麻州保險監理局協商七健保公司調降漲幅 估計為67萬居民節省7200萬元

        (Boston Orange編譯)麻州州長奚莉（Maura Healey）今（22）日宣佈，保險監理局（Division of Insurance）透過重新協商，成功降低七家健保公司原訂的2027年費率調漲幅度，預計為大約67萬名居民與企業節省的保費支出，高達7200萬美元。

        奚莉州長稱，這是簽署新法擴大監理機關對「可負擔性」審查權限後的具體成果，緩解了民眾在高通膨時代面對的醫療負擔。

        監理長麥可·卡爾喬（Michael Caljouw）不僅與藍十字藍盾（Blue Cross Blue Shield of Massachusetts HMO Blue）、哈佛朝聖者（Harvard Pilgrim Health Care）、麻省總醫院健保計劃（Mass General Brigham Health Plan）等七家業者達成調降協議，更直接否決了法倫社區健康計劃（Fallon Community Health Plan）提出的25.7%漲幅申請，認定其過高且不符合消費者利益。該否決案目前正處於行政上訴階段，業者仍有權提出申訴[citation:1]。

        麻州州長奚莉去年簽署的法案，強化了保險監理局在審查合併市場費率時對「可負擔性」的考量權重，使監理官得以更積極介入協商。對比先前為2026年節省的5400萬美元，本次協商成果進一步擴大至7200萬美元，直接受惠者涵蓋合併市場中的個人與小型企業投保戶。

        麻州政府近期還推動多項配套措施，包括首度設定醫療自付額與共付額上限（每年估可為民眾平均省下232美元）、簡化例行醫療服務的事前授權程序，以及禁止醫療債務出現在消費者信用報告中，以從多面向降低整體醫療成本。

Governor Healey: Insurance Commissioner’s Actions Save $72 Million for Massachusetts Residents, Businesses 

Commissioner rejects proposed rate increase from Fallon Community Health Plan, re-negotiated seven proposals to save $72 million for 670,000 residents 

BOSTON – Governor Maura Healey today announced that the Division of Insurance has negotiated down proposed rate increases from seven health insurers, saving Massachusetts residents and businesses a projected $72 million in health care premiums for 2027.   

The Division of Insurance re-negotiated lower rates with Blue Cross Blue Shield of Massachusetts HMO Blue, INC., Harvard Pilgrim Health Care, Health New England, Mass General Brigham Health Plan, Tufts Health Public Plans, United Healthcare and WellSense Health Plan. These efforts will result in savings for the approximately 670,000 Massachusetts residents and businesses who are enrolled in these plans in the Massachusetts merged market. 

Commissioner Michael Caljouw also rejected Fallon Community Health Plan’s proposed 25.7% rate increase for being excessive and inconsistent with his responsibility to Massachusetts consumers and businesses. This disapproval is now subject to an administrative appeal process should the insurance company choose one. 

“Massachusetts residents and businesses are already struggling with the high cost of health care. Nobody can afford massive increases in their health insurance premiums on top of that,” said Governor Healey. “Commissioner Caljouw and his team are always looking for ways to lower people’s costs – whether that’s by capping co-pays and deductibles or removing prior authorizations. Now, he’s saving people tens of millions of dollars next year by negotiating with affordability as his focus.” 

Last year, Governor Healey signed legislation that increased the Division of Insurance’s consideration of affordability during his review of the merged market rate filings. As a result, Commissioner Caljouw was able to initially save residents and businesses $54 million in 2026 by re-negotiating rate increases. 

Governor Healey has also taken action to cap health care co-pays and deductibles for the first time in Massachusetts history, and further lowered that cap this year to save people an estimated average of $232 per year. She also eliminated prior authorization requirements for many routine and essential health care services, reducing delays and administrative costs for patients and providers, and prohibited medical debt from appearing on consumer credit reports.