{"id":74585,"date":"2025-08-11T12:12:11","date_gmt":"2025-08-11T12:12:11","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/74585\/"},"modified":"2025-08-11T12:12:11","modified_gmt":"2025-08-11T12:12:11","slug":"health-insurance-rates-in-maine-set-to-skyrocket","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/74585\/","title":{"rendered":"Health insurance rates in Maine set to skyrocket"},"content":{"rendered":"\n

Editor\u2019s Note:\u00a0The following story first appeared in The Maine Monitor\u2019s free health care newsletter, Health Monitor, that is delivered to inboxes every other Thursday.\u00a0Sign up<\/a>\u00a0for the free newsletter to stay informed of Maine health care news.<\/p>\n

I was absentmindedly opening my mail over the weekend when a number on an innocuous-looking letter from my health insurance carrier stood out to me: 20 percent. That\u2019s how much my health insurance rate could increase next year.\u00a0<\/p>\n

It was buried halfway down the page, with a note saying that \u201cthese adjustments reflect broader trends in healthcare spending, including rising medical service costs and general inflation.\u201d<\/p>\n

I was stunned by that number, and I\u2019ve learned that I won\u2019t be alone. Maine could have among the highest health insurance rate increases in the Northeast next year, according to Bob Carey, superintendent of the Maine Bureau of Insurance.<\/p>\n

\u201cThey are eye-popping numbers,\u201d Carey said.<\/p>\n

Mainers who receive health coverage through the individual and small group employer market could see rate increases up to 32 percent next year, based on\u00a0proposed rates submitted by insurers<\/a>\u00a0and currently under review by the state Bureau of Insurance. If approved, the average rate increase for individuals would be 26 percent and for the small group market it would be 19 percent.<\/p>\n

Carey said he has worked in insurance for 25 years and doesn\u2019t remember another time when health insurance carriers requested 30 percent increases.<\/p>\n

\u201cIt\u2019s a lose-your-sleep moment because I can only push so far,\u201d he said. \u201cWhen the claims come in, they need premium to pay the claims.\u201d<\/p>\n

The state\u00a0publicly reports<\/a>\u00a0how much in premiums health insurers take in and pay out in claims, as well as underwriting gains or losses, which, according to a Bureau of Insurance explanation, are the amount of premium remaining after claims and administrative expenses are paid. Underwriting gains aren\u2019t necessarily profit, the bureau notes, since they don\u2019t reflect income from investments, capital gains and losses and federal income taxes.<\/p>\n

In 2023, health insurance companies in Maine reported an underwriting loss of $1.27 million in the individual market. The large group market reported gains of $54.4 million and the small group market reported gains of $19 million.<\/p>\n

It\u2019s important to note that these proposed rate increases have not yet been approved and are still under review. However, the final rate likely won\u2019t be dramatically different.<\/p>\n

The Bureau of Insurance is in charge of reviewing and approving rate increases for the merged market, which covers roughly 116,000 Mainers.\u00a0Insurers in mid-June submitted proposed increases<\/a>\u00a0based on what they are paying out in claims and expect in market trends.<\/p>\n

Carey\u2019s office then reviewed the requested rates for whether they are excessive, unfairly discriminatory or inadequate. The insurers then resubmit with updated information in mid-July and the final rate is then typically finalized around mid-August.<\/p>\n

(The \u201cmerged market\u201d includes all individuals and all small employers in a single risk pool. Maine merged the two groups several years ago in an effort to keep costs down,\u00a0according to Maine Public<\/a>. Individuals on the market may use the exchange \u2014\u00a0CoverME.gov<\/a>\u00a0\u2014 to purchase coverage.)<\/p>\n

This year, however, due to the \u201cmagnitude of the increase,\u201d Carey has opted to hold a public forum on Aug. 15 for Mainers to hear from insurance carriers about their proposed increases and voice their thoughts. Information about how to register can be found\u00a0here<\/a>.<\/p>\n

After reviewing the public comments, Carey expects to finalize 2026 rates in late August.<\/p>\n

While the rate increases apply to a relatively small group, Carey said Mainers across the board can expect similar increases since they are subject to the same market forces.<\/p>\n

\u201cThere are a lot of bad things happening in the market all at once.\u201d<\/p>\n

\"APhoto by Rose Lundy. <\/p>\n

There are two major factors driving up insurance rates in Maine, Carey said. The first is the rising costs of prescription drugs, which he said could also be impacted by new tariffs on imported drugs. <\/p>\n

Point32Health, which owns Harvard Pilgrim Health Care,\u00a0laid off 2 percent of its workforce<\/a>\u00a0earlier this year due to financial pressures, including spending $70 million on weight loss drugs called GLP-1s. It\u00a0reported an operating loss of $382 million<\/a>\u00a0last year.<\/p>\n

The second factor is that Maine only has two major health systems, and when there\u2019s little competition in the market, that can drive up the cost of care. On top of that, disputes between health systems and insurers, such as the\u00a0ongoing contract fight<\/a>\u00a0between Northern Light and Anthem, can impact rates. And Maine relies heavily on in-patient services, which are more expensive than out-patient services.<\/p>\n

There\u2019s also a lot of other \u201cnoise\u201d coming out of the federal government that impacts rates, Carey said. Congress passed legislation that imposes new restrictions on some Medicaid recipients and is expected to result in\u00a034,000 Mainers losing coverage from MaineCare<\/a>, the state\u2019s version of Medicaid, when the regulations go into effect in between 2026 and 2028.<\/p>\n

With more enrollment restrictions or rate increases, healthier people are the most likely to leave the marketplace, Carey said. That means the remaining people in the insurance pool are sicker, which then increases the premiums for everyone.<\/p>\n

In addition, the enhanced premium health tax credits are set to expire at the end of this year unless Congress votes to extend them. These tax credits were first implemented in 2021 through the American Rescue Plan Act and are saving Mainers an estimated $90 million this year,\u00a0according to the state<\/a>. About 50,000 Mainers qualify and on average the tax credits lower monthly premiums for households by nearly $180.<\/p>\n

\u201cPeople are going to be shocked when they see how much more the prices of health coverage is without those enhanced premium tax credits, and not just poor people,\u201d Carey said.<\/p>\n

Open enrollment begins in November and Carey said it will be important for Mainers to shop around and find the best plan for their situation. Maine\u2019s health insurance marketplace,\u00a0CoverMe.gov<\/a>, allows enrollees to explore their plan options and has people who can assist over the phone.<\/p>\n

Join our community and keep our journalism free <\/p>\n

The Maine Monitor is committed to deeply researched, nonpartisan reporting that informs Mainers about issues of public interest, holds institutions accountable, and profiles solutions. Our reporting takes time, but we believe it is worth doing because it is critical to a functioning society and democracy.<\/p>\n

The Maine Monitor is a nonprofit newsroom that relies on the contributions of our community to sustain our in-depth, independent, free to read journalism.<\/p>\n

If you value this type of reporting, please consider donating<\/a> and becoming a part of the community that makes this reporting possible.<\/p>\n

\"headshot Rose Lundy<\/p>\n

Rose Lundy is a senior public health reporter for The Maine Monitor, with a focus on Maine\u2019s aging care system. She is passionate about stories that highlight systemic problems affecting the most vulnerable in our community.<\/p>\n

Rose was previously a 2022 ProPublica Local Reporting Network fellow and a 2020 Report for America corps member. Before that, she was a reporter for three years at a daily newspaper in southwest Washington state. She now lives in Portland, Maine.<\/p>\n

Her work has been recognized by the New England Newspaper & Press Association, Maine Public Health Association, National Newspaper Association Foundation, Local Independent Online News (LION) Publishers and Maine Press Association.<\/p>\n

Contact Rose with questions, concerns or story ideas: gro.r1754912964otino1754912964menia1754912964meht@1754912964esor1754912964<\/a><\/p>\n

Language(s) Spoken: English<\/p>\n","protected":false},"excerpt":{"rendered":"Editor\u2019s Note:\u00a0The following story first appeared in The Maine Monitor\u2019s free health care newsletter, Health Monitor, that is…\n","protected":false},"author":2,"featured_media":74586,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253,53148],"class_list":{"0":"post-74585","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare","11":"tag-the-latest"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/74585","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=74585"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/74585\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/74586"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=74585"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=74585"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=74585"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}