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Massachusetts Health Insurance Consumer Guide
This guide was created to help you better understand the health coverage options available to you and your family in Massachusetts. The options found in Massachusetts’s ACA Marketplace may be a good choice for many consumers, and we will guide you through the options below.
Massachusetts residents use a fully state-run health insurance marketplace known as Health Connector to shop for and purchase ACA Marketplace plans. The state Marketplace provides access to health insurance products from private insurers along with access to federal and state subsidies.
Explore our other comprehensive guides to coverage in Massachusetts
Dental coverage in Massachusetts
In 2023, two insurers offer stand-alone individual/family dental coverage through Massachusetts Health Connector.1 Learn about other coverage options in the state.
Massachusetts’s Medicaid program
Medicaid expansion in Massachusetts took effect in 2014, and is known as MassHealth CarePlus. Over 2 million people were enrolled in the Massachusetts Medicaid program as of April 2023.2
Medicare coverage and enrollment in Massachusetts
Medicare enrollment in Massachusetts stood at 1,408,811 people as of 2023.3 Our guide will help you better understand Medicare coverage options and Medicare-specific regulations in Massachusetts.
Short-term coverage in Massachusetts
There are currently no short-term plans available for purchase in Massachusetts.4
Frequently asked questions about health insurance in Massachusetts
Who can buy Marketplace health insurance?
To purchase health coverage through the Massachusetts Marketplace, you must:5
- Live in Massachusetts
- Be lawfully present in the United States
- Not be incarcerated
- Not be enrolled in Medicare
Eligibility for premium subsidies and cost-sharing reductions through the Marketplace depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area. In addition, to qualify for financial assistance with your Marketplace plan you must:
- Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
- Not be eligible for Medicaid or CHIP.
When can I enroll in an ACA-compliant plan in Massachusetts?
The open enrollment period for individual/family health coverage in Massachusetts runs from November 1 to January 23, this is slightly longer than in most states.6
Outside of open enrollment, a qualifying life event is generally necessary to enroll in a plan or make coverage changes. But residents who are eligible for ConnectorCare can enroll anytime if they are newly eligible or haven’t previously enrolled.7
How do I enroll in a Massachusetts Marketplace plan?
To enroll in an ACA Marketplace plan in Massachusetts, you can:
- Visit the Health Connector to access Massachusetts’s state-run health insurance marketplace. Here you will find an online platform to shop, compare, and choose the best health plans.
Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.8
How can I find affordable health insurance in Massachusetts?
Residents in Massachusetts use the Health Connector to enroll in Marketplace health coverage as well as to determine subsidy eligibility.
More than 74% of eligible enrollees saved money on 2023 premiums. The average subsidy for these enrollees was $381/month, meaning their average premium after subsidy was $118/month.9
In addition to federal subsidies, Massachusetts residents may also qualify for ConnectorCare plans. ConnectorCare plans qualify for the federally funded ACA premium tax credits, but are also subsidized by the state, resulting in even lower premium and out-of-pocket costs for eligible residents.10
The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset premium payments to help keep your expenses down. People with household incomes below 250%of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce your deductibles and out-of-pocket expenses when you buy a Silver plan. Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.
Source: CMS.gov11
How many insurers offer Marketplace coverage in Massachusetts?
Eight insurers offer exchange plans in the Massachusetts exchange for 2023.12
- 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)
- UnitedHealthcare
In most Massachusetts counties, there are at least five insurers offering 2023 Marketplace health plans.13
Are Marketplace health insurance premiums increasing in Massachusetts?
The Massachusetts Health Connector’s insurers requested the following rate changes for 2024:14
Because Massachusetts has a merged individual and small-group market, each carrier’s rate changes apply to both individual and small group plans.
Massachusetts’ ACA Marketplace Plan 2024 Proposed Rate Increases by Insurance Company |
|
|---|---|
| Issuer | Percent Increase |
| Mass General Brigham Health Plan | 7.4% |
| WellSense Health Plan | -3.8% |
| Fallon Community Health Plan | 3.3% |
| Health New England (HNE) | 7.1% |
| Tufts Health Plan Direct | 3.4% |
| Blue Cross Blue Shield of Massachusetts (BCBSMA) | 4% |
| Harvard Pilgrim Health Care | 7.3% |
| UnitedHealthcare | 12.1% |
Source: Office of Consumer Affairs and Business Regulation14
How many people are insured through Massachusetts’s Marketplace?
During the 2023 open enrollment period, 224,934 people enrolled in a health plan through the Massachusetts exchange.9
The increased enrollment during these past years is likely due to the American Rescue Plan (ARP), which made millions of Americans newly eligible for premium subsidies.15
Source: 2014,16 2015, 17 2016,18 2017,19 2018,20 2019,21 2020,22 2021,23 2022,24 2023,15 202425
What health insurance resources are available to Massachusetts residents?
Massachusetts Health Connector
877-MA-ENROLL (877-623-6765)
State Exchange Profile: Massachusetts
The Henry J. Kaiser Family Foundation overview of Massachusetts’s progress toward creating a state health insurance exchange.
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
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.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- “Massachusetts dental insurance guide 2023” healthinsurance.org, Accessed September 2023 ⤶
- “April 2023 Medicaid & CHIP Enrollment Data Highlights” Medicaid.gov, April 28, 2023 ⤶
- “Medicare Monthly Enrollment” CMS.gov, April 2023. ⤶
- “Availability of short-term health insurance in Massachusetts” healthinsurance.org, Feb. 2, 2023 ⤶
- ”A quick guide to the Health Insurance Marketplace” HealthCare.gov ⤶
- “Request for Open Enrollment Waiver” Mass.gov, 2023 ⤶
- “ConnectorCare Health Plans” masshealthconnector.org ⤶
- “Entities Approved to Use Enhanced Direct Enrollment” CMS.gov, April 28, 2023 ⤶
- “2023 Marketplace Open Enrollment Period Public Use Files”CMS.gov, 2023 ⤶ ⤶
- “ConnectorCare Health Plans” masshealthconnector.org, 2023 ⤶
- “2024 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2024 ⤶
- ”Massachusetts Rate Review Submissions” HealthCare.gov, 2023 ⤶
- “2023 Qualified Health Plans” CMS.gov, Oct. 26. 2022 ⤶
- “2024 Health Insurance Rates”Office of Consumer Affairs and Business Regulation, Mass.gov, Accessed August 2023 ⤶ ⤶
- “Health Insurance Marketplaces 2023 Open Enrollment Report”CMS.gov, Accessed August 2023 ⤶ ⤶
- “ASPE Issue Brief (2014)” ASPE, 2015 ⤶
- “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report”, HHS.gov, 2015 ⤶
- “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016 ⤶
- “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017 ⤶
- “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018 ⤶
- “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019 ⤶
- “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020 ⤶
- “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021 ⤶
- “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022 ⤶
- “HEALTH INSURANCE MARKETPLACES 2024 OPEN ENROLLMENT REPORT” CMS.gov, 2024 ⤶
