2023 Rate Justification MA

Harvard Pilgrim Health Care
Rate Justification for Massachusetts Merged Market Plans
Rate Change Effective January 1, 2023

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, 2023 for the Harvard Pilgrim Health Care Massachusetts Merged Market QHP plans.

Drivers of the rate increase

The average first quarter 2023 rate change for Harvard Pilgrim Health Care (HPHC) and Tufts
Health Plan (THP) renewing members in the Massachusetts Merged Market is a rate increase
of 8.0%.

  •  A key driver of health insurance premium increases year-over-year is medical trend,
    which is comprised of inpatient, outpatient, and physician services as well as pharmacy
    costs. Medical trend includes both increases in the cost of the services provided by
    hospitals and physician groups and increases in the utilization of these services by our
  • HPHC has reflected the anticipated costs of COVID-19 treatment, testing, and vaccines
    in 2023 pricing as we expect these costs to continue into the future.

Rate changes vary by plan and by account based on age composition and rating area.

Massachusetts requires that at least 88% of premium must be used for medical expenses
(otherwise, a rebate is paid to subscribers). This rate increase is calculated to comply with this

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