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Massachusetts health insurance

Nine insurers are offering 2019 health plans through state's exchange. Open enrollment continues through January 23, 2019.

Health insurance in Massachusetts

National leader on health reform

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Massachusetts is one of the states fighting the hardest to preserve the Affordable Care Act’s gains. See the steps Massachusetts has taken.

Massachusetts is a leader in public health and healthcare reform, enacting legislation in 2006 that resulted in the nation’s lowest uninsured rate – a designation the state continued to hold, with an uninsured rate of just 2.8 percent in 2017, according to U.S. Census data.

Massachusetts’ reform strategies, such as an exchange where private insurers compete, a requirement that individuals have coverage or pay a penalty, and subsidies to help those who can’t afford coverage, served as the model Affordable Care Act. The state’s individual mandate will continue to be in effect in 2019 and beyond, after the ACA’s individual mandate penalty is repealed.

Massachusetts’s health marketplace

Massachusetts runs a state-based health insurance exchange called Massachusetts Health Connector. The exchange is an active purchaser exchange, which means the exchange determines which plans are offered for sale. Massachusetts has a very robust exchange, with more participating carriers than most states. The state exchange predates the Affordable Care Act by several years. (Health reform that took effect in Massachusetts in 2006 was widely considered a blueprint for the ACA.

Open enrollment for 2019 individual market plans in Massachusetts runs from November 1, 2018 to January 23, 2019. Plans selected between December 24 and January 23 will be effective February 1, as Massachusetts always gives enrollees until the 23rd of the month to select a plan with coverage effective the first of the following month.

Massachusetts has had its own individual mandate since 2006, and it will remain in effect even after the ACA’s individual mandate penalty is eliminated at the end of 2018.

Nine insurers are offering 2019 plans through the Massachusetts exchange. They include UnitedHealthcare, which was required to rejoin the exchange. Premium increases for 2019 exchange plans, on average, are increasing 4.7 percent.

Massachusetts enrollment in qualified health plans

Prior to Obamacare’s individual mandate taking effect in 2014, Massachusetts had the lowest uninsured rate in the nation, at 3.7 percent. By 2016, it had fallen to 2.5 percent – still the nation’s lowest.

About 31,700 Massachusetts residents enrolled in qualified health plans (QHPs) during 2014 open enrollment. But this number wasn’t really reflective of actual demand, due to problems with Health Connector.

Enrollment in QHPs would have been much higher if it were not for the technical problems with the Health Connector. About 160,000 new applicants with incomes above 133 percent of poverty level who should have been enrolled in QHPS were instead temporarily enrolled in Medicaid and about 112,200 people ended up staying on their Commonwealth Care plans through the end of 2014.

Exchange enrollment has improved substantially ever since. For the 2016 open enrollment period, technology issues seemed to be a thing of the past and Massachusetts Health Connector, Massachusetts’ state-based exchange, exceeded its goal of 190,000 QHP enrollments, including renewals. When 2016 enrollment ended on January 1, there were 196,554 exchange enrollees.

As of June 2, effectuated enrollment stood at 223,778. The majority of those individuals (171,000) were enrolled in ConnectorCare, a Massachusetts program that provides state subsidies in addition to federal ACA subsidies to those with incomes up to 300 percent of the poverty level. ConnectorCare enrollment lasts year-round.

And by 2018, plan selections during open enrollment (which was a week shorter than prior open enrollment periods had been) reached 270,688. By February 1, 2018, effectuated enrollment stood at 252,786, which was about 2.4 percent higher than it had been in 2017.

Read more about the Massachusetts health insurance marketplace.

Massachusetts Medicaid/CHIP

Former Gov. Deval Patrick signed the legislation authorizing the Affordable Care Act’s Medicaid expansion in July 2013.

Through ACA expansion, the Massachusetts Medicaid program covers most non-elderly adults up to 138 percent of FPL. As of July 2018, the Medicaid rolls in Massachusetts had increased by 302,538 – or almost 24 percent over pre-expansion levels.

Read more about Massachusetts’ Medicaid expansion.

Short-term health insurance in Massachusetts

Massachusetts laws are inhospitable to short-term plans and as a result, no insurers offer short-term plans in the state.

This is due generally to guaranteed-issue and rating requirements that apply to all health plans in the state. Since 1996, Massachusetts has required all health plans marketed to individuals to be sold on a guaranteed-issue basis (ie, applications cannot be rejected based on medical history) “according to clearly defined rating rules.”

Massachusetts regulators will continue to impose tight regulations on short-term plans, despite new federal short-term health insurance regulations.

Read more about short-term health insurance in Massachusetts.

Massachusetts health ratings

Massachusetts consistently performs among the top five states in several public health ratings. For 2015, it ranked third in America’s Health Rankings, but on the 2017 edition of the Rankings, Massachusetts was the top-ranked state.

With the nation’s lowest uninsured rate and highest number of primary care physicians per 100,000 people, the state has clear strengths when it comes to access to healthcare. According to this particular report, the state’s biggest public health challenge is a large disparity in health status – Massachusetts ranked 41st for that measure on the 2017 edition of the Rankings (up from 49th in the 2015 edition). And although Massachusetts was ranked number one in 2017, the state has experienced a 69 percent increase in the number of drug deaths since 2012.

The Commonwealth Fund ranked Massachusetts fourth among the states and the District of Columbia in its 2015 Scorecard on State Health System Performance, and although the state dropped to 5th in the 2017 edition of the Scorecard, it rose to second place in the 2019 ranking. Again, The Bay State topped the charts with its low uninsured rate, which contributed to its #1 ranking for the Access category. Massachusetts placed lowest in the Avoidable Hospital Use & Costs category, for which it placed 31st (consistent with its ranking in the 2015 edition of the Scorecard). See the Massachusetts 2019 scorecard for additional details on the state’s performance in several categories and key indicators.

Another source of public health information and comparisons is the 2016 edition of Trust for America’s Health; see Key Health Data About Massachusetts. You can also compare health ranking for Massachusetts counties through the data published by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

Massachusetts and the Affordable Care Act

Democrats dominate Massachusetts politics at the federal and state level, and support for Obamacare is solid. When the Affordable Care Act was up for a vote in the U.S. Senate, John Kerry and Scott Brown represented Massachusetts. Sen. Kerry voted yes of the ACA, while Brown voted no. Brown was elected in a special election following the death of Edward (Ted) Kennedy, who championed health care issues throughout his political career.

Brown was defeated in his re-election bid in 2012 by Elizabeth Warren, who supports the ACA and introduced legislation in 2018 to stabilize and protect it. Ed Markey, who also supports the ACA, was selected in a special election after Kerry assumed the role of U.S. Secretary of State.

In the U.S. House of Representatives, nine of 10 representatives voted in favor of the ACA. Rep. Stephen Lynch voted against the ACA, in part because the final legislation did not include a public option. All 10 Representatives from Massachusetts continue to be Democrats.

At the state level, former Gov. Deval Patrick in 2012 signed two bills to bring Massachusetts’ existing exchange and policies into compliance with the federal health care reform law. In addition, Massachusetts adopted the ACA’s expansion of Medicaid.

Gov. Charlie Baker was sworn into office in 2015. Baker is a Republican, and has been critical of the ACA. But Baker was among a bipartisan group of governors who called on Congressional Republicans to reject the partisan efforts to repeal the ACA in 2017, and he was critical of the Trump Administration’s decision in 2017 to end federal funding for cost-sharing reductions (CSR), noting that ending the funding could result in a destabilized individual health insurance market (ultimately, insurers simply added the cost of CSR to silver plan premiums, resulting in larger premium subsidies — which are funded by the federal government — and protecting most consumers from bearing the brunt of the price increase).

Massachusetts’ Obamacare implementation

The rollout of the ACA in Massachusetts did not go smoothly, despite the fact that the law was modeled on the state’s previous healthcare reform initiatives. The state had to modify many of its existing programs to comply.

Technical upgrades were needed to make Massachusetts’ state-based exchange, Massachusetts Health Connector, ACA-compliant. The upgrades were not implemented correctly or on time, causing many enrollment delays and requiring manual workarounds. The problems with the Health Connector affected not only those who were seeking to enroll for the first time, but also those who had existing state-subsidized coverage.

Prior to the ACA, Massachusetts operated Commonwealth Care, for individuals with incomes below 300 percent of the federal poverty level (FPL), and Commonwealth Choice, for uninsured adults who made too much to qualify for Commonwealth Care. Depending on income levels, some people previously enrolled in Commonwealth Care were transitioned to Medicaid. The rest of the Commonwealth Care population and the Commonwealth Choice population become eligible for federal subsidies to purchase new health plans through Health Connector.

Given the problems with the Health Connector, Massachusetts was forced to keep many people enrolled in their Commonwealth Care plans and temporarily enroll new applicants in the Medicaid program. These temporary fixes expired at the end of the year, and about 400,000 people had to re-apply for coverage by Dec. 31, 2014.

After much analysis, Massachusetts decided to fix the Health Connector rather than transition to the federal marketplace. By October 2015, the total cost of rebuilding Health Connector had reached $285 million and expectations for a stronger 2016 enrollment period were strong. The exchange did, indeed, turn a corner during 2016 and had its most successful enrollment period since ACA implementation.

Since then, enrollment has been smooth and has increased each year.

Other ACA reform provisions

The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program was designed to encourage new, non-profit health insurers to enter the market, but most of the CO-OPs failed in the first few years, due in large part to the shortfalls in the ACA’s risk corridors program, and the way the risk adjustment program is structured.

Twenty-four CO-OPs received loans totaling $2.09 billion as of January 2014. In Massachusetts, Minuteman Health, Inc. received more than $156 million in federal loans. See the states where CO-OPs operated.

Minuteman Health expanded to New Hampshire for the 2015 coverage year. It remained in operation throughout 2017, but ultimately closed at the end of 2017 and was placed in receivership. As of 2018, there are only four CO-OPs still in operation, after the closure of Minuteman Health.

Read more about the Affordable Care Act’s CO-OPs.

Massachusetts Medicare enrollment

Massachusetts Medicare enrollment reached 1,218,036 in 2015, about 18 percent of the state population. Historically, about 83 percent of the state’s Medicare beneficiaries qualify based on age alone, while 17 percent are eligible due to disability.

Medicare spends about $8,861 annually per enrollee in Massachusetts, which is above the national average of $8,790. In terms of overall Medicare spending, as of 2009, the state ranks 12th with $11.7 billion per year.

In Massachusetts, Medicare recipients can select a Medicare Advantage plan instead of Original Medicare if they wish to receive additional benefits, and about 21 percent of them do. Nationally, 33 percent of Medicare recipients select Medicare Advantage instead of traditional Medicare.

Medicare recipients can also buy Medicare Part D plans. In 2017, about 53 percent of Massachusetts Medicare beneficiaries chose stand-alone prescription drug coverage, compared with to the national Rx plan enrollment of 44 percent.

Massachusetts health insurance resources

State-based health reform legislation

Three bills, which were introduced in 2017 and are under consideration in 2018 in the Massachusetts legislature, address the possibility of a public option in Massachusetts (S.638), or a state-based Medicare for All option (S.619 and H.2987).

The public option would be a new insurance option that would be available exclusively via the Massachusetts Health Connector, and would be sold alongside the other private health plans that offer coverage through the Connector. The Massachusetts Campaign for Single Payer Health Care has more information about the Medicare for All proposals.

Scroll to the bottom of this page to see recent state-based legislation related to health reform.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.