#DYK? Massachusetts Association of Health Plans's mission is to promote high-quality, affordable and equitable health care in Massachusetts. All MAHP member plans are dedicated to improving the health of all residents of the Commonwealth.

Investing in the communities they serve: In 2023, Massachusetts Association of Health Plans member plans contributed over $38 million to support initiatives related to women's health, housing, food insecurity & more.

💵#DYK? In Massachusetts, commercial health care price growth outpaces utilization increases. It’s not just more care – it’s more expensive care. The ever-increasing prices charged by hospitals and pharma manufacturers are the primary drivers of increased health care spending.

🏥 Hospital outpatient departments are a leading driver of health care cost increases. According to MA Health Policy Commission, Massachusetts residents disproportionately use hospital outpatient settings, at 40% more than other states, resulting in unnecessary, increased spending for consumers &

The right care, at the right time, in the right setting: Health plans’ prior authorization processes are used on a limited set of services, mostly for high-risk & high-cost treatments, tests or Rx drugs, to ensure patient safety, avoid unnecessary care & promote affordability.

#DYK? Health plans use medical & pharmacy trends to project costs for hospital care, physician services, and prescriptions. Rates are considered actuarially sound when the projected premiums fully cover expected medical costs, admin expenses, taxes, and reserves.

🔄 #DYK? Health plans develop premium rates by projecting all anticipated medical costs based on claims data and projected trends in their rate filings. If hospitals raise prices or new high-cost drugs come to market, those costs are directly reflected in premium rates. Health

🩺🤧 During cold & flu season, knowing where to go matters so patients can receive the right care, at the right place, at the right time. Learn more in Massachusetts Association of Health Plans’s latest animated video here: mahp.com/wp-content/upl…

🏪 Independently owned urgent care centers typically offer the same treatments as hospitals but without the extra fees. That means smaller bills for patients—and better value for the same care. Learn more in Massachusetts Association of Health Plans’s latest animated video here: mahp.com/wp-content/upl…

#DYK? Health plan prior authorization processes are based on national & local standards of care & the latest peer-reviewed evidence-based clinical guidelines. Prior Auth is not designed to deny care, but to maximize patient safety, quality & affordability.

#DYK? Not all urgent care centers are low-cost. Hospital-affiliated urgent cares can charge added facility fees, surprising patients who assumed they were in a cheaper care setting. This is why it is important to know the different prices and services in sites of care. The more

Ever looked at your medical bill and wondered why it’s so high? You might see a charge for “physician services”, but in hospital-owned settings, that can also include a facility fee that’s not directly tied to your care. 📊💡

Paying for the name on the door: Some hospital-owned urgent care centers now charge more than emergency rooms for basic care. These excessive prices are unjustified and increase health care costs for employers and consumers. Learn more in Massachusetts Association of Health Plans’s latest animated video here:

🏨 Health system consolidation is increasing rapidly—including the takeover of independent urgent care centers. This expands the number of high-cost settings and increases costs for consumers and employers. Learn more in Massachusetts Association of Health Plans’s latest animated video here:

As hospital consolidation grows, so do surprise facility fees. This bill levels the playing field, ensuring off-campus hospital sites don’t use their status to drive up prices for routine care. Learn more here: mahp.com/wp-content/upl…

#DYK? Enrollment in integrated care programs (SCO, One Care & PACE) rose 14.8% from 2021 to 2023. These programs offer essential care for dual-eligibles, yet they face uncertain futures under federal changes.

The need to provide predictability, transparency & reduce health care spending in MA: To constrain excessive costs for consumers, @HPC_Mass has long recommended the adoption of a default out-of-network payment rate for surprise billing situations recommended by Mass. Health and Human Services in its

🚨 New from MAHP: Our latest policy brief reveals that more than 50 Massachusetts state-mandated benefits add $2.5 billion to premiums annually, accounting for 17¢ of every premium dollar. Read more to learn about how mandated benefits disproportionately impact the approximately

Health care affordability is the most significant challenge facing Massachusetts employers & consumers today. Massachusetts CHIA 2025 Report found total health care expenditures, driven by increased provider & Rx drug prices, continue to grow faster than the state economy, 5.8%, regional

Massachusetts’s 65+ population is expected to increase 61% by 2030. To account for this growth and the impact of federal changes, Massachusetts must invest in programs that help older adults age safely in place, like SCO and PACE.