Health insurance in Massachusetts
- Massachusetts utilizes a state-based health insurance exchange called Massachusetts Health Connector.
- Open enrollment for 2020 coverage has ended, but residents with qualifying events can enroll. The next enrollment period begins November 1, 2020, for coverage effective in 2021.
- Eight insurers are offering 2020 coverage in the Massachusetts individual market.
- About 312,000 Massachusetts residents enrolled in 2020 coverage through the exchange.
- Massachusetts accepted the ACA’s Medicaid expansion in 2013.
- Massachusetts laws are inhospitable to short-term plans; as a result, no insurers offer short-term plans in the state.
- The state’s CO-OP, Minuteman Health, closed at the end of 2017.
- More than 1.3 million Massachusetts residents are enrolled in Medicare.
National leader on health reform
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 continues to hold, with an uninsured rate of just 2.8 percent in 2018, 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 The state’s individual mandate continues to be in effect, even after the ACA’s individual mandate penalty was repealed.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 2020 individual-market plans in Massachusetts ran from November 1, 2019 to January 23, 2020. Plans selected between December 24 and January 23 took effect 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 remains in effect (the ACA’s individual mandate penalty was eliminated at the end of 2018, so the mandate is assessed on state tax returns in Massachusetts now, instead of federal tax returns).
Eight insurers are offering 2020 plans through the Massachusetts exchange:
- Boston Medical Center/BMC HealthNet Plan (BMCHP)
- Fallon Community Health Plan
- Health New England (HNE)
- AllWays Health Partners (formerly Neighborhood Health Plan)
- Tufts HMO
- Blue Cross Blue Shield of Massachusetts (BCBSMA)
- Harvard Pilgrim Health Care (HPHC)
Read our overview of the Massachusetts health insurance marketplace.
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. It grew a little, to 2.8 percent, by 2018, but was still the lowest in the country.
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. As of June 2016, 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.
Read more about the Massachusetts health insurance marketplace.
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 late 2019, enrollment in Massachusetts Medicaid and CHIP was about 20 percent higher than it had been prior to the expansion of Medicaid.
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 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. In the 2017 edition of America’s Health Rankings, Massachusetts was the top-ranked state.
The Commonwealth Fund ranked Massachusetts second among the states and the District of Columbia in its 2019 Scorecard on State Health System Performance. 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 nine 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 2014, and about 400,000 people had to re-apply for coverage by Dec. 31, 2014.
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, as well as premiums that were perhaps too low.
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.
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.
Read more about the Affordable Care Act’s CO-OPs (as of 2020, four are still operational in five states).
Massachusetts Medicare enrollment
Massachusetts health insurance resources
State-based health reform legislation
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 healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.