Health insurance is necessary to protect your family’s health against unfortunate circumstances of sickness or injury. Before opting for health coverage, you need to assess through your family’s medical needs and your budget. Being a Massachusetts resident, you can choose from various health insurance alternatives. The Massachusetts Division of Insurance supervises the regulations under which the Massachusetts health insurers can sell private health insurance to individuals and families.

We offer access to more sources of health insurance quotes for individuals, families and groups in the state of Massachusetts. The information and resource links provided below are designed to help you learn more about finding affordable medical insurance in your state.

Massachusetts (MA)
Individual Health Insurance Regulations

Learn more about Massachusetts Individual Health Insurance

Massachusetts residents age 18 and older under the Individual Mandate law are required to have health insurance that is deemed by the state to be affordable to them at their income level or they risk being fiscally penalized on their personal state income taxes. Individual health insurance policies in Massachusetts are not permitted to be medically underwritten. Accordingly, you may not be denied coverage based upon your current health status or past health history. Massachusetts requires health insurance carriers who sell individual health insurance policies to offer standardized policies to all applicants. Standardized plans are broken down into three categories: 1) Medical Plan Option 2) Preferred Provider Plan Option and 3) Managed Care Plan Option. All plan options must offer comprehensive coverage, including hospital and physician care, maternity care, preventive care and immunizations and prescription drug coverage. Exclusionary and look back periods on pre-existing conditions are limited to 6 months. Provided there is no more than a 63 day break in coverage, credit for prior coverage is required. Premium rates are determined under a modified community rating system and may vary based on age, family size and geographic location.

Massachusetts (MA)
Small Group Health Insurance Regulations

A small group, for the purpose of health insurance in Massachusetts, is defined as a group of employees between 1 and 50. A full-time employee is defined as an individual who works 35 hours or more per week at a Massachusetts location (even if they live in another state). However, independent contractors, seasonal employees, temporary employees or workers from temp agencies cannot be considered full-time employees. Small group health insurance in Massachusetts is issued on a guaranteed issue basis, meaning that no group can be denied health insurance coverage as a result of their overall health history. Under an employer-sponsored group health plan, employers may require employees to incur a waiting period before becoming eligible to apply for coverage under the group health plan. Applicants not able to provide proof of prior creditable coverage may be subjected to a 6 month pre-existing condition exclusionary period by the health insurance carrier after reviewing their 6-month health history. Group health insurance rates in Massachusetts are community based and may vary in accordance with age, industry, group size, geography, family composition and group participation percentages. Discounted rates are available to groups that participate in wellness programs.

Employers with one or more full-time employees may establish a group plan with employer contributions so long as the premium contribution towards full-time non-bargaining employees (defined by the state as working 35 hours or more) is not discriminatory. An employer may also establish a Section 125 plan for employees who are not eligible for their group plan and allow them to purchase insurance through the Commonwealth Connector.

Employers with 11 or more full-time equivalent employees have four requirements:

• You must offer a Section 125 cafeteria plan that meets Commonwealth Connector regulations. If you don't offer a Section 125 cafeteria plan, you will pay the Free Rider Surcharge if your employees or their dependents get medical care that is paid by the state's Free Care Pool- now called the Health Safety Net -for the uninsured;
• You must make a “fair and reasonable” contribution to your employees’ health insurance or pay a Fair Share Contribution or fine of up to $295 per employee per year.
  
  A "fair and reasonable" contribution by an employer is:
  • 25% of an employer’s full-time employees are participating in the employer’s group health plan or
  • An employer’s contribution of at least 33% toward a health plan premium for all full-time employees who are employed for more than 90 days.
• Employers must complete an Employer Health Insurance Responsibility Disclosure (HIRD) Form/Report which must be filed on-line, to report if you offer a Section 125 Plan that complies with Commonwealth Connector regulations;
• Employers must collect an HIRD Employee Form from employees who decline your employer sponsored health insurance and/or your employer sponsored Section 125 Plan.

Massachusetts COBRA and Continuation Coverage

Since all individuals in Massachusetts are eligible for personal medical insurance, COBRA and continuation options are of less importance. However, COBRA laws still exist to give people the option of remaining on their group health plan versus moving to an individual health plan. Groups of less than 20 must abide by the state mini-COBRA regulations enacted by Chapter 176, Section 9 of 22 – Small Group Health Insurance/Continuation of Coverage, which closely follow the guidelines of federal COBRA that applies to larger companies. COBRA is a continuation of coverage under the employer sponsored health plan, which may be elected upon the occurrence of a specific qualifying event, allowing the employee to remain on the group health plan and receive the same level of coverage for a specific period of time. Under Massachusetts law, the period of time you may remain on the plan is dependent upon the qualifying event, with maximums of 18, 29 and 36 months. The premium for COBRA coverage may not exceed 102% of the cost of the employer sponsored health plan and shall be at the employee's sole expense. Conversion plans are also available for those that exhaust their COBRA options or elect this type of coverage over continuation on the group health plan.