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Massachusetts Health Insurance Marketplace

With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.

The following guide offers a glimpse at the various types of ACA-compliant health insurance in Massachusetts, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.

Health and healthcare in Massachusetts

Massachusetts ranked 3rd overall in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths include a low prevalence of obesity, a low percentage of uninsured population, and ready availability of primary care physicians and dentists.

The U.S. Department of Health and Human Services reported that 31,695 individuals in Massachusetts selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Massachusetts enrolled in a marketplace plan increased to 140,540 during the open enrollment period.3

Massachusetts individual and family health insurance

Massachusetts operates a state-based Obamacare health insurance exchange. State residents can use Massachusetts Health Connector to shop and apply for individual and family health plans. Those who buy health insurance through Massachusetts’ health insurance exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.

Massachusetts residents may also buy affordable, Obamacare qualified health insurance in the private marketplace at websites such as Use’s tax subsidy calculator to see if you qualify for a premium tax credit. If you do, visit Massachusetts Health Connector to enroll in a health insurance plan.

Massachusetts’ health insurance exchange:
Massachusetts department of insurance:

Massachusetts small group health insurance plans

In Massachusetts, small business owners may set up group health insurance coverage through the Massachusetts Health Connector exchange. They may also find group health insurance plans in the private marketplace through websites such as such as Small businesses that shop Massachusetts’ exchange and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.

Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the state’s exchange.

Massachusetts state COBRA variations for small groups

The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit

In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.

Massachusetts’ small group COBRA continuation variations are as follows4:

Mini-COBRA option Yes
Eligible group sizes 2–19
Maximum continuation period – standard 18 to 36 months, depending on the qualifying event
Maximum premium Increase 102 percent – full group rate charged by the carrier, plus a maximum 2 percent administration fee
State legislation reference Mini-COBRA law (G.L. c. 176J, § 9)
More information 877-563-4467 – Massachusetts Division of Insurance Consumer Service Line
Additional notes Qualified beneficiaries must be enrolled on the small group health insurance plan on the day before the qualifying event; qualified beneficiaries include an employee, the spouse of an employee, and the dependent child of an employee

Massachusetts high-risk pools

It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5

The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.

Massachusetts Medicaid

Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to

Massachusetts expanded its Medicaid program in 2014.7 Medicaid/CHIP open enrollment takes place year-round.

The information below is specific to MassHealth, Massachusetts’ Medicaid program:

Medicaid expansion No
Governing agency Centers for Medicare & Medicaid
Administrator Massachusetts Executive Office of Health and Human Services
How to apply
Phone number 855-MA-4-Hlth (855-624-4584) / 800-497-4648 / TTY 877-623-7773
More information
Open-enrollment period Year-round in all states

Massachusetts CHIP

The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.

The information below is specific to MassHealth, Massachusetts’ health insurance program for low-income children:

Program name MassHealth
How to apply
Phone number 855-MA-4-Hlth (855-624-4584) / 800-497-4648 / TTY 877-623-7773
Eligibility Dependent upon MassHealth program

1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.”

2 Kaiser Family Foundation

3 Kaiser Family Foundation

4 Massachusetts Office of Consumer Affairs & Business Regulations. “MiniCobra Continuation of Coverage Benefits.” N.D.

5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from

6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” N.D. Retrieved from

7 Centers for Medicare & Medicaid Services. “Massachusetts.” N.D. Retrieved from