Harvard Pilgrim Health Care
Rate Justification for New Hampshire Individual Plans
Rate Change Effective January 1, 2025
Qualified Health Plan (QHP) issuers are required to post justifications for any QHP rate changes to their websites. Below, please find the justification for the rate change effective January 1, 2025 for the Harvard Pilgrim Health Care (HPHC) New Hampshire Individual QHP plans.
Drivers of the rate change
- Trend: 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 changes in the cost of the services provided by hospitals and physician groups and changes in the utilization of these services by our members. In particular, for 2025, Harvard Pilgrim expects upward pressure on medical unit cost increases, driven primarily by the higher inflationary environment. While Harvard Pilgrim expects to successfully manage these unit cost increases, they are expected to be above recent levels. Additionally, pharmacy trends continue to put upward pressure on overall claim trend, and this is expected to continue in 2025.
- Reinsurance: Effective January 1, 2021, the New Hampshire Insurance Department began operating a reinsurance program with the goal of lowering insurer liability for Individual Plans. HPHC’s rates reflect the impact of this program.
Under the Affordable Care Act, at least 80% of premium must be used for medical expenses (otherwise, a rebate is paid to subscribers). The 2025 rates were calculated to comply with this requirement.
Harvard Pilgrim’s strategy to keep premiums affordable
Harvard Pilgrim Health Care is committed to delivering increased access to high-quality care and lowering out of pocket costs for members, wherever possible. To support these objectives, we continue to focus on the following areas:
- Preventive care to keep our health plan members thriving and health care costs lower
- Active management of our pharmacy programs, including changes to control the cost of certain medications, as well as ensuring access to effective and affordable therapeutic solutions
- Delivering a wide array of health-based rewards, incentives, and reimbursements to our health plan members
- Providing access to doctors, specialists and facilities to ensure our members can easily seek the care they need
- Managing chronic conditions and diseases through our integrated care team
- Development of innovative programs, services and resources to meet the ever-growing health and well-being needs of our health plan members
- Maintaining a focus on reducing fraud, waste, and abuse
- Frequent review of medical policy, plan design and coverage to deliver equitable access to all health plan members throughout the communities we serve