GIC Premiums Increase 7.5% on Average
In late February, public retirees and employees achieved a major victory when it comes to the benefits and cost of your health insurance plans.
All the Fiscal Year 27 cost shifting proposals under consideration by the state’s Group Insurance Commission (GIC) have been defeated!
This means that for FY27 there will be NO changes to the premium contribution percentage splits for surviving spouses, no change in hearing aid coverage, and no increases in out-of-pocket costs – AKA copayments and deductibles.
Representing tens of millions of dollars in new costs for retirees and employees enrolled in the GIC, these proposals were adamantly opposed by our Association, public employee unions, the MA AFL – CIO, scores of legislators, and of course the enrollees who would have been stuck with higher costs and lower quality insurance benefits.
While these proposals were specific to the GIC, had they been implemented, enrollees in municipal health plans would have also very quickly felt the pinch of higher costs and fewer benefits.
Our combined efforts with labor led to Governor Maura Healey urging the 17-member Commission not to move forward with the proposals. The opposition of Governor Healey, which came after reviewing enrollee impact data and hearing the concerns of our coalition, was the final step needed to soundly defeat the cost shifting proposals.
Referencing the GIC’s impact analysis the Governor stated: “First, with the benefit of clearer data on member impact, I do not believe this is the right time to increase cost-sharing for members. I, therefore, strongly encourage you to vote against the remaining proposals that would increase out-ofpocket costs. These changes would disproportionately impact low and fixed-income members and retirees who are already facing high costs of food, housing and energy; and could discourage use of cost-saving, preventative care.”
COVERAGE OF GLP-1 FOR WEIGHT LOSS ENDING
However, the February 26 meeting did not result in universal good news. While the Governor opposed cost shifting, she continued to call on the Commission to discontinue coverage of GLP-1 for the treatment of obesity.
Following her statement in opposition to cost shifting, Governor Healey reiterated her request that the GIC discontinue GLP-1 coverage solely for obesity, stating the following: “I hope you will seriously consider one remaining proposal: eliminating GLP-1 coverage for weight loss. This is not a change I take lightly, but it is necessary to curb the unsustainable growth in GIC premiums paid by all state employees. Fewer than 5 percent of GIC members use GLP-1s, yet the projected increases in GLP-1 spending accounted for nearly one-third of the average 11.7 percent premium increase all members experienced this year.
“These pressures are not unique to the GIC. For many public health plans, including MassHealth and municipal plans offered through the Massachusetts Interlocal Insurance Association (MIIA), the cost of GLP-1s has become unsustainable. In fact, this change will bring Massachusetts in line with most other states, more than 35 of which do not cover GLP-1s for weight loss. It is also consistent with decisions made by private insurers in our state, including for example Blue Cross Blue Shield and Point 32 of Massachusetts, as well as benefit managers such as CVS Caremark.
“Importantly, without action, members are projected to see double- digit average premium increases this year. If adopted, this proposal will reduce that average premium increase to 7.5 percent – representing meaningful annual savings for all members.”
Following a lengthy debate, the Commission, by a vote of 10-7, ended coverage of the popular obesity treatment as of July 1, 2026.
To be clear, this decision only applies to non-Medicare plans. Coverage for Medicare enrollees is determined by the federal government. As it now stands, Medicare does not cover GLP-1 medications for weight loss alone. Coverage is only available when very specific FDA approved comorbidities exist, such as sleep apnea, kidney failure, and certain types of cardiovascular disease – to name a few examples.
Medicare is now considering expanded coverage of GLP-1 for the treatment of obesity, but the specific details and timeframe are not yet known.
Planning is currently underway to support members who may be affected by the change in coverage beginning July 1. Key considerations include minimizing disruption for members, providing clear communication, and identifying cost-saving options where possible.
AVERAGE RATE INCREASE OF 7.5%
To be very clear, our Association does not support ANY increases in healthcare costs. There already is a healthcare affordability crisis here in Massachusetts. Any time costs go up, the problem gets worse and the more people suffer to make ends meet.
That said, it was well known that insurance costs were going to rise again this year. The question was by how much and within what capacity – higher out-of-pocket costs, higher monthly premiums, or both.
Once again, the drivers of rising health insurance costs are higher unit costs (prices charged by doctors and hospitals for their services), as well as pharmaceuticals. Except for the Tufts Medicare Advantage plan, the state GIC is self-insured. This means that the Commonwealth assumes the risk of cost overruns. The insurance carriers are paid an administrative fee to run the plans.
As expected, the GIC’s insurance premiums will increase by a weighted average of 7.5% across all plans. The GIC offers 7 non-Medicare in-state plans, 1 non-Medicare plan for those living out-side of New England and 4 Medicare plans. The average increase across the 8 non-Medicare plans is 8%, a lower increase than the 9-10% national average in 2026.
Increases for the 4 Medicare plans range from 4% to 7.5%. For the highly popular Wellpoint Medicare Extension Plan, rates will increase 4.5%. Nearly 78,000 enrollees are projected to take part in the Medicare Extension plan for FY27.
We should note that the standard Medicare Part-B premium increased 10% ($17.90 per month) for a total monthly cost of $202.90 for 2026. However, the GIC’s Medicare plans have far lower out-of-pocket costs than do non-Medicare plans.
While non-Medicare eligible retirees can participate in any of the GIC’s non-Medicare plan offerings, Wellpoint’s Plus and Total Choice plans remain most popular due to their broad or open networks. Harvard Pilgrim Explorer and MGB Complete HMO are also popular choices amongst retirees, given the plans’ broad networks.
Health New England continues to offer a regional plan, that tends to be popular in western Massachusetts.
Lower cost alternatives are the GIC’s 2 narrow network plans Wellpoint Community Choice and Harvard Pilgrim Quality.
Non-Medicare eligible GIC enrollees who legally live outside of New England must enroll in the one national plan offered by the state, Harvard Pilgrim Access America. Wellpoint’s Total Choice Plan is available for those non-Medicare eligible retirees living outside of the United States.
Medicare enrolled retirees can choose from the three Medicare supplement plans offered by the GIC.
Please note, enrollees traveling outside of Massachusetts or the New England area are fully covered for emergency care. For the Retiree Pay-All Dental Plan, rates will increase just 1.5%. Currently, just over 47,000 state and local retirees participate in the Altus Dental Plan.
GIC OPEN ENROLLMENT BEGINS APRIL 1
GIC Annual Enrollment begins on April 1st and runs through May 1st. We strongly advise members to carefully review your plan options and look beyond the cost when choosing the plan that is best for you. Whichever plan you choose, make sure that your doctors and related hospitals are covered. For instance, you do not want to choose a narrow network plan that does not include your physician – because if you do, you may be faced with significant out-of-pocket costs.
“With Governor Healey’s help, retirees and active employees avoided a major increase in costs for FY27. However, if we do not collectively find a way to reform the systemic drivers of healthcare costs, we will be right back here again next year facing even higher costs,” said Mass Retirees CEO Shawn Duhamel. “When the Governor called Frank Valeri and I following the GIC’s vote, we made it clear to her to that we cannot allow that to happen. Something must give and that is not forcing those who can least afford it to pay more.”
Mass Retirees will continue to closely monitor developments stemming from the newly formed Healthcare Affordability Task Force, which is expected to report cost containment recommendations to the Governor in June.