En español | Most Massachusetts residents are eligible to buy health insurance through Massachusetts Health Connector, the state’s Affordable Care Act (ACA) marketplace, when open enrollment begins this fall.
If you experience a qualifying life event — such as the birth of a child, a move, a marriage, a divorce or the loss of your employer-provided health insurance — you may be able to enroll or change your coverage outside of open enrollment.
Most people enrolled in ACA marketplace plans have seen their premiums go down because the 2021 American Rescue Plan Act (ARPA) increased tax credits for insurance premiums and expanded the number of households that qualify for them. Every household that pays more than 8.5 percent of its income qualifies for federal tax credits to help afford health insurance. These enhanced subsidies are available through 2025.
Before the 2021 law, such tax credits were only available to people earning less than a certain salary ($54,360 for one person). Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.
First, collect documents you may need for the application process, including your Social Security number or immigration documents and your federal tax return from last year.
Online applications are typically the fastest way to get coverage, but you can also apply by phone or mail. Or you can visit a Health Connector walk-in center in Boston, Springfield or Worcester. Note that capacity may be limited at the centers due to COVID-19 guidelines.
Once you’re approved for a plan, you’ll need to pay your first monthly premium by the 23rd of the month for your coverage to begin.
To apply and enroll:
You can preview your and your family’s eligibility for certain plans and check coverage and cost estimates on the Health Connector page. If you need help with your application, check Health Connector’s guide to enrollment or call 1-877-623-6765 to speak with a customer service representative. Or contact a local enrollment assister or application counselor who can answer questions and help determine if you qualify for financial assistance.
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family.
If you qualify for Medicaid through MassHealth, you’ll be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All Health Connector plans cover 10 “essential” benefits, including:
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
Dental plans are available for children under 19, families and individuals, and you can add them to your existing plan or enroll at any time of the year. Deductibles and out-of-pocket costs vary between plans. Children’s plans cap out-of-pocket expenses at $350 and cover medically necessary orthodontia. To purchase a dental-only plan, call 1-877-623-6765.
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2025.
According to Megan O’Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have already seen average annual savings of more than $950.
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
The MassHealth Premium Assistance (PA) program reimburses some or all of the premium costs for people with certain types of employer-provided health plans. Eligibility varies based on household income and several other factors, including disability status, the presence of children in the home and the type of plan offered by the employer. Call MassHealth premium assistance experts to learn more: 800-862-4840.
Massachusetts Health Connector’s plans are organized into four categories:
You can compare plans and estimate costs using the Health Connector website, but you’ll need to complete an application to see whether you qualify for tax credits or other financial assistance. Massachusetts residents under 30 can also apply for a catastrophic plan offering low premiums but with very high deductibles.
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to Massachusetts Health Connector. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.12 percent of your household income for individual coverage.
If you lose coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may be able to sign up for a Health Connector plan during a 60-day special enrollment window. Try to apply and select your Health Connector plan before your COBRA coverage ends to make sure there's no gap in coverage. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a local enrollment expert.
That depends. Major insurance providers, including UnitedHealthcare, Blue Cross Blue Shield of Massachusetts and Health New England offer Health Connector plans, but not all doctors accept them. You can talk to your primary care physician to see whether he or she accepts a particular marketplace plan or search the Health Connector provider directory.
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs such as Medicare, Medicaid or the Children’s Medical Security Plan, which is available to children in households with income too high to qualify for Medicaid but who may still need help paying for health insurance. Such families may choose to enroll separately. They may still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.
This guide was updated on Jan. 25, 2023, with new information about open enrollment.
This story is provided by AARP Massachusetts. Visit the AARP Massachusetts page for more news, events, and programs affecting retirement, health care, and more.
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