Healey Administration Further Caps Growth of Health Care Deductibles and Co-Pays

Massachusetts on Monday said it will further limit the growth of health care deductibles, co-pays and other out-of-pocket costs in the state’s merged individual and small-group insurance market.

The Division of Insurance said average member cost-sharing growth will be capped at 3.6 percent for plans sold beginning in January 2027. That is down from the previous 4.8 percent limit.

The Healey administration framed the move as part of an effort to keep patient costs in check as medical prices rise. The state said the new cap is tied to the five-year average change in Boston-area consumer price inflation.

Officials said Massachusetts will have the tightest limits on out-of-pocket costs in the country under the policy and estimated the change will save patients about $232 per year.

The announcement comes as insurers prepare filings for 2027 merged-market rates under the updated guidance. It also sets up a new point of friction with the health insurance industry, which responded to the administration’s action with a statement from the Massachusetts Association of Health Plans.

The policy takes effect for plans sold beginning in January 2027. The state did not say in its announcement whether any insurer or trade group will challenge the guidance.

The move is the latest step in Massachusetts’ effort to restrain the growth of deductibles and co-pays for residents buying coverage in the merged market.