Commercial Insurance: Premiums and Member Cost-Sharing


Key Annual Report
Commercial Insurance Premiums Findings

Health Care Premiums in Massachusetts

CHIA collects annual commercial health insurance premiums data from health care payers, allowing for insights into the costs borne by both Massachusetts employers and employees. CHIA also monitors high deductible health plan enrollment and consumer cost-sharing over time. These measures are reported in CHIA's Annual Report on the Performance of the Massachusetts Health Care System.

 

Commercial Insurance Premiums are costs borne by the majority of individuals under 65 years old, both in Massachusetts and nationally.  These individuals are usually  enrolled in employer sponsored insurance, where both the employer and the employee make premium contributions to a commercial payer for an employee’s health plan. Health care payers use the premiums to pay for their member's medical expenses. Payers also retain a portion of the premium to cover administrative expenses, reserves, commissions, contributions to surpluses and profits, premium taxes, and medical management expenses.

 

Commercial Insurance Member Cost-Sharing includes all medical expenses allowed under a member’s plan but not paid for by the payer, employer, or CSR subsidies (e.g., deductibles, copays, and co-insurance). CHIA also reports on member cost-sharing by market sector, product type (HMO, PPO, POS), funding type, and benefit design type (HDHP, tiered network, limited network).

Cost-sharing research and data is also included in findings from CHIA’s Massachusetts Health Insurance Surveys (MHIS). The survey findings reflect the impacts of medical costs on Massachusetts households with all forms of insurance coverage (including private commercial, MassHealth, and Medicare) as well as the uninsured.

Please note: Figures in CHIA's  2019 Annual Report are inclusive of members who incurred little to no medical costs as well as those who may have experienced substantial medical costs. However, these figures do not include out-of-pocket payments for goods and services not covered by the members’ health insurance policies (e.g.,over-the-counter medicines, vision, and dental care). Member cost-sharing also does not account for employer offsets, such as health reimbursement arrangements or health savings accounts.

 

Key Premiums and Member Cost-Sharing Findings from CHIA's 2019 Annual Report on the Performance of the Massachusetts Health Care System

  • Annual growth in fully-insured premiums accelerated — from 4.8% in 2017 to 5.6% in 2018.

 

  • Most market sectors experienced average annual premium increases between four and six percent in 2018.

 

  • Between 2017 and 2018, private commercial member cost-sharing increased by 5.6% to $55 PMPM.

 

  • Cost-sharing continued to be higher among unsubsidized individuals and smaller employer groups.

 

Previous Commercial Insurance Publication Materials

2018

2017

2016

2015