Medical Expenditure Trends

Medical Expenditure Trends
(December 2016 Report)

Medical Expenditure Trends uses payers' Massachusetts All-Payer Claims Database (MA APCD) submissions to monitor medical claims spending in the Commonwealth over time. This report highlights aggregate medical claims spending trends by payer, funding type, and product type.

Medical claims spending data is reported for unique Massachusetts residents with private, primary, medical health insurance in 12 of the Commonwealth's largest commercial payers. Member medical claims were aggregated for calendar year 2014 dates of service with claims run-out through June 2015.

Key Findings

  • In Massachusetts, average private commercial member medical claims totaled an estimated $366 per member per month (PMPM) in 2014.

  • Payers paid for approximately 91% of medical claims costs, while patients covered the remainder through deductibles, copayments, and coinsurance.

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