As many of you have read and seen on the news, the state continues to grapple with unsustainable health care cost increases. The federal-state program, known as MassHealth, now costs more than $15 billion a year – nearly forty percent of the state budget. As a result, all state agencies, including the GIC, must trim their sails.
The state benchmark for health care increases under Chapter 228 is set at 3.6%. This has been extremely hard to achieve with skyrocketing drug costs and excessive charges by certain providers. A January 2017 Freedman Healthcare report found that provider price variation — the difference in price providers command for the same healthcare services — is worse in Massachusetts than in "nearly all other markets," with the state's highest priced hospitals consistently being 2.5 to 3.4 times more expensive than lowest-priced hospitals between 2010 and 2014.
Initial premium increase requests from our health plans came in at 10.2%. After negotiation, these increases will be lower, but other changes were needed to come in within the benchmark. The goals of the Commission as they tackled these challenges were to spread the burden fairly, align benefits between plan options, and use methods other than benefit changes to bring down the trend wherever possible.
To this end, the Commission authorized staff to move ahead with renegotiating the contract with CVS Caremark and endorsed legislation that would help with controlling provider prices charged to the GIC and its members.
Employee/non-Medicare Health Plans
The Commission provisionally voted to make the following employee/non-Medicare benefit changes effective July 1, 2017. These changes are subject to final review on February 9:
- Increase the fiscal year deductible to: $500 individual/$1000 family (regardless of family size). For the Fallon Health Direct and Select plans, the deductible would increase to $550 individual/$1,100 family.
- Freeze enrollment in Tufts Navigator and Fallon Health Select and continue to freeze enrollment in Harvard Pilgrim Independence Plan.
- Harvard Pilgrim Independence and Primary Choice plans – will change to a closed prescription drug formulary similar to the other plans. This means certain prescription drugs will be excluded from coverage, but will have alternatives available that are more cost effective.
- Add a prescription drug deductible to all employee/non-Medicare plans except Fallon Health Direct and Select of $100 individual/$200 family.
- Harvard Pilgrim Independence Plan and Tufts Health Plan Navigator – implement group tiering of providers based on value and tier PCP copays: $10/$20/$40.
Medicare Health Plans
For Medicare members, the Commission provisionally approved the following benefit changes. These changes are also subject to final review at the February 9 meeting:
- Harvard Medicare Enhance, Health New England MedPlus, and Tufts Medicare Complement: Prescription drug coverage will be moved to the GIC’s SilverScript EGWP program.
- All Medicare plans: office visit copay of $20/visit
- UniCare Indemnity Plan Medicare Extension (OME): Eliminate $35 calendar year deductible and increase Emergency Room copay to $50.
DCAP for State Employees: The Commission voted to change eligibility for the pre-tax Dependent Care Assistance Program (DCAP) to match all GIC benefits. This means that only active state employees eligible for GIC health insurance benefits will be eligible for this program. Unlike other GIC coverage, the coverage effective date will continue to be the first date of employment.
GIC Dental/Vision and Retiree Dental: On the good news front, the Commission awarded a new contract to MetLife. Benefits for the active plan will be enhanced and rates will decrease. For retirees, reimbursements will increase and rates will remain the same.
Coordinator Training: We will again hold Coordinator training across the state. Please mark your calendars for March 28-March 31. Details and the RSVP will be in my next communication.
What’s Next: The GIC’s Public Hearing will be held on Wednesday, February 1, 2017, at 12:30 pm. Originally scheduled for Minihan Hall, we’re looking for a larger facility. Check our website and Twitter feed for an update on the location. At the hearing, the GIC will describe these prospective benefit changes and members can provide their feedback. The GIC will send Coordinators a link to the presentation after this hearing.
The Commission will finalize details on the above on Thursday, February 9. I will send you more information after that vote. The Commission will vote on rates on Wednesday, March 1. Annual Enrollment takes place April 5-May 3 for benefit changes effective July 1, 2017. It’s safe to say that this year it will be extremely important for members to weigh their options and consider changing health plans. We will be working as expeditiously as possible in order to update our website and get guides to all agencies and municipalities before Annual Enrollment begins.
Stay tuned for more information.