Rate Justification for Maine Individual Plans

Harvard Pilgrim Health Care
Rate Justification for Maine Individual Plans
Rate Change Effective January 1, 2022

Qualified Health Plan (QHP) issuers are required to post justifications for any QHP rate increases to their websites. Below, please find the justification for the rate increase effective January 1, 2022 for the Harvard Pilgrim Health Care Maine Individual QHP plans.

Drivers of the Rate Increase

There are several key drivers of the 2022 rate increase:

  • The medical trend which is comprised of inpatient, outpatient, and physician services, as well as pharmacy costs. The expected medical cost trend includes increases in the cost of the services provided by hospitals and physician groups and increases in the utilization of these services by our members. HPHC has not explicitly reflected any rate impact related to COVID-19, except to cover the expected costs associated with vaccination.
  • The Maine Guaranteed Access Reinsurance Association program (MGARA), which was implemented by the state of Maine on January 1, 2019, continues to help lower the net claims costs by reimbursing insurance carriers for the excess claims of certain high-risk members, and therefore contributes to a lower rate increase.

Harvard Pilgrim carefully monitors administrative expenses year to year. Administrative costs for Harvard Pilgrim have not increased significantly and therefore do not factor into the overall rate increase for 2022. Under the ACA, at least 80% of premium must be used for medical expenses (otherwise, a rebate is paid to subscribers). After the 2022 rate increase, Harvard Pilgrim expects to comply with this requirement.

Harvard Pilgrim’s Strategy to Keep Premiums Affordable

Harvard Pilgrim is committed to improving value and quality across the health care system. Some of the ways we are working to meet our goals include:

  • Establishing collaborative arrangements with health care providers that control costs and enhance health outcomes
  • Negotiating pharmacy contracts aligning payments with outcomes
  • Managing rare diseases through our nurse care managers
  • Updating our payment policies to deter inappropriate payment for services on selected medical infusible drug claims
  • Maintaining focus on reducing fraud, waste, and abuse

Continuing to find ways to lower health care costs while providing enhanced value to our customers through our products and services is a keystone to Harvard Pilgrim’s long-term strategy.

The combined organization of Harvard Pilgrim and Tufts Health Plan is committed to guiding and empowering healthier lives for everyone

Harvard Pilgrim’s commitment to its members, customers, communities and provider partners has never been stronger. It has included financial support to independent primary care practices and community health centers, as well as the waiver of telehealth and COVID-19 testing and treatment cost sharing. From the start of the COVID-19 pandemic, Harvard Pilgrim Health Care, through its Foundation, quickly responded to the immediate needs facing nonprofit partners and communities throughout Maine. Last year, the Harvard Pilgrim Health Care Foundation provided over $2 million in grants to more than 110 nonprofit organizations in Maine to help strengthen and respond to communities in need. This support included increased access to food and meal delivery, services for older adults and immigrant families, social and community services, and emergency response.