Mass. health insurance companies directed to limit growth of deductibles, copays

The state has directed Health insurance companies operating in Massachusetts to limit the growth of deductibles and copays at the rate of medical inflation — approximately 4.8%.

On Thursday, Gov. Maura Healey announced the new regulatory guidance issued by Insurance Commissioner Michael Caljouw that will go into effect in January 2026.

Over the past two years, deductibles have gone up by nearly 23% in the individual and small group insurance market — known as the merged market — resulting in increased costs of more than $200 per patient.

Healey’s office hailed the action as the first time the state has taken steps to limit deductibles in such a way. The governor signed legislation earlier this year that increased the insurance commissioner’s consideration of “affordability” when reviewing the merged market.

“Massachusetts families across the state are struggling with high health care costs,” Healey said in a statement. “Deductibles and co-pays are a significant health cost driver, so we are taking action to limit those costs that come right out of the pockets of patients and families.”

The growth of deductibles and copays has outpaced wages and salaries for Massachusetts residents, Caljouw added.

According to the Center for Health Information and Analysis’ annual report, the average deductible in 2024 for small-to-mid-size groups (3 to 100 employees) was $2,120.

“Today’s announcement is an important first step to protecting our residents from these difficult costs,” Caljouw said.

Health Care For All Executive Director Amy Rosenthal said her organization hears from thousands of callers annually on its free HelpLine who are struggling to pay their deductibles and copays, and ultimately skip necessary health care altogether in order to save money.

She celebrated the directive as “a meaningful step in addressing our state’s health care affordability challenges.”

The new guidance comes after the Massachusetts Health Connector Board voted to raise the minimum creditable coverage (MCC) deductible limit for individuals and families in 2026.

Policyholders might pay more out of pocket, State House News Service reported, but the higher limits also create more flexibility for insurers and employers as they design plans and keep up with rising care costs and inflation.

The Group Insurance Commission, which provides health insurance coverage for state workers, has kept deductibles, copays and out-of-pocket limits stable for eight years, but recently ran out of money and has stopped paying providers.

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