What Massachusetts Residents Need to Know About Obamacare for 2023
In Massachusetts, Affordable Care Act (Obamacare) open enrollment is over, but you may still qualify for 2023 coverage.
This website provides information about getting health insurance under the Affordable Care Act (ACA), including:
To begin, keep in mind these key points about health insurance in Massachusetts:
1. Massachusetts law requires you to have health insurance.
Obamacare's federal tax penalty went away in 2019. But Massachusetts has had its own health insurance requirement since 2006. That means most Massachusetts residents must have health insurance or face a state tax penalty. The penalty applies only to adults, and the cost depends on your income and the rates for various health plans offered in the state. (You can find the most recent penalty amounts in this document from Mass.gov.)
To find out if your current health plan complies with state law or to learn whether you qualify for an exemption, see Do I Have to Get Health Insurance in Massachusetts?
2. Massachusetts open enrollment has ended, but you may be able to use a special enrollment period to get covered.
In Massachusetts, open enrollment for 2023 Affordable Care Act (Obamacare) coverage has ended. This means that, unless you qualify for an exception or your income is low enough for Medicaid, you won't be able to get health insurance through Massachusetts Health Connector until open enrollment for 2024 begins next fall.
If you’ve lost your job or significant income in the past 60 days, you might qualify for a special enrollment period (SEP). A SEP allows you to sign up for a new health insurance plan or change your current one outside the open enrollment window.
In addition to job or income loss, many other qualifying events may make you eligible for a SEP. To learn more, see What Happens If I Missed the Massachusetts Obamacare Enrollment Deadline?
3. You may qualify for new Affordable Care Act subsidies.
In 2021, President Biden signed the American Rescue Plan Act (ARPA). The law provided $1.9 trillion of federal aid to Americans struggling with the COVID-19 crisis, including additional premium subsidies for those who purchase health insurance through Massachusetts Health Connector. In 2022, the Inflation Reduction Act extended these more generous subsidies through 2025. Also, Massachusetts offers its own financial assistance programs. Here's a quick summary of the main programs available to you:
Federal tax credits. Under ARPA, no one will have to pay more than 8.5% of their household income for a mid-level plan purchased from Massachusetts Health Connector. Technically, the subsidies are tax credits, but you can choose to have them automatically deducted from the cost of your monthly premiums.
Cost-sharing subsidies. More than half of the people who purchase coverage through Massachusetts Health Connector receive assistance through cost-sharing reductions (CSRs). CSRs automatically reduce your premiums and lower your costs when you use your insurance benefits—for example, when you go to the doctor, get lab work, or have to stay in the hospital.
CSRs are available to people who make between 100% and 250% of the federal poverty level. (For 2023 health plans, that means a family of four in Massachusetts can't earn more than $75,000 and an individual not more than $36,450.) But these benefits are available only on silver plans. If you think you may qualify, look carefully at the costs for silver plans available at Massachusetts Health Connector while shopping for coverage.
Massachusetts subsidies. The Commonwealth of Massachusetts offers its own set of subsidies for those who earn less than 300% of the federal poverty level. You can find out whether you qualify for these subsidies when you apply for a plan at Massachusetts Health Connector.
Medicaid. If your income is very low, you may qualify for free or low-cost coverage through MassHealth in Massachusetts.
For more information, see Ways to Save Money on Obamacare in Massachusetts. You may also want to watch the video presentation Need Health Insurance? New Savings Are Here Through the Health Connector, presented by Massachusetts Health Connector.
4. Average premium rates went up for 2023, but that doesn't mean everyone is paying more.
Nationwide, the average rate increase for 2023 health plans was about 7.7%. However, these numbers aren't final; more importantly, this doesn't tell you how much you'll pay for health insurance. Costs vary from state to state and plan to plan within a state. For example, Texans are looking at an average premium increase of more than 8% while Virginians, generally, will benefit from an average decrease of about 13%. Also, if premiums for the benchmark plan (the plan used to determine subsidy amounts) go up, subsidies will also go up. This is a long way to say don't let the numbers scare you. Comparison shop at Massachusetts Health Connector to find the plans and subsidies available to you.
5. You can get help signing up if you need it.
The Biden administration has greatly increased enrollment assistance, making it much easier to get the information you need to get covered. To connect with local support resources, see How To Sign Up for Obamacare in Massachusetts.