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Bill

SD 1981

An Act limiting out of pocket health expenses

194th Legislature (2025-2026) Introduced by Mike Barrett and 1 co-sponsor

Massachusetts bill caps individual out-of-pocket health expenses to reduce patient medical costs, but may increase insurance premiums and overall healthcare spending.

House concurred
0
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Bill Summary · SD 1981

Legislative bill overview

SD 1981 proposes to cap out-of-pocket health expenses for Massachusetts residents, limiting the amount individuals must pay directly for medical services. The bill establishes maximum thresholds for deductibles, copayments, and coinsurance to reduce financial barriers to healthcare access. These caps would apply to health insurance plans operating in the state.

Why is this important

Out-of-pocket costs remain a significant burden for many Americans and Massachusetts residents, often forcing individuals to delay or forgo necessary medical care due to expense. Capping these costs could improve healthcare access and financial security for patients while potentially increasing insurance plan utilization. However, this directly affects insurance premiums, plan design, and healthcare market dynamics in the state.

Potential points of contention

  • Premium implications: Insurers may raise premiums to offset reduced out-of-pocket revenue, potentially shifting costs to employers and all enrollees rather than just high-utilizers
  • Market scope and definition: Unclear which plans are covered (individual, group, employer-sponsored, self-insured) and whether federal requirements create conflicts
  • Healthcare cost inflation: Reduced cost-sharing may increase demand for services, potentially driving up overall healthcare spending and state costs if public programs are affected

Compiled from official sources — confirm details with the bill’s official record.

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