Massachusetts

Massachusetts’ Marketplace is state-run and residents should use the Massachusetts Health Connector site to enroll in Marketplace plans. Open enrollment runs from November 1, 2023 until January 23, 2024.

Under federal law, individuals may enroll in the Marketplace outside of the open enrollment period if they experience certain qualifying events, such as the loss of employer-based insurance, marriage, or having a baby (see a more complete list here). Massachusetts offers additional special enrollment periods (SEPs), including when the following occurs:

• Having a household income at or below 150 percent of the federal poverty level ($21,870 for an individual, $45,000 for a family of four) and being eligible for Marketplace subsidies.
• Indicating on a tax return that you would like to receive information about how to enroll in health insurance and qualifying for Marketplace coverage. More information about this program is available here.
• Losing Medicaid after March 31, 2023—the Massachusetts Marketplace offers an extended opportunity to enroll in Marketplace coverage that lasts until November 23, 2023.

Restrictions may apply, including those outlined in this FAQ. Some SEPs may only be available to individuals who have current Marketplace coverage, and some SEPs may only be accessible through the Marketplace call center. The list of SEPs on our website is not an exhaustive one. If you recently experienced a change in circumstances that you think may qualify you for a SEP, check with the Marketplace, Massachusetts Health Connector site to see if any other special enrollment opportunities are available.

• Under federal law, short-term plans are not required to cover services for pre-existing conditions and typically provide far fewer benefits and cost-sharing protections compared to health plans available through the Marketplace. Federal rules allow these plans to last up to 12 months and be marketed as a substitute for Affordable Care Act coverage. However, states may modify these federal standards to make them more strict and also require short-term plans to follow additional consumer protections.
• Massachusetts prohibits short-term plans from denying or limiting coverage for people with pre-existing conditions. As a practical matter, these protections prohibit short-term plans within the state.

Massachusetts requires individuals to pay a penalty if they fail to maintain minimum creditable coverage. Individuals who cannot afford insurance or face other hardships may apply for an exemption to the mandate penalty. More information about exemptions can be found here.

Under the Affordable Care Act, individuals may qualify for premium tax credits and plans with reduced cost-sharing based on their income and other factors. Massachusetts provides additional financial assistance to certain populations:

• Massachusetts provides premium and cost-sharing subsidies for Marketplace enrollees with incomes up to 500 percent of the federal poverty level ($72,900 for an individual, $150,000 for a family of four in Plan Year 2024) who enroll in its ConnectorCare program. More information is available here.

Under the Affordable Care Act, individual and group health plans that offer dependent benefits must allow parents to keep their children up to age 26 on their plan. Massachusetts law is consistent with this requirement.

The Affordable Care Act gives states the option to expand Medicaid to adults with household income at or below 138 percent of the federal poverty level. Massachusetts has taken advantage of this option so that adults with household incomes at or below 138 percent of the federal poverty level ($20,120 for an individual, $41,400 for a family of four annually) are eligible for Medicaid. Consumers can learn about what coverage options they are eligible for, including Medicaid, through Massachusetts's state-based Marketplace, the Massachusetts Health Connector.

• In Massachusetts, children under age 19 are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) with household incomes at or below 305 percent of the federal poverty level ($91,500 for a family of four annually).
• Pregnant people are eligible for Medicaid with household incomes at or below 205 percent of the federal poverty level ($91,500 for a family of four annually).

• Generally, lawfully residing immigrants are eligible for Medicaid after a 5-year waiting period with some exceptions.
• In Massachusetts, lawfully residing children and pregnant people are exempt from the 5-year waiting period.
• Pregnant people who are otherwise qualified are eligible for Medicaid regardless of immigration status through the CHIP unborn child option.
• Additionally, income-eligible children and adults who are not eligible for Medicaid or CHIP due to immigration status may qualify for state-funded coverage.

Federal law gives states the opportunity to optionally extend Medicaid eligibility for postpartum individuals up to 12 months. Massachusetts has implemented this coverage expansion.