HomeFactsDo I Need Health Insurance In Massachusetts

Do I Need Health Insurance In Massachusetts

What Types Of Alternative Health Insurance Plans Are Available In Massachusetts

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An increasingly popular alternative health insurance plan is what is known as a health care cost-sharing plan or a faith-based health plan. These plans can be sold in Massachusetts because Massachusetts doesnt consider them to be health insurance plans, and therefore, theyre not regulated by the state and dont count as mandated insurance. Before you sign up for a cost-sharing health plan, understand the plan may not cover all conditions and typically does not cover pre-existing conditions.

Do I Have To Use The Massachusetts Health Connector The Health Care Marketplace In Massachusetts

No, you can still buy cheap health insurance from any insurance company. However, the private companies that sell insurance through the Massachusetts Health Connector have met all the rules and regulations required to provide comprehensive coverage to an individual or a family. The Massachusetts Health Connector can also help you find plans that can save you money on out-of-pocket costs.

Where To Apply For Health Coverage

People in most states use HealthCare.gov to apply for and enroll in health coverage.

If your state appears on the list below, you wont use HealthCare.gov. Youll use your states website to enroll in individual/family or small business health coverage, or both.

Covered California is your state’s Marketplace. Visit Californias website.

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Benefits That Work For You And Your Family

Our health insurance plans were created with you in mind. Discover an extensive list of covered services that allow you to live your life on your terms. To see all that our plans have to offer, view our product guide:

When youre covered by Harvard Pilgrim, you also get access to:

  • $0 copay for your annual physical exam and flu shot
  • Reimbursement for gym memberships, fitness classes and more
  • Monthly gift card drawing entries through our Living Well program that includes complimentary online classes, like yoga, Zumba® and meditation sessions
  • Personal health coaching at no additional cost

More reasons to choose us

Do You Need Health Insurance

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Health insurance is a type of coverage that pays a portion or all of your medical bills for doctor visits, hospital stays, prescription drugs and other healthcare services. You pay premiums for your coverage.

If youre young and relatively healthy, you may wonder: Is health insurance worth the money?

Despite the cost of health insurance, having it can make a big difference when you need medical services. If youre healthy, your routine care may be covered at no charge. Preventive care is covered if you are healthy or not.

If you need regular visits or prescriptions, coverage can reduce or eliminate your out-of-pocket costs. You also have more options when you go to the hospital for non-emergency reasons. If you dont have coverage, the hospital could refuse to treat you.

And since one injury or emergency room visit can leave you hundreds, if not thousands, of dollars in debt, health insurance can protect you from catastrophic bills.

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Understanding The Rules For Health Insurance Can Be Confusing

The Affordable Care Act , signed into law in 2010, was designed to make health insurance coverage more affordable for Americans through the creation of tax subsidies while also opening up Medicaid eligibility to more low-income individuals and families. The ACA effectively made having health insurance mandatorynot having it meant you would incur a tax penalty. But what about now? What is the penalty for not having health insurance?

The Cheapest Health Insurance In Massachusetts By Metal Tier

The Massachusetts insurance exchange divides private plans into four metal tiers, including Bronze, Silver, Gold and Platinum. Though these do not affect the quality of care you receive, they determine the percentage of your medical expenses to be covered. Lower level plans, such as Bronze ones, cost less each month but may require you to pay more out-of-pocket if you need medical care.

The cost of health insurance policies in Massachusetts within a metal tier vary, but on average, their monthly premiums are:

  • Bronze: $403 per month
  • Gold: $634 per month
  • Platinum: $843 per month

Tiers named after more valuable metals, like gold or platinum, require you to pay a higher monthly premium. If you have a lot of medical expenses, this may turn out to be more cost-effective since youll pay less out of pocket.

In the Massachusetts insurance exchange, policy premiums, out-of-pocket maxes and deductibles vary within tiers. The table below reflects the cheapest health insurance in Massachusetts for each metal tier using monthly premiums.

If you earn less income, check if youre eligible for cost-sharing reductions . These are available for those who purchase Silver plans and cause your deductibles to be lower than usual, making them an excellent deal.

These are plans for a 40-year-old male buyer for EPO and HMO plans. Of these, HMOs are most common in Massachusetts.

Cheapest Health Insurance in Massachusetts by Metal Tier

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  • $3,000

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What Does Connectorcare Cover

ConnectorCare provides comprehensive coverage for individuals and families who earn up to 300% of the federal poverty limit. This coverage includes doctors visits, hospitalizations, and prescription drug coverage.

Dr. Noor Ali is a licensed medical doctor and surgeon with an established national health insurance consulting practice serving clients in more than 30 states. Dr. Ali has worked in the health care field since 2012 as a doctor, researcher, and advisor. She earned her Bachelor of Medicine and Bachelor of Surgery degrees from Kumudini Womens Medical College, followed by a masters degree in international public health from the University of South Florida. She holds a Certified in Public Health credential and is a licensed life, health, and annuities professional in Florida.

Dr. Ali regularly contributes to the medical and public health field with research and community-based work in the womens reproductive health and maternal and child health spheres. She has built a brand around bridging the gap between patients and health insurance services through education, information and empowerment.

She is a frequent expert guest on podcasts including Next Level Success and Miller IP Law and a medical proofreader for EvesDisclosure.com. Dr. Ali has been consulted for articles by Denver News Channel 7, Business.com, Massage magazine, and the Journal of American College Health.

What Plans Are Available

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Massachusetts Health Connectors plans areorganized into four categories:

  • Bronze plans have the lowest monthly premiums and the highest deductibles and copays, and cover roughly 60 percent of care costs. Theyre 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. Theyre 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 youll 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.

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Options For Health Insurance Coverage

Before going without health insurance, Nicholson reviewed all of her options, which included being added to her husbands plan and enrolling in a healthcare cost-sharing program. These are also things that you might consider if youre without health insurance or thinking about canceling your plan since coverage is no longer mandatory.

You may consider short-term health insurance or catastrophic care policies, but these have their limitations in terms of whats covered and whos eligible. Applying for Medicaid may also be an option, but whether you qualify is dependent on your income and family size. Each state has different guidelines with regard to the income and asset thresholds allowed for eligibility for Medicaid coverage.

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 employers plan unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.61 percent of your household income for individual coverage. If you lose coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 , 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 youre not sure about whether making this switch makes sense for you, you can ask for free advice from a local enrollment expert.

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How Do I Enroll In Massachusetts’ Health Insurance Marketplace

Massachusetts law mandates every individual or family must have health care coverage or face financial penalties. If you dont receive health care through your employer, you can enroll for health care using the Massachusetts Health Connector. You can do it online or by phone at 1-800-841-2900. You can also mail the application form or fax it to 617-988-8903.

When you create an account, youll need to provide information including:

  • Contact information
  • Immigration status
  • Income

Youll need to provide this information for every member of your household for which you are applying for health care:

  • Social Security number
  • Name

All plans carried by the Health Connector cover prescription drugs and visits to the hospital or doctor. The Health Connector allows you to compare out-of-pocket costs, deductibles, and copays. The Massachusetts Health Connector can also determine whether youre eligible to receive tax breaks or subsidies based on your household income.

Best Cheap Health Insurance In Massachusetts 2022

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Find Cheap Health Insurance Quotes in Massachusetts

The cheapest health insurance plan for most people in Massachusetts is the Standard Silver: BMC HealthNet Plan Silver A II, which is the most affordable Silver policy in nine of the state’s 14 counties.

If you are shopping for individual health insurance in Massachusetts, you can purchase cheap coverage through the state’s online exchange. In the marketplace, you may be able to find a policy that fits your financial situation and provides adequate coverage for your medical needs.

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According To My Divorce Decree My Ex

Does the employer who sponsors the plan have to permit that? Can my ex-spouse remove me from his/her health insurance without my permission? If so, does the health insurer have to notify me that my coverage has been canceled?

In most instances, if a judge has ordered your spouse to continue to carry you on his/her fully insured health insurance, the health insurer and/or the employer need to abide by this judgment. Generally, the law only applies if the employers health plan does not change. If you remarry, you may wish to consult with an attorney to review whether the judgment still applies or if you need to find alternate health insurance.

Massachusetts Health Insurance: Find Affordable Plans

See how you can get cheap health insurance in MA, including marketplace plans, Medicare, and Medicaid.

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Massachusetts residents have many health care options to choose from. The number of options is one of the reasons Massachusetts has the lowest number of uninsured residents in the United States.

This guide provides a detailed overview of your health insurance options in Massachusetts.

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Disasters In Massachusetts By Year

Massachusetts residents deal with an average of about two declared disasters a year. While there have been severe snowstorms over the years, nothing rivals the Blizzard of 78, one of the most memorable and destructive storms in the states history. It began on the morning of Feb. 8 and after 32 hours had dumped up to 4 feet of snow amid hurricane-strength winds and paralyzed the state for days.

While trading survivor stories about the Blizzard of 78 is a favorite local pastime, 2011 also ranks high among memorable disasters. A series of six tornadoes touched down in the central and western parts of Massachusetts on June 1, 2011, some reaching 160 mph. Four people were killed, hundreds were injured, 48,000 lost power and the National Guard was deployed to help clean up debris in the 19 communities affected.

Four months later, on Oct. 29, 2011, came the Halloween Noreasteralso dubbed Snowtober, Shocktober and Oktoberblastthat covered parts of the state with nearly 40 inches of snow. The snowstorm left 450,000 without electricity, some for more than a week.

How Do I Use My Health Plan

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Once you have enrolled in a health plan, be sure you understand your plan and the cost implications of various procedures and services. For example, going to an out-of-network doctor versus in-network traditionally costs a consumer much more for the same type of service.

When you enroll you will be given a certificate or evidence of coverage. The insurance company may mail a copy to you, or it might give you access to the information on a website. If you have a health plan through your employer, the employer will have information on your plan. Read your certificate, and keep it handy to look at when you use health services.

Know Your Benefits and Exclusions

Be sure you know exactly what your plan covers. Not all health plans cover the same services in the same way. Your certificate will list all of the services that are covered under your plan. It will also tell you if any services have limitations . And it should tell what services are not covered at all . Do your homework, research all the options available, and review your insurance policy before making any decisions.

How to Access Services

The plan certificate will tell you if you need to use network providers to be covered. It should tell you if you need to have the health plan authorize care before you see a provider. It should also tell you:

  • If you need to have the plan authorize care before you see a provider
  • What to do in case of an emergency
  • What to do if you are hospitalized

How to File a Claim

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Finding The Best Health Insurance Coverage In Massachusetts

The best health insurance coverage for you will be determined by your level of income and expected medical costs. These factors will directly affect which plans will be affordable and appropriate for the medical services you require.

Massachusetts has adopted the expanded version of Medicaid. This allows anyone with a household income of less than 138% of the federal poverty level to enroll in Medicaid. If you are not eligible for this program, you can purchase an individual health insurance policy through the Massachusetts state marketplace.

To help you in choosing a tier level that fits your needs, we have detailed each level of coverage and who its best for.

Start with Silver plans

We recommend beginning your health insurance search with Silver metal tier plans. These policies have modest premiums and deductibles. For instance, the cheapest Silver plan has a monthly premium that is $74 more expensive than the cheapest Bronze plan but a deductible that is $1,200 less.

In some situations, a Silver plan can be the most cost-effective health policy due to cost-sharing reductions. These reductions decrease the amount you pay in deductibles, coinsurance and copays. However, you are only eligible for cost-sharing reductions if your household income falls below 250% of the federal poverty level.

Gold and Platinum plans: Great if you have expensive medical costs

Bronze: Best if you are young and healthy

What To Know About Health Insurance In Massachusetts

MoneyGeek used private plans to complete this analysis, but its possible to find more affordable health insurance in Massachusetts once you apply for one through the Insurance Exchange. Older buyers should also check whether or not they qualify for Medicare or Medicaid. These are healthcare programs from the government and are likely to be cheaper than any private plan in the Insurance Exchange.

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What Is Covered In My Health Plan

Your insurance company or your employer will give you an “evidence of coverage” certificate that tells you about your benefits. You may receive this certificate directly from the insurer, through your job, or through the internet. Not all health plans are the same, so you should read your certificate carefully. In order to get all of the coverage available to you, you should know your benefits and the procedures you must follow.


It is important that you read your policy carefully so that you know the benefits and services that are covered under your plan. You should also know what benefits and services are excluded from coverage. Massachusetts law requires that certain benefits be covered by all plans. However, all other services are only covered if they are specifically listed as a benefit in your plan certificate.

Health plans may have limits that apply when you first join the plan. Some plans have a pre-existing condition limit or a waiting period during which the enrollee is only covered for emergency treatment. According to Massachusetts law, insured plans may not have a pre-existing condition limitation of more than six-months. They also may not have a waiting period of more than four-months. Also, if you were covered by another health plan before you joined and you did not have more than 63 days between plans, the time that you were in the other plan may reduce or eliminate the pre-existing condition limit or waiting period.



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