Most Massachusetts residents, including non-U.S. citizens with worker or student visas, are eligible to buy health insurance through Health Connector.
Depending on your income, you may qualify for free or low-cost options such as ConnectorCare or MassHealth, which combines Medicaid and Children’s Medical Security Plan (CMSP) enrollment. Certain low-income residents may also be eligible for a Health Safety Net (HSN) plan, which covers costs related to hospital and community health center care.
If you don’t qualify for year-round enrollment and missed the open enrollment deadline (Jan. 23, 2024), you can buy health insurance if you experience a life event that qualifies for a special enrollment period. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances, including the loss of MassHealth coverage. You typically only have 60 days from that event to enroll. For more information, call 1-877-623-6765.
You also can request an open enrollment waiver that allows you to enroll in health insurance without a qualifying event. More information is available online through the state Office for Patient Protection.
The income limits for ConnectorCare will increase and all major insurance carriers, including United HealthCare and Blue Cross Blue Shield of Massachusetts, will be included in the program starting Jan. 1, 2024.
ConnectorCare is expanding its eligibility from Massachusetts households who earn up to 300 percent of the federal poverty level to those who earn up to 500 percent of the federal poverty level. This means that individuals whose annual income is no more than $72,900 or a family of four whose annual income is no more than $150,000 now can qualify.
Find more information about these changes at the exchange’s website.
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.To apply and enroll:
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. 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.
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.
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 may be eligible for free or low-cost coverage, and may not have premiums or co-pays, 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.
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.
The federal government increased tax credits for insurance premiums in 2021 and expanded the number of households that qualify for them. As a result, most people enrolled in ACA marketplace plans have seen their premiums go down. This expanded financial assistance is available through 2025.
If you’re eligible, Massachusetts Health Connector will automatically apply the credits when you enroll.
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 at 800-862-4840.
ConnectorCare offers plans with low or no premiums, no deductibles and low out-of-pocket costs to Massachusetts households who earn up to 500 percent of the federal poverty level.
Certain residents also may be eligible for Health Safety Net, which can help cover hospital and community care center costs if your household is at or below 300 percent of the federal poverty level — or in other words, an annual income of $43,740 per person or $90,000 for a family of four. You may still need to meet a deductible, depending on your income.
Use the marketplace website’s Get an Estimate tool to see if you qualify for savings.
If you already have affordable coverage — through your employer, for example — you most likely will not qualify for financial help offered through the marketplace plans.
If you’re independently enrolled in a private health insurance plan, not through an employer, you may qualify for significant savings if you switch to a Massachusetts Health Connector plan. But you may need to wait until open enrollment begins.
If you were receiving temporary continuation of your health care coverage under COBRA, and that coverage has ended, you may be able to sign up for a Massachusetts Health Connector plan during a 60-day special enrollment window. Try to apply and select your plan before your COBRA coverage ends to make sure there’s no gap in coverage.
If you already have a marketplace plan and want to adjust your coverage, you'll need to do so during open enrollment, unless you experience a qualifying life event or qualify for year-round enrollment.
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 Nov. 3, 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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