Availability of short-term health insurance in Massachusetts

Due to the fact that health plans in Massachusetts must follow the state’s rules, including “guaranteed-issue and rating restrictions,” short-term health insurance in Massachusetts is non-existent. As a result, there are no short-term health plans available for purchase in the state.

State regulators in Massachusetts, along with a coalition of Massachusetts health plans, urged the Trump Administration to retain states’ rights to regulate short-term plans even after the federal rules were relaxed. The Trump Administration’s rules for short-term plans, which took effect in 2018, are clear in noting that states may continue to impose tighter regulations than the new federal rules, and Massachusetts regulators made it clear that they intend to do so, noting that

“We therefore support the ability to regulate our own insurance market in a manner consistent with our commitment to broad, shared, and stable risk pools, and, as such, do not intend to take up the new flexibility around STLD plans offered in the proposed regulation.”

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 has had its own state-based individual health insurance mandate since 2006, and traditional short-term health insurance would not count as having coverage for the purpose of fulfilling the mandate. Although there is no longer a penalty from the federal government for not having minimum essential coverage, the individual mandate penalty in Massachusetts is still in force, and is collected on state tax returns.

The Massachusetts health insurance marketplace is available to residents in need of health insurance coverage, and offers a large variety of coverage options with premium subsidies and cost-sharing subsidies available based on household income (these subsidies help to offset monthly premium costs as well as out-of-pocket costs, with eligibility based on household income).

The health insurance plans sold in the marketplace are designed for people who are self-employed, employed by a small business that doesn’t offer health coverage benefits, or early retirees who aren’t yet eligible for Medicare.

Healthcare plans in the Massachusetts marketplace are available to anyone during the annual open enrollment period (which tends to continue until January 23 in Massachusetts, offering one of the longest enrollment periods in the United States). If it’s outside of the annual open enrollment period, you may qualify for a special enrollment period if you’ve experienced a qualifying event, such as losing healthcare coverage through an employer, moving to a new area, or getting married.

As discussed below, Medicaid is available year-round to people who are eligible for it. In addition, Massachusetts offers ConnectorCare coverage to residents with income up to 300% of the poverty level. And enrollment is available at any time to people who are either newly eligible for ConnectorCare, or who haven’t applied for that coverage in the past.

Based on your income you may also qualify for health insurance in Massachusetts under expanded Medicaid coverage. When the Affordable Care Act was enacted in 2010, Medicaid expansion was a cornerstone of lawmakers’ efforts to expand realistic access to health coverage and healthcare to as many people as possible. If you have a household income up to 138% of the poverty level, you will likely be able to enroll in Medicaid (MassHealth), and enrollment is available year-round.

Medicaid eligibility is also calculated on a monthly basis, so even if you earned more than 138% of the poverty level earlier in the year, or expect to do so later in the year, MassHealth can serve as temporary coverage during a time when your income is low. Once your income picks back up, you and your dependents will be eligible for a special enrollment period (triggered by loss of eligibility for Medicaid) during which you can change to private coverage offered via the Massachusetts marketplace.

Yes. Starting in 2006, Massachusetts residents were required by law to have qualifying health insurance coverage or to pay a penalty when filing a state tax return (uninsured residents who qualify for an exemption do not have to pay a penalty).

From 2014 to 2018, Massachusetts suspended collection of its individual mandate penalty because the federal government had a similar penalty. But Massachusetts began imposing the state-based penalty again in 2019, after the federal penalty was reduced to $0.

The penalty in Massachusetts is calculated as 50% of the cost of the lowest-cost plan that the person could have purchased.

Short-term health insurance is not available in Massachusetts, but even if it were, it would not satisfy the state’s individual mandate requirements.

Consumers in Massachusetts can buy ACA-compliant health insurance through the state’s marketplace, Massachusetts Health Connector. Eight carriers offer coverage through the exchange in 2023.

Massachusetts residents may also be eligible for Medicaid coverage.