Massachusetts Health Insurance Consumer Guide

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.

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

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

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

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

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.

Source: Office of Consumer Affairs and Business Regulation¹⁴

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

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.