Green Mountain Care Board sets insurance premium rates

Vermont's healthcare regulation board announced Tuesday it has signed off on health insurance rate increases lower than what the companies had requested.

According to the Green Mountain Care Board, Blue Cross Blue Shield of Vermont asked for a 6.5% increase on individual plans and a 4.5% increase for small group plans.

It was approved for a 2.2% increase on individual plans and a 1.2% increase on small group plans. MVP Health Care, meanwhile, requested a 7.8% increase on individual plans, a 9.1% increase on small group plans, and was approved for 3.9% and 6.2%, respectively.

The care board stated these rates will apply to about 67,000 Vermonters. It claimed that the rates will see premiums for 2027 reduced by $24 million from what the companies requested.

"The Board's decisions continue our work to bring Vermont's commercial premiums more in line with national and regional trends," stated Owen Foster, chairman of the Green Mountain Care Board, in a news release. "Through strong legislative efforts and GMCB's work to control costs, Vermont had the second-lowest increase in ACA Marketplace benchmark premiums in the nation for 2026. This year's approved increases are again well below national trends and reflect our continued commitment to making health care more affordable for Vermonters."

Each decision by the Green Mountain Care Board came with two supplemental orders, one telling the companies to prepare for reference-based pricing, and the other telling them to look at what they're paying to hospitals in other states.

The first order states that the board has to establish reference-based pricing for hospitals no later than fiscal year 2027. This is required under Act 68 of 2025.

"The reference-based prices established by the Board under this new program will be based on a percentage of the Medicare reimbursement for the same or a similar item or service, or on another benchmark, as appropriate," the order states.

Unrelated to the statement about the insurance rates, on Monday the Green Mountain Care Board announced that on Aug. 26 at 10:30 a.m. it would hold a public meeting on referenced-based pricing to update Vermonters on the work it has done so far. According to the board, that work includes looking at what hospitals have for prices, building a methodology for setting reference-based prices, working with outside experts to refine those methods, and having hospitals and insurers prepare for the changes.

"Reference-based pricing represents a significant change in how commercial hospital prices may be established in Vermont, and we know there is considerable interest in this work. We encourage you to join us on August 26 to learn more about where things stand and what comes next," the care board stated.

Information on how to participate in the meeting will be posted to the care board's website.

The second order states that in Vermont, the care board carefully considers hospital prices, as these impact insurance premiums. Prices at out-of-state hospitals impact them as well. The order directs the insurers to consider this when determining what it pays those out-of-state hospitals.

keith.whitcomb

@rutlandherald.com