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Massachusetts health insurance

Eight insurers offer health plans through state's exchange; uninsured rate is consistently the lowest in the nation.

Massachusetts health insurance

This page is dedicated to helping consumers quickly find health insurance resources in the state of Massachusetts. Here, you’ll find information about the various types of health insurance coverage available. You can find the basics of the Massachusetts health insurance marketplace and the current COVID-related special enrollment period; a brief overview of Medicaid expansion in Massachusetts; a quick look at why there are no short-term health insurance plans available in Massachusetts, details about state-specific Medicare rules; as well as a collection of Massachusetts health insurance resources for residents.

National leader on health reform

Massachusetts is a leader in public health and healthcare reform, enacting legislation in 2006 aimed at achieving nearly universal healthcare coverage. The state’s reforms resulted in the nation’s lowest uninsured rate — a designation the state continues to hold, with an uninsured rate of just 3 percent in 2019, according to U.S. Census data (although that was a slight increase from 2.8 percent in 2018).

Massachusetts’ reform strategies, such as an exchange where private insurers compete, a requirement that individuals have health insurance coverage or pay a penalty, and subsidies to help those who can’t afford coverage, served as the model Affordable Care Act.

The ACA’s individual mandate (ie, the provision to require most Americans to maintain health coverage or pay a penalty) was based on a similar program that Massachusetts had implemented a few years earlier. The state’s individual mandate continues to be in effect, even after the ACA’s individual mandate penalty was repealed. Uninsured Massachusetts residents once again pay the penalty on their state taxes, after doing so via their federal taxes for 2014 through 2018.

Massachusetts’s health insurance marketplace

Massachusetts runs a state-based health insurance exchange called Massachusetts Health Connector. The exchange offers health coverage to individuals and families, and to small businesses with up to 50 people. People who are employed by larger businesses that provide health coverage do not use Massachusetts Health Connector, nor do Massachusetts residents with Medicare, which is run by the federal government.

Massachusetts Health Connector is the only place a Massachusetts resident can obtain financial assistance with their health insurance premiums and cost-sharing, with eligibility based on income. People can purchase private coverage outside the exchange (ie, directly from health insurance companies), but without financial assistance.

The exchange is an active purchaser exchange, which means the exchange determines which plans are offered for sale. The Massachusetts health insurance marketplace is very robust, 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).

Eight insurers are offering 2021 plans through the health insurance marketplace in Massachusetts:

  • Boston Medical Center/BMC HealthNet Plan (BMCHP)
  • Fallon Community Health Plan
  • Health New England (HNE)
  • AllWays Health Partners (formerly Neighborhood Health Plan)
  • Tufts (Tufts HMO and Tufts Health Public Plan)
  • Blue Cross Blue Shield of Massachusetts (BCBSMA)
  • Harvard Pilgrim Health Care (HPHC)
  • UnitedHealthcare

The service areas of most of the insurers include much of the state, although insurer participation ranges from four to seven, depending on the county. There are also several insurers in Massachusetts that only offer plans outside the marketplace. Across the entire individual and small group market (which are merged in Massachusetts), premiums increased by an average of 7.9 percent for 2021. This was a more significant increase than the national average, but Massachusetts has had the nation’s lowest average premiums for the last several years.

Read our overview of the Massachusetts health insurance marketplace  – including news updates and exchange history.

Massachusetts open enrollment period and dates

Open enrollment for 2021 individual-market plans in Massachusetts ran from November 1 to January 23, 2021 (several weeks longer than open enrollment in states that use, where enrollment ended on December 15, 2020).

Due to the ongoing coronavirus pandemic, Massachusetts Health Connector has opened a new special enrollment period for uninsured residents and residents who have coverage under COBRA. It continues through March 23, 2021. (Massachusetts also offered a COVID-related special enrollment period  in 2020, which ran through July 23, 2020.)

All state-regulated medical insurance in Massachusetts — which includes all health plans that are sold through Massachusetts Health Connector — is required to cover coronavirus testing with no cost-sharing, and also cover treatment (in a doctor’s office, urgent care clinic, or ER, but not inpatient hospital care) with no cost-sharing.

In Massachusetts, special enrollment period enrollments completed by the 23rd of the month are effective the first of the following month (as opposed to a 15th of the month enrollment deadline in most states).

Massachusetts enrollment in qualified health plans

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. Despite the fact that Obamacare was modeled on the reforms that Massachusetts had implemented in 2006, technical upgrades were needed to make Massachusetts’ state-based exchange, Massachusetts Health Connector, ACA-compliant and they did not go well in the early days of ACA implementation.

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.

[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 whose incomes were too high 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 under the ACA for federal subsidies to purchase new health plans through Health Connector, but the full implementation of this took until 2015 in some cases.]

Exchange enrollment has improved substantially in the ensuing years. 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.

And by 2020, more than 312,000 people signed up during the open enrollment period, which ended on January 23, 2020. Enrollments have increased year-over-year for six years in a row in the Massachusetts health insurance marketplace, although it appears that enrollment for 2021 will end up a little lower.

Read more about the Massachusetts health insurance marketplace.

Medicaid expansion in Massachusetts

Former Gov. Deval Patrick signed the legislation authorizing the Affordable Care Act’s Medicaid expansion in July 2013, which has helped to drive the uninsured rate in Massachusettes even lower than it already was pre-ACA.

Through ACA expansion, the Massachusetts Medicaid program covers most non-elderly adults with household income up to 138 percent of FPL. As of May 2020, enrollment in Massachusetts Medicaid plans and CHIP was about 23 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 health insurance 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 — including short-term health insurance. 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 relaxed federal short-term health insurance regulations that took effect in 2018.

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, and the state’s nearly universal health insurance coverage plays a significant role in its high health rankings.

In the 2017 edition of America’s Health Rankings, Massachusetts was the top-ranked state; in the 2019 edition, it was the second-ranked state, trailing only Vermont.

The Commonwealth Fund also ranked Massachusetts second among the states and the District of Columbia in its 2020 Scorecard on State Health System Performance.

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).

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; that will drop to three CO-OPs in four states as of 2021, with the closure of New Mexico’s CO-OP at the end of 2020).

Medicare coverage and enrollment in Massachusetts

Massachusetts Medicare enrollment reached 1,358,936 as of November 2020. Eligibility for Medicare is based on age (being at least 65) for most people, but 16 percent of Massachusetts Medicare beneficiaries are under 65 and are eligible for Medicaid because of a disability.

Read more about Medicare in Massachusetts, including details about optional private Medicare coverage and benefits, including Medicare Advantage, Medigap, and Medicare Part D.

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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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