Massachusetts Health Insurance

Health insurance in Massachusetts

● Massachusetts uses a state-based health insurance exchange called the Massachusetts Health Connector.

● Open enrollment for 2021 coverage is from November 1 to December 15, 2020, although an extension has been issued in past years.

● Eight insurers offer 2020 coverage in the Massachusetts individual market.

● About 312,000 Massachusetts residents enrolled in 2020 coverage through the Massachusetts health insurance market.

● Massachusetts accepted the ACA's Medicaid expansion in 2013.

● Massachusetts laws are inhospitable to short-term plans; as a result, no insurer offers short-term plans in the state.

● The state's CO-OP, Minuteman Health, closed at the end of 2017.

● More than 1.3 million Massachusetts residents are enrolled in Medicare.

This page is dedicated to helping consumers quickly find health insurance resources in the state of Massachusetts. Here you will find information about the many types of health insurance coverage available. You can find the basics of the Massachusetts health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in Massachusetts; a quick look at short-term health insurance in Massachusetts (it's so tightly limited that no plans are currently offered); statistics on state-specific Medicare rules; as well as a collection of Massachusetts health insurance resources for residents.

National leader on health reform

Massachusetts is a leader in public health and health reform, enacting legislation in 2006 aimed at achieving near-universal health coverage. The state's reforms have led to the nation's lowest uninsured rate - a designation the state continues to maintain, with an uninsured rate of just 2.8% in 2018, according to U.S. Census data.

Massachusetts reform strategies, such as an exchange in which private insurers compete, the requirement that people have health insurance coverage or pay a penalty, and subsidies to help those who can't afford coverage, have served as the Affordable Care Act model.

The ACA's individual mandate (i.e. 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 individual mandate of the state continues to be in force, even after the sanction of the ACA's individual mandate has been lifted. Uninsured Massachusetts residents once again pay the penalty on their state taxes, after doing so through their federal taxes for the period 2014-2018.

Massachusetts health insurance marketplace

Massachusetts operates a state-based health insurance exchange called the Massachusetts Health Connector. The exchange offers health coverage to individuals and families and small businesses with up to 50 people. People who are employed by larger companies that provide health coverage do not use Massachusetts Health Connector, nor Massachusetts residents with Medicare, which is operated by the federal government.

Massachusetts Health Connector is the only place a Massachusetts resident can get financial assistance with health insurance premiums and cost-sharing, with income eligibility. People can buy private coverage outside the exchange (i.e., directly from health insurance companies), but without financial assistance.

The exchange is an active buyer exchange, which means that the exchange determines which plans are offered for sale. Massachusetts' health insurance market is very solid, with more carriers participating than most states. The state exchange predates the Affordable Care Act by several years. (The health care reform that was in effect in Massachusetts in 2006 was widely considered a project for the ACA.)

Eight insurers offer plans for 2020 through the Massachusetts health insurance market:

● Boston Medical Center/BMC HealthNet Plan (BMCHP)

● Fallon Community Health Plan

● Health New England Health (HNE)

● AllWays Health Partners (formerly Neighborhood Health Plan)

● HMO tufts

● Blue Cross Blue Shield of Massachusetts (BCBSMA)

● Harvard Pilgrim Health Care (HPHC)

● UnitedHealthcare

The service areas of most insurers comprise much of the state, although insurers' participation varies from four to seven, depending on the county.

Massachusetts open enrollment period and dates

Open enrollment for 2021 individual market plans in Massachusetts will run out from November 1 to December 15, 2020, though Massachusetts has issued enrollment extensions in previous years and could do so again for 2021 coverage.

In light of the coronavirus pandemic, massachusetts health connector announced in March a special enrollment period during which uninsured residents can get medical insurance for 2020. It has been extended and has worked until 23 July 2020.

All state-regulated medical insurance in Massachusetts - which includes all health plans sold through the Massachusetts Health Connector - is needed to cover coronavirus testing without cost sharing and also cover care (in a medical practice, urgent care clinic, or ER, but not in hospital hospital care) without any cost sharing.

In Massachusetts, enrollment in the special enrollment period completed by the 23rd of the month is effective the first of the following month (compared to a 15th-of-month enrollment deadline in most states).

Massachusetts enrollment in qualified health plans

Prior to the adoption of Obamacare's individual mandate in 2014, Massachusetts had the lowest uninsured rate in the nation, at 3.7 percent. By 2016, it had fallen to 2.5%, still the lowest in the nation. It grew a bit, to 2.8%, in 2018, but was still the lowest in the country.

About 31,700 Massachusetts residents enrolled in qualified health plans (QSPs) during the 2014 open enrollment. But this number didn't really reflect actual demand, due to issues with Health Connector. Despite the fact that Obamacare was modeled after reforms massachusetts implemented in 2006, technical updates were needed to make the massachusetts-based, Massachusetts Health Connector-based exchange compliant with the ACA and did not go well in the early days of implementing the ACA.

QHP enrollment would have been much higher had it not been for technical issues with the health connector. About 160,000 new applicants with incomes above 133% of the poverty level that was supposed to be enrolled in QHPS were temporarily enrolled in Medicaid and about 112,200 people ended up staying in their Commonwealth Care plans until the end of 2014.

[Prior to the ACA, Massachusetts ran Commonwealth Care, for individuals with incomes below 300% of the federal poverty level (FPL), and Commonwealth Choice, for uninsured adults whose incomes were too high to qualify for Commonwealth Care. Depending on income levels, some people previously enrolled in Commonwealth Care were transitioned to Medicaid. The rest of the Commonwealth Care population and commonwealth choice population become eligible under the ACA for federal subsidies to purchase new health plans through Health Connector, but full implementation of this required until 2015 in some cases.]

Exchange rate registration improved considerably in the following years. As of June 2016, registration was 223,778. Most of these individuals (171,000) have been enrolled in ConnectorCare, a Massachusetts program that provides state subsidies in addition to federal ACA subsidies to those on incomes up to 300% of the poverty level. ConnectorCare registration lasts all year round.

And by 2020, more than 312,000 people signed up during the open enrollment period, which ended on January 23, 2020. Enrollment has increased year on year for six consecutive years in the Massachusetts health insurance market.

Medicaid expansion in Massachusetts

Former Governor Deval Patrick signed legislation authorizing the Affordable Care Act's Medicaid expansion in July 2013, which helped lower massachusetts' uns insured rate even lower than it was already pre-ACA.

Through the expansion of the ACA, Massachusetts' Medicaid program covers most non-elderly adults with family incomes up to 138% of the FPL. As of May 2020, enrollment in Massachusetts' Medicaid and Chip plans was about 23 percent higher than before medicaid expansion.

Short-term health insurance in Massachusetts

Massachusetts laws are inhospitable to short-term health insurance plans, and as a result, no insurer offers short-term plans in the state.

This is typically due to guaranteed issuance and classification requirements that apply to all health plans in the state, including short-term health insurance. Since 1996, Massachusetts has requested that all health plans marketed to individuals be sold on a guaranteed emission basis (i.e., applications cannot be rejected based on medical history) "according to clearly defined evaluation rules."

Massachusetts regulators continue to impose strict regulations on short-term plans, despite relaxed federal short-term health insurance regulations that are government and is 2018.

Massachusetts health ratings

Massachusetts consistently behaves among the top five states in different public health ratings, and the state's nearly universal health insurance coverage plays a significant role in its top health rankings.

In the 2017 edition of America's Health Rankings, Massachusetts was the most ranked state; in the 2019 edition, it was the second-ranked state, after only Vermont.

The Commonwealth Fund ranked Massachusetts second among states and the District of Columbia in its 2019 Scorecard on state health care. For more details on state performance across different categories and key indicators, see the 2019 Massachusetts scorecard.

Another source of public health information and comparisons is the 2016 edition of Trust for America's Health; see Key Health Data About Massachusetts. You can also compare the health ranking for Massachusetts counties through data published by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

Massachusetts and the Affordable Care Act

Democrats dominate Massachusetts politics at the federal and state levels, and support for Obamacare is solid. When the Affordable Care Act was in preparation for a vote in the U.S. Senate, John Kerry and Scott Brown represented Massachusetts. Kerry voted yes to the ACA, while Brown voted no. Brown was elected in a special election after the death of Edward (Ted) Kennedy, who defended health issues during his political career.

Brown was defeated in his 2012 re-election candidacy by Elizabeth Warren, who supports the ACA and introduced legislation in 2018 to stabilize and protect it. Ed Markey, who also supports the ACA, was selected in a special election after Kerry assumed the role of U.S. Secretary of State.

In the U.S. House of Representatives, nine of the 10 representatives voted in favor of the ACA. Stephen Lynch voted against the ACA, in part because the final legislation did not include a public option. All nine Massachusetts representatives continue to be Democrats.

At the state level, former Governor Deval Patrick signed two bills in 2012 to bring Massachusetts' existing exchanges and policies into compliance with the federal health reform law. In addition, Massachusetts adopted the ACA's expansion of Medicaid.

Governor Charlie Baker was sworn in in 2015. Baker is a Republican, and has been critical of the ACA. But Baker was among a bipartisan group of governors who called on congressional Republicans to reject party efforts to repeal the ACA in 2017, and was critical of the Trump administration's decision in 2017 to end federal funding for cost-sharing reductions (CSR), noting that ending funding could result in a destabilized individual health insurance market (ultimately , insurers simply added the cost of RSI to the silver plan premiums , which translates into higher premium subsidies — funded by the federal government — and protecting most consumers from bearing the burden of rising prices.

Other ACA reform provisions

The ACA's Consumer Operated and Oriented Plan (CO-OP) was designed to encourage new non-profit health insurers to enter the market, but most CO-OPs failed in the early years, largely due to shortcomings in the ACA's risk corridor program and the way the risk adjustment program is structured , as well as premiums that were perhaps too low.

Twenty-four CO-PO received loans totaling $2.09 billion in January 2014. In Massachusetts, Minuteman Health, Inc.

Minuteman Health expanded to New Hampshire for the 2015 coverage year. It remained in operation throughout 2017, but was eventually closed at the end of 2017 and placed into receivership.

Read more about the Affordable Care Act's CO-PO (as of 2020, four are still in operation in five states; which will drop to three CO-OOs in four states starting in 2021, with new Mexico's CO-OP closing in late 2020).

Medicare coverage and enrollment in Massachusetts

Enrollment in Massachusetts Medicare reached 1,351,586 as of August 2020. Eligibility for Medicare is age-based (at least 65) for most people, but 16% of Massachusetts Medicare beneficiaries are under 65 and eligible for Medicaid due to a disability.

Massachusetts Health Insurance Resources

● Children's medical safety plan

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

● Health Care for All - Massachusetts Consumer Care Program  Assists people insured by private health plans, Medicaid, or other plans to address issues related to their health coverage; assists uninsured residents with access to care. (800) 272-4232

● Massachusetts Division of Insurance (supervises, licenses, and regulates health insurance companies, brokers, and agents)

● Office for Patient Protection, Department of Public Health

800-436-7757 (national toll-free)

● It 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 national service that can provide assistance and information on a variety of Medicare issues)

● Massachusetts SHINE program (serving everyone's health insurance needs) - the state's Medicare consulting and care program