En español | Most Massachusetts residents are eligible to buy health insurance through Massachusetts Health Connector, the state’s Affordable Care Act (ACA) marketplace. And you might be able to save money on premiums, thanks to expanded federal tax credits in last March's coronavirus relief bill. Health Connector’s open enrollment period begins in November, but you may still be able to switch to a marketplace plan if you get married, have a baby or experience another qualifying life event.
Most people already enrolled in ACA marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
Who is eligible?
- Most Massachusetts residents, including non-U.S. citizens with worker or student visas, are eligible to buy health insurance through Health Connector.
- Low-income individuals and families can get coverage through MassHealth — which combines Medicaid and Children’s Health Insurance Program (CHIP) enrollment. People with MassHealth plans may be able to get some or all of their insurance premiums covered, depending on household income and if they’re parents or pregnant, need long-term care, living with a disability or meet other criteria.
- ConnectorCare plans are available to Massachusetts households with annual income at or below 300 percent of the federal poverty level (around $38,000 for one person) that do not have access to an affordable plan through an employer. These plans have low or no monthly premiums, no deductibles and low out-of-pocket costs.
- Certain low-income residents may also be eligible for a Health Safety Net (HSN) plan, which covers costs related to acute care and community health center care. These are not full insurance plans but can help cover hospital costs for households at or below 300 percent of the federal poverty level. You may still need to meet a deductible, depending on your income.
When can I enroll?
- Health Connector open enrollment runs from Nov. 1 through Jan. 23.
- You can enroll anytime if you experience a qualifying life event, but you usually only have 60 days from that event to enroll. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances.
- You can also enroll anytime if you qualify for a MassHealth plan, if you had a life event that qualifies you for a ConnectorCare plan, if you’re applying for dental coverage, or if you’re a member of a recognized American Indian tribe.
How do I sign up?
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 by mail. Usually, you can also apply in person at certified enrollment centers, but those facilities are currently closed due to COVID-19. 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:
- Online: Click Apply Now on the Health Connector page. You’ll be asked to create an account if you don’t already have one. You’ll also be asked for personal information like your Social Security number (if you have one), your address and proof of income. Your application will determine whether you qualify for a Health Connector, MassHealth or ConnectorCare plan, so you won’t need to submit separate applications.
- By phone: Call 800-841-2900. If you’re deaf, hard of hearing or speech disabled, call 800-497-4648.
- By mail: Mail a completed application to:
Health Insurance Processing Center
P.O. Box 4405
Taunton, MA 02780
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.
What is covered, and how much will it cost?
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:
- Emergency services and hospitalization
- Pregnancy, maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and pediatric care
- Prescription drugs
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.
What about new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums.
For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
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.
If you’ve collected unemployment benefits this year, even for just one week, you may qualify for a ConnectorCare $0/month premium plan, thanks to the American Rescue Plan. This extra financial help will expire at the end of 2021.
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.
What plans are available?
Massachusetts Health Connector’s plans are organized into four categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays, and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover roughly 70 percent of costs. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums and lower deductibles and copays, and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays, and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
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 age 30 can also apply for a catastrophic plan offering low premiums but with very high deductibles.
What if I already have health insurance?
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 9.83 percent of your household income for individual coverage or more than 8.27 percent for family coverage in order for you to qualify for the tax credits.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours prior to Oct. 1, you’ll be able to switch over to a Health Connector plan during a 60-day special enrollment window, as if you had a qualifying life event.
If you’re on COBRA, you may want to sign up for a marketplace plan that starts as soon as your COBRA coverage ends. 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.
Will I need to get a new doctor?
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.
Will my family members qualify for the same health plan that I do?
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 Oct. 1 with more information about open enrollment.