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Massachusetts residents have many health care options to choose from. The number of options is one of the reasons Massachusetts has the lowest number of uninsured residents in the United States.
This guide provides a detailed overview of your health insurance options in Massachusetts.
Massachusetts law mandates every individual or family must have health care coverage or face financial penalties. If you don’t receive health care through your employer, you can enroll for health care using the Massachusetts Health Connector. You can do it online or by phone at 1-800-841-2900. You can also mail the application form or fax it to 617-988-8903.
When you create an account, you’ll need to provide information including:
You’ll need to provide this information for every member of your household for which you are applying for health care:
All plans carried by the Health Connector cover prescription drugs and visits to the hospital or doctor. The Health Connector allows you to compare out-of-pocket costs, deductibles, and copays. The Massachusetts Health Connector can also determine whether you’re eligible to receive tax breaks or subsidies based on your household income.
You can enroll in individual or family insurance through the Massachusetts Health Connector. Since the Health Connector is an active adjuster exchange, all plans carry comprehensive benefits. You can still use any health insurance company you wish, but they may not provide the same comprehensive benefits that you’ll find through the Health Connector. Use the tools provided to compare the benefits of the plans and how it will serve your needs.
As all the individual plans on the Massachusetts’ state healthcare exchange areguaranteed issue, choosing the right plan can be tricky. It’s wise to take into account your current health situation, level of usage and precise needs for healthcare coverage when selecting a plan. For example, if you are planning to have a baby, look for plans with good maternity coverage and lower deductibles and max out of pockets.
If you are generally healthy and have low usage of insurance, look for a balance of premiums and deductibles that is affordable for you to meet in case of emergencies. Those with chronic health problems may be better off with a plan that charges a higher premium, a lower deductible, and makes it easier to see out-of-network specialists.
There are several types of private plans available to residents of Massachusetts:
The following companies offer individual health insurance plans through the Massachusetts Health Connector:
When shopping for insurance for a family, you need to take the individual health concerns of each family member into consideration. If your family is healthy, you may only need an HMO. However, if one or more of your family members have a chronic health condition that requires constant care, you might be better off purchasing a PPO or a POS plan.
The Massachusetts Health Connector site can help you narrow your choices, so you can find a plan that offers the best coverage for your needs. You’ll want to take your family’s budget and ability to pay out-of-pocket costs, such as deductibles and coinsurance, into consideration. Pay attention to the max out of pocket, as that will act as the stop loss in case of catastrophic events.
In Massachusetts, insurance rates for couples can be based on the age of the youngest person applying for the policy. If there’s an age difference of several years between you and your partner, you may be able to save some money by applying for the same plan.
|Average premium in Massachusetts in Massachusetts||2018||2019||2020||2021|
|Most affordable bronze plan||$252||$257||$259||$277|
|Most affordable silver plan||$307||$323||$324||$353|
|Most affordable gold plan||$378||$363||$386||$419|
Massachusetts has two plans that provide healthcare for low-income residents of Massachusetts: MassHealth (Medicaid and CHIP) and ConnectorCare. MassHealth is a joint program between Massachusetts and the federal government that provides health care to low-income Massachusetts residents and their children. ConnectorCare is a program that offers affordable health care to low- and middle-income Massachusetts residents.
Massachusetts expanded its Medicaid health care coverage under the ACA in 2013. As of November 2020, Massachusetts had enrolled 1,699,664 individuals in MassHealth, a net increase of 31.11%. MassHealth pays part of or all your health insurance premiums, depending on your family’s income. It also offers coverage based on your age, parent status, health conditions, HIV or cancer status, and whether you work for a small employer. To qualify for MassHealth, you must be a U.S. citizen or a permanent resident and live in Massachusetts, and your financial situation must be categorized as low-income or very low-income. There are certain financial limits based on your income, your household size, and federal poverty levels. For example, a single person-household can only earn up to $17,131 per year, while a household of two can’t earn more than $23,169 per year, and households of three are limited to $29,207 per year. You can apply for MassHealth online. You’ll need to fill out an application and provide information about your income and household size. If you’re eligible, you can find a plan that suits your budget and your health care needs.
ConnectorCare plans are known as qualified health plans (QHP’s) and offer year-round enrollment with some limitations. These plans qualify for the ACA premium tax credits but are also subsidized by Massachusetts. This results in lower premiums and out-of-pocket costs for eligible residents. ConnectorCare plans are available to Massachusetts residents who earn up to 300% of the Federal Poverty Level and can’t get affordable health care insurance through work or qualify for other public insurance plans, such as MassHealth. There are three different levels of plans available, based on your income. The insurance companies that offer ConnectorCare plans through the Massachusetts Health Connector are:
Massachusetts has Medicare options available to older adults and people with disabilities.
If you’re worried about out-of-pocket costs for Original Medicare, you can purchase a Medicare Supplement Insurance plan, also known as Medigap. It can help with deductibles, copays, and coinsurance costs. Some Medicare Supplement Insurance Plans also provide coverage when you travel outside of the United States.
To qualify for Medicare in Massachusetts, you need to meet certain eligibility requirements. You must be 65 or older, or younger with a qualifying disability, and you must be a U.S. citizen or a permanent resident for at least the past five years. Applicants with certain diseases or conditions, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, may also qualify at a younger age.
You first become eligible to enroll in Medicare during your seven-month initial enrollment period. This period starts three months before your 65th birthday, includes your birth month, and continues for the three months following your 65th birthday.
The open enrollment period runs from October 15th to December 7th every year. During this enrollment period, you can switch from Original Medicare to a Medicare Advantage Plan or vice versa. You can also switch between different Medicare Advantage Plans.
Qualifying life events can trigger a special enrollment period. You may become eligible for a special enrollment period if you lose your job, move, or become eligible for a Special Needs Plan (SNP).
There are resources in Massachusetts that can help you or your caregiver find out more about your Medicare options. One option is the Massachusetts Executive Office of Elder Affairs. Individuals with questions about their Medicare options can call the office at 1-800-243-4636.
Serving the Health Insurance Needs of Everyone (SHINE) is Massachusetts’ version of the State Health Insurance Assistance Program. Trained SHINE counselors can provide free, unbiased and confidential information to you or your caregiver about your Medicare options in Massachusetts. No SHINE counselors work for a health insurance company, and they will never try to sell you a plan.
No, there are no short-term health insurance plans in Massachusetts. Since health care plans in Massachusetts must follow the state’s regulations, no insurance company in the state carries short-term insurance.
Yes, Massachusetts law mandates that every individual in Massachusetts have health insurance. Any individual who does not have insurance or any business that does not provide it to employees is liable for financial penalties.
No, you can still buy health insurance from any insurance company. However, the private companies that sell insurance through the Massachusetts Health Connector have met all the rules and regulations required to provide comprehensive coverage to an individual or a family. The Massachusetts Health Connector can also help you find plans that can save you money on out-of-pocket costs.
An increasingly popular alternative health insurance plan is what is known as a health care cost-sharing plan or a faith-based health plan. These plans can be sold in Massachusetts because Massachusetts doesn’t consider them to be health insurance plans, and therefore, they’re not regulated by the state and don’t count as mandated insurance. Before you sign up for a cost-sharing health plan, understand the plan may not cover all conditions and typically does not cover pre-existing conditions.
In Massachusetts, everyone is required to have health insurance, regardless of whether you have an FSA or an HSA. FSAs and HSAs are good ideas to help with out-of-pocket costs, but you’ll still need to have health insurance.
Short-term disability coverage is used to cover living expenses that you must pay, even when you can’t work. Health insurance will not pay for these living expenses. Short-term disability insurance can help you cover these costs.
Since you’re required to have health insurance in Massachusetts, your health care costs are covered regardless of how long you’re disabled. However, if you work at a job where injury is a serious concern, it may be worthwhile to purchase a long-term disability plan to pay for household costs if you’re disabled for a long period of time.
ConnectorCare provides comprehensive coverage for individuals and families who earn up to 300% of the federal poverty limit. This coverage includes doctor’s visits, hospitalizations, and prescription drug coverage.