Massachusetts Health Insurance Consumer Guide

To purchase health coverage through the Massachusetts Marketplace, you must:⁵

• Live in Massachusetts
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for premium subsidies and cost-sharing reductions through the Marketplace depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.⁶
• If married, file taxes jointly with your spouse.⁷ (with very limited exceptions)⁸
• Not be able to be claimed by someone else as a tax dependent.⁹

It’s important to note that Massachusetts is one of the states that has its own individual mandate, and residents who don’t have health insurance are subject to a penalty when they file their state tax returns.¹⁰  The individual mandate in Massachusetts pre-dates the ACA. It was paused from 2014 through 2018, when there was a federal penalty for not having health insurance. Massachusetts revived the state-based penalty in 2019.

The open enrollment period for individual/family health coverage in Massachusetts runs from November 1 to January 23. This is slightly longer than in most states.¹¹ 

Outside of open enrollment, a qualifying life event is generally necessary to enroll in a plan or make coverage changes. But residents who are eligible for ConnectorCare can enroll anytime if they are newly eligible or haven’t previously enrolled.¹²

Massachusetts also has a “Simple Sign Up Program” that allows people to use their state tax return to gain access to health coverage.¹³ Several other states have similar programs.

To enroll in an ACA Marketplace plan in Massachusetts, you can: 

• Visit the Health Connector to access Massachusetts’s state-run health insurance marketplace. Here you will find an online platform to shop, compare, and choose the best health plans. 
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.¹⁴

The Massachusetts Health Connector debuted a program for automatic enrollment in 2022. It allows applicants to check a box on the application indicating that if they are eligible for a $0 premium ConnectorCare plan but don’t select a plan themselves, the exchange will automatically enroll them in a $0 premium plan. If the applicant had coverage in the past with a carrier that offers one of the available $0 premium plans, the exchange will enroll the person with that carrier. If not, and if multiple $0 premium plans are available, the exchange will randomly assign the person to one of the available plans. But applicants in this scenario have the option to select a different plan instead of the one to which they’re automatically assigned.¹⁵

The federal government reported that 1,568 people who previously had MassHealth coverage had been automatically enrolled into a qualified health plan by the Massachusetts Health Connector between April and June 2023.¹⁶

Residents in Massachusetts use the Health Connector to enroll in Marketplace health coverage as well as to determine subsidy eligibility. Both non-standardized and standardized health plans are available through the Health Connector.¹⁷

The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset premium payments to help keep your expenses down. About 80% of Massachusetts Health Connector enrollees saved money on 2024 premiums. The average subsidy for these enrollees was $385/month, resulting in an average after-subsidy premium of $118/month.¹⁸

In addition to federal subsidies, Massachusetts residents may also qualify for additional subsidies via the ConnectorCare program. ConnectorCare plans qualify for the federally funded ACA premium tax credits, but are also subsidized by the state, resulting in even lower premium and out-of-pocket costs for eligible residents.¹⁹

ConnectorCare was historically available to applicants with income up to 300% of the poverty level. But starting in 2024, ConnectorCare eligibility was expanded to 500% of the poverty level.²⁰

ConnectorCare enrollment has been steadily increasing since mid-2023, due to the post-pandemic return to normal eligibility redeterminations and disenrollments for MassHealth (Medicaid). Many people who are no longer eligible for MassHealth are now eligible for ConnectorCare instead.²¹ And the expansion of eligibility to 500% of the poverty level also helped to drive ConnectorCare enrollment to record-high levels for 2024.²²

ConnectorCare plans are offered by the same insurers that offer other QHPs via MA Health Connector. There are seven plan variations available, access to each plan depends on the applicant’s income. The premiums range from $0/month (for those with income up to 150% FPL) to $255/month (for those with income between 400% and 500% FPL).²³

Source: CMS.gov²⁴

Eight insurers offer exchange plans in the Massachusetts exchange.²⁵ Coverage areas vary from one insurer to another, so plan availability depends on where you live. All eight insurers will continue to offer coverage in 2025.¹

Another insurer, HPHC Insurance Company, only offers plans outside the exchange, and has just over 1,000 enrollees in 2024.¹

Another off-exchange insurer, ConnectiCare, did not file rates for 2025, so their enrollees may need to select a new plan during the open enrollment period in the fall of 2024.

The following average rate changes have been approved for 2025. The overall average approved rate increase is 7.9%, which is a little lower than the initially proposed rate increases.¹

Source: Massachusetts Division of Insurance; Office of Consumer Affairs and Business Regulation¹

Although the weighted average rate increase for 2025 is 7.9%, most people enrolled in individual/family coverage through MA Health Connector are subsidy-eligible and thus do not pay the full price of their coverage.²⁶ Subsidies are designed to keep pace with the cost of the benchmark plan (second-lowest-cost Silver plan), so they will grow if the price of the benchmark plan increases.

Because Massachusetts has a merged individual and small-group market, each carrier’s rate changes apply to both individual and small-group plans.

For perspective, here’s a summary of how average premiums have changed in Massachusetts over time:

• 2015: 1.6% increase²⁷
• 2016: 6.3% increase²⁸
• 2017: 19% increase²⁹
• 2018: 18% increase³⁰
• 2019: 4.7% increase³¹
• 2020: 5.2% increase³²
• 2021: 7.9% increase³³
• 2022: 6.9% increase³⁴
• 2023: 7.6% increase³⁵
• 2024: 3.2% increase³⁶

During the 2024 open enrollment period, 311,199 people enrolled in a health plan through the Massachusetts exchange.³⁷

This was the highest enrollment had been in Massachusetts since 2019 (see chart below). The enrollment increase was driven by the continued enhancement of subsidies under the American Rescue Plan and Inflation Reduction Act, Massachusetts’ decision to extend ConnectorCare eligibility to 500% of the federal poverty level (up from 300% in previous years),²² and the “unwinding” of the pandemic-era federal Medicaid continuous coverage rule.

According to a CMS report, almost 89,000 Massachusetts residents transitioned from MassHealth to a Marketplace plan through Massachusetts Health Connector between April 2023 and April 2024, due to the “unwinding.”³⁸

Source: 2014,³⁹ 2015,⁴⁰ 2016,⁴¹ 2017,⁴² 2018,⁴³ 2019,⁴⁴ 2020,⁴⁵ 2021,⁴⁶ 2022,⁴⁷ 2023,⁴⁸ 2024⁴⁹

Massachusetts Health Connector
877-MA-ENROLL (877-623-6765)

State Exchange Profile: Massachusetts
The Henry J. Kaiser Family Foundation overview of Massachusetts’s progress toward creating a state health insurance exchange.

Health Care for All – Massachusetts Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.(800) 272-4232

Office of Patient Protection, Department of Public Health
800-436-7757 (toll-free nationwide)
Serves residents and other consumers who receive health coverage from a Massachusetts carrier, insurer, or HMO.