium rates for individual and small group health plans, securing lower-than-requested increases from 6 insurers and rejecting proposals from two others deemed excessive and inconsistent with state law.
According to DOI estimates, the negotiations will save consumers $54 mn in premiums in the 2026 policy year.
Final rate approvals show cuts ranging from 1% to 3.3% off initial requests. Fallon Community Health, for example, sought a 9.9% increase and received approval for 7.1%.
Health New England’s request of 10.4% was trimmed to 9.4%, while Harvard Pilgrim Health Care’s proposed 14.8% was approved at 12.2%.
The DOI rejected filings from Blue Cross Blue Shield of Massachusetts HMO Blue, Inc. and WellSense Health Plan, citing noncompliance with affordability standards.
Insurance Commissioner Michael Caljouw noted both carriers may appeal the decision.
Governor Maura Healey credited new affordability-focused laws and regulatory guidance with enabling the rate reductions. These rules include limits on deductible and co-pay increases tied to the rate of medical inflation.
While there is more work to be done, this is another important step that will better control costs for thousands of people and businesses
Massachusetts Gov. Maura Heale
Despite lower approved increases, insurers say rising expenses are putting pressure on rate adequacy. Carriers pointed to growing costs for inpatient and outpatient care, increased behavioral health use, and an aging population. Medication expenses, particularly for GLP-1 weight loss drugs, were also a key driver.
In 2024, Blue Cross Blue Shield of Massachusetts reported spending more than $300 mn to cover five GLP-1 drugs.
Citing high prices, the insurer announced it would stop covering GLP-1s for weight loss in 2026, which cut its rate request by 3% for merged market plans.
WellSense, whose filing was denied, said its rising utilization stems from a significantly expanded membership base since 2024.
Many of these members were only partially enrolled during the rate-setting base period and are now expected to use services at full levels.
Insurers across the board expect these cost and usage trends to continue into 2026.
