Nearly 86,000 people who purchase largely unsubsidized health insurance on the Massachusetts Health Connector will face a 7.6 percent premium increase next year, on top of increases totaling at least 31 percent since 2015.
The uptick will make it more difficult for some people to afford health care as consumers face a slew of other rising costs, from inflation to increases in the price of heating and electricity.
“We do hear from people regularly not going to specialists because it’s another cost when their family can’t afford to put food on the table,” said Hannah Frigand, director of education and enrollment services at Health Care For All, a consumer advocacy group. “I remember a family who ended up having to move in with family members because they had rising medical costs and weren’t able to keep up with working and paying rent.”
The premium increases will be felt by people who buy insurance on the connector website or directly through a carrier. Those who make less than 300 percent of the federal poverty level — $40,770 for an individual or $83,250 for a family of four — qualify for ConnectorCare, which offers subsidized health insurance coverage for 140,000 people in the state. For ConnectorCare members, the lowest-cost plans are increasing by $3 per month or less in 2023.
Some residents with lower incomes qualify for MassHealth, which provides health insurance at very little cost to more than 2 million people.
The premium increases, approved by the Division of Insurance in August and reviewed by the Health Connector Board on Sept. 8, range from 5.5 percent at Tufts Health Plan-Direct (which has the most members on the connector) to 11.9 percent at Health New England. Increases will be higher for older individuals, as insurers can raise rates every year after a person’s 25th birthday.
In one example, a silver plan, which is often described as a middle-tier health insurance plan, will cost $449.09 to $674.73 a month for an individual in 2023, with open enrollment starting in November.
Those costs are just the baseline, and many plans have deductibles in the thousands of dollars that members must pay before health insurance kicks in, as well as copays and other cost sharing.
The latest premium hikes come on top of a spate of increases in recent years. From 2015 to 2021, the lowest-cost premiums on the connector increased between 31 percent and 74 percent, depending on the particular region of the state, according to a report issued last year by the Health Connector. The steepest increases came in counties that include Nantucket and Cape Cod; the smallest increases came in Region 2, which includes Essex, Middlesex, and Worcester counties.
The increases were reviewed by the Health Connector Board on the same day Blue Cross Blue Shield of Massachusetts published a survey showing that Massachusetts residents say their top health concern is not the COVID-19 pandemic or the quality of care they receive, but the cost of health care in the state.
Additionally, the Centers for Health Information and Analysis reported that 41 percent of Massachusetts residents surveyed from July to December 2021 said they had trouble affording health care. The challenges were even more pronounced for Black and Hispanic families, 50.8 and 54.9 percent of whom reported affordability issues, respectively.
While many people receive health insurance through their employers, some employees, part-time workers, and self-employed people buy insurance for themselves and their families on the connector; others purchase plans directly through insurers.
Tax credits are available to some subscribers to help offset the rate hikes. Approximately 34,000 people currently purchasing health insurance on the connector qualify for the credits.
The credits are based on factors including income, place of residence, and age. A 60-year-old Boston resident earning $55,000 a year, for example, could receive $302 a month to offset health insurance costs. If that same person lived in Edgartown, they would receive $707 a month. The federal government’s American Rescue Plan provided additional tax credits in 2021 and 2022, and those enhanced tax credits will remain in place for another three years.
While enhanced tax credits have made health care premiums more affordable, Frigand said deductibles and other cost-sharing expenses continue to make health care out of reach for many.
Ann Marie McGovern-Theriault said she ultimately switched to a high-deductible connector plan last year because the premium on her previous plan was too high. But specialists she saw for skin cancer on her face and a tumor behind her eye cost $175 for each visit, and she struggled to afford the copayments.
“They are talking about the cost of my heat and electricity. I have to say, and I’m embarrassed, at the end of the summer I had to charge groceries [to my credit card],” she said. “I didn’t have any groceries in my fridge. I’m hurting a bit.”
When asked about the increases, the state’s two largest insurers, Blue Cross Blue Shield of Massachusetts and Point32Health, said much of the uptick was because of higher provider reimbursements and pharmacy costs.
“Some of the requests for increase [from providers] are three, four, five times what we’ve traditionally seen, well into double digits,” said Michael Guerriere, chief actuary for Blue Cross Blue Shield of Massachusetts. “It does reflect a compromise and us holding the line but also . . . [the] inflationary and post-pandemic environment we find ourselves in.”
Matt Day, senior adviser for provider strategy for Blue Cross Blue Shield of Massachusetts, acknowledged that premium increases were affecting plans both on and off the connector and said insurers, providers, and the government need to work together on a solution.
“Like we did with coverage reform, payment reform, we need to come together on this affordability crisis,” he said.