Weekly Update, October 3, 2025: This week our focus returns to retiree healthcare, both at the state and municipal levels of government. The sharply rising cost of healthcare is a major concern for state and local officials, as well as retirees struggling to afford higher monthly premiums and out-of-pocket costs.
But first a reminder of today’s (Friday, 10/3) Plymouth Area Meeting taking place at the 1620 Hotel in Plymouth at 11:00 AM. Next week we will be in Pittsfield (Thursday, 10/9), at the Holiday Inn & Suites Pittsfield-Berkshires at 1PM) and West Springfield (Friday, 10/9) at the Storrowton Tavern at 11AM.
Plymouth Area Meeting
Friday, October 3, 2025, at 11:00 AM
Hotel 1620
180 Water Street
Plymouth, MA 02360
Area Meetings are open to all members and associate members. You are also welcome to bring a guest. For those who have not previously attended, Area Meetings feature light refreshments and a door prize drawing at the conclusion of the meeting for those remaining in attendance. President Frank Valeri, I and other Association officials will be on hand to answer your questions – both before and after the meeting.
GLP-1s
In recent months a major focus of cost containment efforts has been the class of prescription drugs known as GLP-1s. Originally developed to treat Type 2 Diabetes, GLP-1s have proven to be highly effective, albeit very expensive, when prescribed for weight loss. The widespread popularity of the medication has caused prescription drug costs to skyrocket over the past several years, leading insurance carriers to no longer cover the medication for weight loss. The state’s GIC is amid reconsideration of its GLP-1 policy, with a decision possibly coming as early as the Commission’s October 16 meeting.
Over the past six months several MA insurance companies, such as Blue Cross Blue Shield and Harvard Pilgrim, have opted to end blanket coverage of GLP-1 medications solely for weight loss. The insurance carriers, like many others across the country will continue to cover the drugs in certain circumstances for individuals with specific underlying medical conditions, as well as offer the coverage through employer-sponsored plans if the plan sponsor opts to continue coverage (with a premium surcharge).
Under all circumstances, GLP-1s continue to be available for those prescribed the drug to treat Type-2 diabetes.
At the federal level under Medicare, GLP-1s are not available solely for weight loss. However, there are exceptions involving use of the medication for weight loss in conjunction with treatment for certain medical conditions, such as cardiovascular disease.
The growing popularity of GLP-1s for weight loss has sparked concern amongst state budget writers. According to the GIC, 1/3 of the FY26 premium increase is directly attributable to GLP-1 coverage for weight loss. Currently, some 16,000 GIC enrollees (3.5% of total GIC population) are on GLP-1 for weight loss – with a net spend of $120 million in FY25. However, it is estimated that 27% of the state’s adult population suffers from obesity an indication of the significant growth potential for enrollees prescribed a GLP-1 for weight loss.
Largely due to cost concerns, Governor Healey has proposed significant restrictions on GLP-1 access through the GIC starting on January 1. Since state law prohibits mid-year plan design changes, the governor has asked the legislature to suspend the law for FY26 – something our Association adamantly opposes. At this time, it is unclear whether the legislature will grant the governor’s request.
Whether the GIC addresses the issue of GLP-1s for January 1 or at the start of FY27 on July 1, 2026, the Commission will be forced to confront a difficult and controversial issue.
Given the highly effective nature of GLP-1s and the proven benefit to patients and toward lowering long-term healthcare costs, Mass Retirees urges state and local officials to find a middle ground on the issue. We believe that a total ban on coverage for GLP-1s would prove to be a mistake and is unfair to those now benefiting from this life-altering medication. And to be clear, obesity has been recognized as a chronic disease since 2013 – a disease that often begins in childhood.
Our Association is also deeply concerned that GLP-1s are being singled out simply due to the cost of the medication. Opting what valid medications to cover based on cost is a dangerous and slippery slope. Today it is a weight loss drug, but tomorrow it could be an innovative, but expensive, cancer treatment.
However, as we have written extensively about over the course of the past two years, we are deeply concerned about healthcare affordability. Whether it be through higher monthly premiums or increased out-of-pocket costs, there is a limit to what retirees can afford. What this means is that the status quo of higher costs is not sustainable. Changes must be made, but those changes must be well thought out, meaningful, and humane.
At the GIC’s September meeting, Executive Director Matt Veno and the GIC staff, along with Commissioners such as Jane Edmonds, Bobbi Kaplan, and Tobey Choate each indicated the need for a careful approach to the issue that takes into account the impact on people’s lives. We hope this to be an indication that the GIC may help to lead by example on what is a national debate and find middle ground.
We anticipate that GLP-1s will be a main topic at the GIC’s meeting on Thursday, October 16.
Medicare Buy-In: A Source of Mutual Savings
Given the need to realize healthcare savings, now is the time for the state and municipal governments to accelerate adoption of the Medicare Buy-In program for those retirees who are age 65 and older, but not eligible for Medicare. This program, already adopted by dozens of municipal governments, has proven to be highly effective at lowering costs for retirees AND government plan sponsors. We believe it would save the Commonwealth tens of millions in the first year alone. Now is the time to move forward with an enrollment plan.
At the local level, it was BCBS that first proposed Medicare Buy-In some 7 years ago as a step to reduce costs for both municipal governments and retirees. The concept has been adopted by several dozen Massachusetts communities and proven to be a true win-win. In fact, we have yet to hear a single complaint from any of the several thousand retirees who have transitioned into Medicare A & B under the program.
As members know, the Massachusetts public sector workforce does not participate in Social Security. Those who began their public sector career prior to April 1, 1985, also did not pay into Medicare as a public employee. Unless you paid into Medicare through private sector work and earned the minimum of 40 quarters needed to qualify or you qualify through a spouse, then you are not eligible to enroll in Medicare without additional fees and penalties.
Under the Buy-In program, the state or local government would pay the additional fee for Medicare Part A, as well as any late-enrollment penalties that would be accessed to retirees over the age of 65.
What makes the Medicare Buy-In program so attractive, despite the fees and penalties, is the fact that monthly premiums and out-of-pocket costs for retirees enrolled in Medicare Parts A and B are considerably lower than those incurred through non-Medicare plans. One reason for this is the fact that the federal government generally incurs 80% of healthcare costs under Medicare B after the deductible.
Another fact is that while Medicare plans are crafted specifically for retirees and the health challenges that often come from aging, non-Medicare plans are designed for active employees who are often younger and have children. The healthcare needs of the two groups are often quite different, which can place non-Medicare eligible retirees at a disadvantage in terms of proper coverage, as well as managing the costs of the coverage.
Under the GIC, it is estimated that some 10,000 current enrollees are not Medicare eligible. These enrollees participate in non-Medicare health plans, which are not designed for retirees and are far costlier than Medicare Supplement or Medicare Advantage plans.
For the past several years we have been advocating for the GIC to start a Buy-In program. Such a move has the potential to save tens of millions a year for the Commonwealth and its non-Medicare enrollees. However, largely due to the administrative and logistical challenge of the enrollment process, the GIC has not been able to move forward with a plan.
Our Association has engaged Governor Healey on the issue and is advocating that her Administration help develop a plan and grant the GIC the needed resources to implement a Medicare Buy-In program prior to the start of FY27 next July.
As we have said, this is a logical and relatively easy way for the Commonwealth to save significant money without cost shifting or making regressive plan design changes.
Growing Municipal Health Insurance Activity
In addition to closely monitoring all developments with the GIC, our Association is also deeply involved in retiree health insurance at the local level.
By state law, Mass Retirees is the only organization with direct local retiree representation on municipal Public Employee Committees (PEC) which negotiate health insurance changes. This means that it is a retiree representative appointed by Mass Retirees serving on the dozens of PECs across the state.
While not all PECs are active at the same time, we are now seeing an upsurge in activity across the state. Some communities appear to be simply reviewing their insurance plan or possibly going out to bid to address rising costs, others are considering enrolling their employees and retirees into the state’s GIC. Currently 40 municipalities and more than a dozen school districts participate in the GIC.
That said, the process to transfer enrollees to the GIC requires direct negotiation with the local PEC either through coalition bargaining (MGL Chapter 32B, section 19) or by adopting MGL Chapter 32, sections 21-23 – which also requires a demonstrated savings of at least 5% to force enrollment in the GIC. Whichever route is chosen, there is a defined legal process that must be followed.
In addition, state law requires that a municipal government must notify the GIC of its decision to enroll in the state plan no later than December 1, for a July 1, 2026, enrollment date. With just two months remaining before the deadline, time is short for communities not already well along in the process. We will have more to say on this issue if communities enter into that process.
Meanwhile, our Association will continue to work directly with our PEC members to help provide guidance. Nancy McGovern is our point person for all municipal health insurance activity.
On Thursday, October 16, Nancy and I will participate in the 3rd Annual Municipal Health Insurance Summit hosted by BCBS MA. The summit is open to all local PEC representatives, both active employees and retired. If you are involved in your municipal health insurance plan, either as a PEC or Insurance Advisory Committee member, please contact Nancy for information on attending the Summit.
Next week we will focus directly on Medicare, with information on Turning 65 and how to avoid falling victim to Medicare scams during the opening Open Enrollment period for Medicare Advantage plans.
With great appreciation,
Shawn
Shawn Duhamel
Chief Executive Officer
Mass Retirees Association
PS: If you have been forwarded this email and are a retired Massachusetts public employee, but not a member of the Mass Retirees Association, please join us today!
We also offer an Associate Membership option to allow active public employees nearing retirement age to subscribe to our Weekly Update, newsletter, and other informational resources that will keep you well informed and help you better prepare for your future retirement. Subscribe today at https://massretirees.com/subscribe/