Do I Have to Get Health Insurance in Massachusetts?
Massachusetts law requires you to have health insurance.
Even though the federal requirement to have health insurance went away in January 2019, Massachusetts has had its own health insurance requirement since 2006. In fact, the Bay State served as the model for the Affordable Care Act's principle that everyone should have essential health care coverage.
To avoid a state tax penalty, adults 18 or older must have what the Massachusetts considers "minimum creditable coverage (MCC)" or prove eligibility for an exemption. The rule applies even if you are not required to pay state taxes.
What qualifies as minimum creditable coverage (MCC) in Massachusetts?
In Massachusetts, you will automatically meet MCC requirements if you have:
- Medicaid (MassHealth)
- a Qualified Health Plan purchased through Massachusetts Health Connector or directly from an insurance provider
- a federally-qualified high deductible health plan (HDHP)
- a student health plan
- a tribal or Indian Health Service plan
- TRICARE or veterans coverage
- a federal employee health plan, or
- Peace Corps, VISTA or AmericCorps or National Civilian Community Corps coverage.
For other types of plans, be aware that all Massachusetts licensed health insurance companies must put a notice on your plan that indicates whether it meets MCC. If you have questions, talk to a licensed insurance broker or a representative at Massachusetts Health Connector before signing up.
Am I exempt from the Massachusetts health insurance penalty?
In Massachusetts, you will be penalized for going without health insurance only if you could afford to buy it but failed to do so -- or if you qualify for one of a few other exemptions. Usually, you won't be penalized if:
- You are transitioning between insurance plans and you have a gap of fewer than three calendar months.
- You are unable to purchase affordable coverage as defined by the latest state affordability schedule. (This Health Connector presentation provides the affordability schedule for 2019 as well as proposals for 2020.)
- Your family size is so large that relying on the affordability schedule (see just above) to determine how much you could afford to pay for health care would be unfair.
- Your income is below 150% of the federal poverty level. For 2019, for example, this would be less than $18,735 for an individual, $25,365 for a married couple, and $38,625 for a family of four.
- You refuse health insurance because of sincerely held religious belief. You may be required to offer proof to qualify for this exemption.
- You can prove a qualifying financial hardship. In determining whether you qualify, Massachusetts Health Connector will consider many factors, such as whether you were homeless, couldn't pay your utility bills, or incurred an unexpected increase in essential expenses due to circumstances beyond your control, among others.
- Your health insurance didn't meet MCC requirements because that was all your employer offered and your circumstances prevented you from buying better coverage.
Contact Massachusetts Health Connector to find out more about exemptions to the Massachusetts health insurance requirement.
For more information about how the Massachusetts health insurance requirement works, including penalty amounts and exmptions, see Health Care Reform for Individuals on the state government's website or Massachusetts Individual Mandate on the Health Connector website.
To find out how to obtain affordable coverage, see How to Sign Up for Obamacare in Massachusetts.
For information about costs, see How Much Does Obamacare Cost in Massachusetts?
You may also be interested in:
Where to go in Massachusetts to get health plans under the Affordable Care Act (Obamacare) and how to get help with the application process.
Essential facts about the Affordable Care Act (ACA or Obamacare) in Massachusetts, including whether you must get health insurance, how much it will cost, and how you can save money.
The Affordable Care Act (Obamacare) tax penalty has been set to zero, but some states have enacted their own health insurance requirements.