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 self-purchased 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 several participating insurers. 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).
In Massachusetts, open enrollment for individual/family health plans runs from November 1 through January 23. This is slightly longer than the enrollment window that most states have.
Learn more in our comprehensive guide to open enrollment.
Although open enrollment ends on January 23 each year, enrollment in ConnectorCare is available year-round for people who are newly eligible or who haven’t previously applied for ConnectorCare.
In Massachusetts, special enrollment period applications completed by the 23rd of the month are effective the first of the following month.
In Massachusetts, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). Nearly 90% of consumers who enrolled in 2022 coverage through their state exchange received premium subsidies.
Massachusetts residents may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Massachusetts.
Eight insurers offer plans through the health insurance marketplace in Massachusetts for 2023:
- WellSense (formerly Boston Medical Center/BMC HealthNet Plan)
- Fallon Community Health Plan
- Health New England (HNE)
- Mass General Brigham Health Plan (formerly AllWays Health Partners; formerly Neighborhood Health Plan)
- Tufts Health Plan Direct
- Blue Cross Blue Shield of Massachusetts (BCBSMA)
- Harvard Pilgrim Health Care (for 2023, this includes members who had Tufts Premier in 2022, as a result of a merger)
The service areas of most of the insurers include much of the state, although insurer participation does vary from one area to another. There are also several insurers in Massachusetts that only offer plans outside the marketplace.
For 2023, Massachusetts Health Connector’s insurers implemented rate changes that amounted to an average increase of 7.6%.
Because Massachusetts has merged its individual and small group health insurance markets, each insurer’s rate changes apply to plans in both markets. The weighted average rate change based on enrollment in group and non-group coverage was 6.6% for 2023.
This was very similar to the year before, when premiums increased by an average of 6.9% for individual and small-group plans.
By January 15, 2023, private plan enrollment through Massachusetts Health Connector stood at 224,934. At that point, there were still eight days remaining in the open enrollment period for 2023 coverage in Massachusetts.
Enrollment in private plans through Massachusetts Health Connector is not as high as it was in prior years, but enrollment in MassHealth (Medicaid) has increased significantly during the COVID pandemic. And in keeping with federal rules in place during the pandemic, MassHealth suspended disenrollments 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. But the ban on disenrollments ends March 31, 2023, and enrollment in MassHealth (and Medicaid throughout the country) is expected to decline throughout the rest of 2023 and early 2024. Some of the people who lose Medicaid will transition to private coverage through Massachusetts Health Connector.
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 late 2022, enrollment in Massachusetts Medicaid plans and CHIP was about 51% 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 1,402,442 as of October 2022. Eligibility for Medicare is based on age (being at least 65) for most people, but nearly 13% 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
Yes. Massachusetts implemented an individual mandate in 2006. The penalty is half of the lowest priced ConnectorCare enrollee premium for individuals with incomes from 150.1% to 300% of the Federal Poverty Level.