Massachusetts Health Insurance: 2023 Coverage Guide

Massachusetts Affordable Healthcare Insurance

In Massachusetts, you'll have to wait another year if you miss the deadline for Open Enrollment. The people of Massachusetts have the best healthcare in the country, and you are penalized for having no health insurance so it’s important for you to know all your options before you buy because you have plenty! It's also important to compare rates and benefits carefully. Whether you’re buying an individual plan or you’re buying coverage for a family, you can get the coverage you need for the best value by comparing your options with SmartFinancial. Do keep in mind that you may have to wait a year to enroll in a health plan if you do not do so during open enrollment and you'll face penalties. Some people, however, are eligible for the Special Enrollment Period due to a qualifying event. For more information, keep reading!

When Is Open Enrollment in Massachusetts?

November 1, 2022 – January 23, 2023

How to Get Health Insurance in Massachusetts

First, begin by having a projection of healthcare costs for 2022. You can estimate what you’ll need based on the previous year. This information can help you decide which type of plan is right for you and which level tier suits your needs. If you’re trying to be economical, for instance, a health plan that costs more each month may have little or no out-of-pocket expenses.

The best way to get the most value for what you buy is to compare health insurance companies and health insurance quotes. After you submit the form with SmartFinancial, we’ll put you in touch with a knowledgeable agent in your area. You can ask questions about the plan you’re considering and purchase a policy from anywhere.

What Types of Health Insurance Are Available in Massachusetts?

HMOs, EPOs, PPOs and POS plans are the most common types of health insurance policies sold in Massachusetts.

Does Health Insurance Cover Pre-existing Conditions?

It is illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

Compare Health Insurance Plans in Massachusetts

Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

• When a person loses a job or quits a job and they lose health insurance, they can buy one outside the Open Enrollment Period. The same goes for those who start a new business or start a job that doesn’t offer health insurance.
• When you turn 26, you can’t be on your parents’ health coverage any longer. But you can enroll in a new health insurance plan.
• Some insurance plans have coverage zones. If you move out of a coverage area, you can buy a new plan.
• When you elect Cobra coverage from a previous job and that coverage term comes to an end, you may buy health insurance.
• If you shared health insurance with a spouse/partner and you divorce that person, you can buy a new health insurance policy.
• If you just got married, you and your spouse can buy a new plan, together or separately.
• Birth or adoption of a child. If your baby was born or brought home after the open enrollment date, you can still buy health insurance for that child.
• Death of spouse/partner. If you were covered under your spouse/partner’s health plan but that person passed away, you can enroll in an individual plan.
• Spouse of partner loses coverage. If you previously had health insurance through a partner or spouse who lost his/her coverage for any qualifying reason, you are eligible to buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in Massachusetts?

Yes, California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty.

How Much Is Health Insurance in Massachusetts?

Insurance in this state is not cheap. The average cost of health insurance in Massachusetts for a 40 year old is about $617 a month. Health insurance is less expensive the younger you are. Tobacco use increases your rate.

How to Save on Health Insurance in Massachusetts

The best way to save on health insurance in Maine is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs

Medicare in Massachusetts

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in Massachusetts?

19% of Massachusetts’ population is on Medicare.

How Much Is Medicare in Massachusetts?

If you do not qualify for Medicare, you can buy it for $499 a month for Part A in 2022 and a standard monthly premium for Medicare Part B was $177.10, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2022, it was $7,550 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in Massachusetts

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in Massachusetts?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

Massachusetts State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Massachusetts Health System are listed below:

• Massachusetts: Overall Ranking: 2 of 51
• Massachusetts: Overall Performance: Above U.S. Average
• Massachusetts: Access and Affordability: 1
• Massachusetts: Prevention and Treatment: 7
• Massachusetts: Avoidable Hospital Use and Cost: 37
• Massachusetts: Healthy Lives: 2
• Massachusetts: Health Care Disparities: 3

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Massachusetts Health Insurance Coverage

The people of Massachusetts have different kinds of health insurance while some Massachusetts residents are not insured at all. See the breakdown below:

• Private coverage: 64%
• Medicaid: 24%
• Medicare: 9%
• Uninsured: 3%

Report: America's Health Insurance Plans

Massachusetts Health Insurance Companies

• Blue Cross and Blue Shield of Massachusetts HMO Blue Inc.
• Tufts Associated Health Maintenance Organization, Inc.
• Tufts Benefit Administrators, Inc.
• Blue Cross and Blue Shield of Massachusetts, Inc.
• Falton Community Health Plan
• Harvard Pilgrim Health Care, Inc.
• Harvard Pilgrim Insurance Company Inc. (MA)
• Health New England, Inc.
• Aetna Life Insurance Company (Massachusetts)
• Cigna Health and Life Insurance Company (Massachusetts)
• ConnectCare of Massachusetts Inc.
• Connecticut General Life Insurance Company (Massachusetts)
• Martin’s Point US Family Health Plan
• Neighborhood Health Plan, Inc.
• United HealthCare Services, Inc. (Massachusetts)
• UnitedHealthcare Insurance Company (Massachusetts)
• Aetna Health Inc. (Pennsylvania) - Massachusetts
• Minuteman Health, Inc.