Frequently asked questions about health insurance
coverage options in Massachusetts
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.
Massachusetts Health Connector 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).
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 HealthCare.gov, where enrollment ended on December 15, 2020).
(That enrollment window has since ended, but people can still enroll in 2021 coverage in Massachusetts if they experience a qualifying life event, if they’re eligible for MassHealth (Medicaid), or if they’re enrolling in ConnectorCare for the first time.)
The extended enrollment opportunity in 2021 gave new and existing enrollees an opportunity to take advantage of the enhanced premium subsidies created by the American Rescue Plan.
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).
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.
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)
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.
Fallon Health is discontinuing its broad network plans at the end of 2021, but will continue to offer its Community Care plans (narrow network) through Massachusetts Health Connector.
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.
Although the open enrollment period for 2021 coverage has been extended into July 2021, private plan enrollment through Massachusetts Health Connector stood at 280,612 as of early February.
That was about a 12% drop from enrollment the year before, when enrollment hit a record high and more than 312,000 Massachusetts residents signed up during open enrollment. At that point, enrollments had increased year-over-year for six years in a row in the Massachusetts health insurance marketplace.
But enrollment in MassHealth (Medicaid) has increased significantly during the COVID pandemic. And in keeping with federal rules in place during the pandemic (for any states receiving additional COVID-related Medicaid funding, which includes every state), MassHealth has suspended eligibility redeterminations during the COVID emergency period. So people who were eligible for Medicaid as of March 2020 are still eligible and enrolled, reducing the normal churn from public coverage to private coverage.
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% in 2019, according to U.S. Census data (although that was a slight increase from 2.8% 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.
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 Massachusetts 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% of FPL. As of November 2020, enrollment in Massachusetts Medicaid plans and CHIP was about 31% higher than it had been prior to the expansion of Medicaid.
Read more about Massachusetts’ Medicaid expansion.
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 Medicare enrollment reached 1,359,680 as of January 2021. 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.
- Children’s Medical Security Plan
- Massachusetts Health Connector 877-MA-ENROLL (877-623-6765)
- 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
- Massachusetts Division of Insurance (oversees, licenses, and regulates health insurance companies, brokers, and agents)
- 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.
- The Health Foundation of Central Massachusetts
- Medicare Rights Center (a nationwide service that can provide assistance and information about a variety of Medicare issues)
- Massachusetts’ SHINE Program (Serving the Health Insurance Needs of Everyone) — the state’s Medicare counseling and assistance program