Health Insurance That Fits Your Needs and Your Budget.
Boston strong, healthcare smart. Massachusetts insurance options.
Massachusetts Health Insurance
Obamacare, otherwise known as The Affordable Care Act, requires all U.S. residents to have an active health insurance policy as of 2014. This means that if you live in the state of Massachusetts and you do not have qualifying health coverage or “minimum essential coverage”, you will be fined either a flat fee of $695 or 2.5% of your income - whichever is higher - to be paid when you file your 2016 federal tax return.
Don’t Have Qualifying Health Coverage?
The enrollment deadline for 2016 insurance ended January 31, 2016. If you didn’t get health insurance coverage during the enrollment period, you may be able to decrease your fine and begin coverage if you’ve had a qualifying life event.
Qualifying Life Events for a Special Enrollment Period
Have you experienced any of following qualifying life events? If so, you may be able to add or change your health insurance coverage during a special enrollment period.
- Loss of health coverage
- Change in household size
- Change in residence
- Exceptional circumstances
See more details about Qualifying Life Events
Have more questions about qualifying life events? Talk with an advisor (888) 554-3287.
2017 Open Enrollment for Massachusetts Health Insurance
We are fast approaching the enrollment period for 2017 Massachusetts health insurance, which is November 1, 2016 to January 31, 2017. The penalty for not having health insurance coverage during 2017 will be a bit different than 2016. The 2.5% of income percentage fee will still remain and the $695 flat fee will be adjusted for inflation; again you will pay whichever of the two is higher.
Our Advisors Know Massachusetts Health Insurance So You Don’t Have To. Get a Quote.
Understand Your Massachusetts Health Insurance Options
There are many options when it comes to buying affordable Massachusetts health insurance. Most of your insurance decisions should be made based upon your current finances, financial goals, employment, marital status, children, age, health conditions, and planned or anticipated life events and medical needs.
Because there are many health insurance options, the most common types, plans, and FAQs and terms are outlined in a simple way below. Choose which area of Massachusetts health insurance that you’d like to learn more about and click for more information.
Private Health Insurance Options
Public Health Insurance Programs
Learn more about Massachusetts Obamacare, Medicaid, and Medicare
Massachusetts Private Health Insurance Plans
Want to learn more about different private health insurance plans in Massachusetts? This Massachusetts private health insurance page will talk you through the difference between PPO and HMO plans, along with their pros and cons. Ever heard of an EPO or POS plan? We discuss those too. We also cover FSA, HSA, Flexible Benefits Plans, and Medical Savings Accounts (MSA), the pros and cons of each kind of plan, and why you would want to choose one over the other.
Learn more about Massachusetts Private Health Insurance Plans
Massachusetts Health Insurance Companies
If you are looking for private health insurance coverage in Massachusetts then you’ll want to know which providers are offering coverage plans in 2017 and at what rates. Because some health insurance companies are leaving the Massachusetts exchange in 2017 and most of those that are staying are proposing higher plan rates, you’ll want to see the following pages.
Massachusetts Health Insurance Marketplaces and Exchanges
If you’ve ever found health insurance terms to be confusing, you are not alone. Terms like “marketplace” and “exchange” are used by both private and public health insurance companies when presenting their plans, and navigating the many options can sometimes feel like a battle of endurance.
Check out our page on Massachusetts health insurance marketplaces and exchanges to answer common questions like:
- What are health insurance marketplaces and exchanges?
- What are Private Exchanges?
- What are Public Exchanges?
- What is the difference between private exchanges and public exchanges in Massachusetts?
Learn More About Massachusetts Health Insurance Marketplaces and Exchanges
Massachusetts Health Insurance FAQs
- What is a qualified health plan?
A qualified health plan is one that has limits on cost sharing (e.g. deductibles, out-of-pocket maximums, copayments, etc.), provides the appropriate level of coverage by including the minimum essential coverage, and meets other requirements as determined by the Affordable Care Act, otherwise known as Obamacare. A qualified health plan must also be certified by the Health Insurance Marketplace. To avoid paying the health insurance penalty, a person must be covered by a qualified health plan.
- How do I know which health insurance plan is best for me?
As you are looking for the best plan for you, consider two major things: 1) your previous year's medical costs, any known upcoming healthcare costs, and any potential healthcare costs, and 2) each potential plan's premium cost, deductible amount, and out-of-pocket or co-pay amounts. As you evaluate these two things, try to find the sweet-spot between your upcoming healthcare needs and the benefits and coverage offered in each plan. We recommend that you find the health insurance option that makes your total cost of healthcare most affordable and that also gives you the best healthcare coverage. It is tempting to pick the option with the lowest monthly premiums, but if that results in you paying large dollar amounts for every visit to the doctor or hospital or to hit your deductible, it might not be the best option by the end of the year (learn more about how a deductible impacts you premium).
- What is open enrollment and how does it work?
Open enrollment is the annually designated period when you can enroll in an insurance plan or change your existing health insurance coverage from the previous year.
- When is the open enrollment deadline?
Insurance plans typically follow the open enrollment deadline of the Health Insurance Marketplace; for 2017 the deadline for enrollment is January 31, 2017. The open enrollment period starts November 1, 2016 and ends January 31, 2017.
- What if I missed the open enrollment deadline?
If the Marketplace open enrollment deadline has passed, you may be able to get health insurance coverage if you have had or will have a Qualifying Life Event (e.g. getting married or having a baby) that allows you to qualify for a Special Enrollment Period. You can also attempt to apply for short term health insurance, Medicaid, CHIP (the Medicaid Children's Health Insurance Program), or Medicare; all of these insurance programs accept applications all year long depending on your eligibility.
- How much do I have to pay if I don't have health insurance?
Since the 2014 enforcement of the Affordable Care Act or Obamacare, all individuals who reside in the United States are required to have active health insurance coverage through a qualified health plan. You will be required to pay a penalty for any time in which you do not have this minimum coverage. This penalty should be paid when you file your federal taxes for the tax year in which you did not have coverage. For the year 2016, the fee is 2.5% of your household income or $695.00 per adult and $347.50 per child under 18 (whichever is higher). The penalty for 2017 is fairly similar with the household income percentage fee of 2.5% remaining the same, while the flat fee will be adjusted for inflation.
- Where do I buy health insurance if I live or work in two different states?
If you live or work in two different states, seek a multi-state plan from either the private or public Marketplace. Multi-state plans will provide you with more coverage options as you move between states.
- How does a deductible impact your premium?
With health insurance, you will either pay more in your monthly premium or pay more out-of- pocket when accessing care. If you opt for a lower monthly premium payment, you will most likely be responsible to hit a higher deductible before insurance coverage kicks in and/or pay a higher co-pay or percentage of the cost of medical care.
- Can I be denied coverage for a pre-existing condition?
No, since the signing of the Affordable Care Act, or Obamacare, it is no longer legal for health insurance companies to deny anyone heatlh insurance coverage based on a pre-existing condition. Pre-existing conditions can include pregnancy and any medical condition that was diagnosed prior to enrollment in a health insurance plan.
- Is pregnancy a pre-existing condition?
Since the passing of Obamacare, the Affordable Care Act, you can no longer be denied health insurance coverage for pregnancy or any other pre-existing condition. All Medicaid and Marketplace plans are required to cover pregnancy, regardless of the timing of the pregnancy.
- How do I update my health insurance if I am recently divorced or widowed?
Any change in marital status, such as divorce or the death of a spouse is considered to be a Qualifying Life Event. These qualifying life events allow you to participate in a Special Enrollment Period 60 days before or after the date of the event. Find out how to update your insurance if you've had a Qualifying Life Events.
- Can I update my insurance if I get married or divorced, have a baby or adopt a child, or change jobs?
Significant life events such as a change in marital status, having a baby or adopting a child, or experiencing a change in employment are all categorized as Qualifying Life Events. When you have a qualifying life event, you have up to 60 days prior to or after that event to participate in a Special Enrollment Period. Check to see if your recent or upcoming life event is a Qualifying Life Event.
- Is health insurance tax deductible?
If you are self-employed, your health insurance premiums may be tax deductible. Deductions are for long-term, medical, dental insurance premiums that typically cover the self-employed individual, their spouses, and dependents. See if you qualify for deductions. According to the IRS, "You may deduct only the amount of your total medical expenses that exceed 10% of your adjusted gross income or 7.5% if you or your spouse is 65 or older. The 7.5% limitation is effective only from January 1, 2013 to December 31, 2016 for individuals age 65 and older and their spouses. You figure the amount you are allowed to deduct on Form 1040, Schedule A."
- What information and documents should I have when I'm signing up for health insurance?
When signing up for a health insurance plan, you will need to verify your annual income and U.S. citizenship or immigration status.
- Who can buy individual health insurance?
Anyone can opt to buy individual health insurance through a private Marketplace or through the federal Marketplace. Most typically, people buy individual health insurance when they do not feel that their company group insurance options adequately meet their needs or they are not offered group insurance benefits through their employer.
- Does health insurance auto renew each year like my auto insurance?
It depends, each health insurance provider and plan functions a bit differently. A majority of health insurance companies will require you to enroll or reenroll in an insurance plan each new year. There are some health insurance providers that will auto-renew you each year into the same plan you had and some may auto-renew you into a similar plan if your current plan does not exist that next year. All Medicare and most Medicaid plans and programs will not require reenrollment, unless your situation has changed from the previous coverage year.
- What does it mean to be on-exchange or off-exchange?
If you are on-exchange, then you purchased your coverage via the Health Insurance Marketplace. If you are off-exchange, then you opted to purchase your coverage via a private insurance. Learn more about exchanges and marketplaces.
- What is a Special Enrollment Period?
A Special Enrollment Period is granted to those individuals who have had or will have a Qualifying Life Event. The special enrollment period allows these individuals to enroll in a new public or private health insurance plan or update their current health insurance coverage up to 60 days before or after the qualifying life event.
- When is open enrollment for health insurance?
The 2017 health insurance open enrollment period runs from November 1, 2016 to January 31, 2017. These open enrollment dates apply to any public health insurance or private health insurance plans or programs in which you are interested in enrolling.
- What is health insurance?
Health insurance is a type of insurance that covers medical, surgical, hospital, and prescription expenses for the insured individual and/or their covered dependents. The level of healthcare coverage varies from plan to plan. This coverage determines the amount of the expense that the insured will be responsible to pay and how much the insurance provider will be responsible to pay.