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Healthcare Advisor

Dr. Noor Ali is a licensed medical doctor and surgeon with an established national health insurance consulting practice serving clients in 34+ states.

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.

What to know about insurance in Massachusetts

  • Massachusetts Health Connector: In Massachusetts, if you don’t have health insurance through your employer, or your employer’s health care plan doesn’t provide enough coverage, you can buy a private health insurance plan through the Massachusetts Health Connector.
  • Open Enrollment: The open enrollment period for Massachusetts health insurance tends to run a bit longer than most states. It opens on November 1 and lasts until January 23. If you fail to enroll during this timeframe and you lack a qualifying event, you can request an Open Enrollment Waiver, which may allow you to enroll outside of these dates.
  • Special Enrollment: Special enrollment periods allow you to enroll in health insurance outside of normal enrollment dates. You may qualify for a special enrollment period if you have a qualifying event, such as having a child, getting married, losing your job, or moving.
  • ConnectorCare: Massachusetts households with incomes that are 300% of the federal poverty level or lower may qualify for ConnectorCare. Even if your income is above this level, you may still be eligible for tax credits that can help you lower your health care costs. You can still purchase a plan through the exchange no matter what your income level is.
  • Coverage types: Almost 56% of Massachusetts residents obtain health coverage through an employer. Another 22.1% are enrolled in Medicaid, 13.1% are enrolled in Medicare, and less than 1% of residents obtain their coverage through the military. At 3%, Massachusetts has the lowest number of uninsured residents in the nation.

How do I enroll in Massachusetts' health insurance marketplace?

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:

  • Contact information
  • Employer’s name
  • Household status
  • Immigration status
  • Income

You’ll need to provide this information for every member of your household for which you are applying for health care:

  • Social Security number
  • Name

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.

How do I enroll in Massachusetts individual and family insurance?

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.

Insurance for individuals in Massachusetts

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:

  • Health Maintenance Organization (HMO) plans are typically the lowest-priced plans, but they also have the most restrictions. You’ll need to use in-network providers, name a primary care physician, and obtain referrals to see a specialist.
  • While Preferred Provider Organizations (PPOs) cost a bit more, they allow you to see out-of-network providers, and you won’t need to name a primary care physician or obtain a referral to visit specialists.
  • A Point-of-Service (POS) plan combines features of HMO and PPO plans. You’ll still need referrals to see a specialist, but you can use out-of-network providers.

The following companies offer individual health insurance plans through the Massachusetts Health Connector:

  • Allways Health Partners
  • Blue Cross Blue Shield of Massachusetts
  • Boston Medical Center HealthNet Plan
  • Fallon Health
  • Harvard Pilgrim Health Care
  • Health New England
  • Tufts Health Plan Direct
  • Tufts Health Plan Premier
  • UnitedHealthcare

Insurance for families in Massachusetts

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.

How much does health insurance cost in Massachusetts?

Many of the health care plans offered through the Massachusetts Health Connector are ACA compliant. The ACA plans break down into four tiers, known as the metal categories: bronze, silver, gold, and platinum. The categories are based on premium, deductible, and coinsurance costs.

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

  • Bronze plans have the lowest monthly premiums. However, these plans also have high deductibles. You’ll also need to pay coinsurance payments of 40% for each medical service you receive. These may be the best plans if you’re healthy and don’t have any chronic health concerns. In 2021, the most affordable bronze plan in Massachusetts costs $277 per month.
  • Silver plans offer lower deductibles, but you’ll pay a higher monthly premium. With these plans, you’ll only pay a 30% coinsurance fee for each medical service you receive. Many plans in the Massachusetts Health Connector offer extra savings, which are often only available when you purchase a silver plan that uses the Federal Health Exchange. In 2021, the lowest-priced silver plan in Massachusetts costs $353 per month.
  • Gold and platinum plans have the highest monthly premiums, but you’ll have a lower deductible. These plans also have very low coinsurance fees — only 20% with a gold plan and 10% with a platinum plan. These are good plans if someone in your family has a chronic health condition. In 2021, the most affordable gold plan in Massachusetts costs $419.

What kind of low-income health insurance is available in Massachusetts?

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.

Medicaid in Massachusetts

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

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:

  • Allways/Neighborhood Health Plan
  • Boston Medical Center HealthNet Plan
  • Fallon Health
  • Health New England
  • Tufts Health Plan Direct

What are Massachusetts’ Medicare options for seniors and people with disabilities?

Massachusetts has Medicare options available to older adults and people with disabilities.

  • Original Medicare is the standard version of Medicare available to seniors aged 65 and older and those with qualifying disabilities in Massachusetts. It includes Part A, which covers hospitalizations, hospice, skilled nursing care, and home care, and Part B, which covers hospital visits, ambulance services, preventative health care, mental health care, and durable medical equipment. However, Original Medicare doesn’t cover prescriptions. If you need prescription coverage, you’ll need to purchase a separate Medicare Part D plan.
  • Medicare Advantage Plans, also known as Medicare Part C, offer more coverage than Original Medicare. In 2019, there were 57 Medicare Advantage Plans available in Massachusetts. These plans include vision, hearing, and dental coverage, and many also include fitness memberships and prescription drug coverage.

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.

Eligibility

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.

Enrollment

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).

Medicare Resources

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.

Are there short-term health insurance plan options in Massachusetts?

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.

Massachusetts Insurance FAQs

Does Massachusetts require health 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.

Do I have to use the Massachusetts Health Connector, the health care marketplace in Massachusetts?

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.

What types of alternative health insurance plans (like cost-sharing plans) are available in Massachusetts?

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.

Do I need health insurance if I have an FSA/HSA?

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.

Do I need short-term disability coverage in Massachusetts if I 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.

Do I need long-term disability coverage in Massachusetts if I have health insurance?

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.

What does ConnectorCare cover?

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.

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