In Massachusetts, Affordable Care Act (Obamacare) open enrollment is over, but you may still qualify for 2022 coverage.
This website provides information about getting health insurance under the Affordable Care Act (ACA), including:
- whether you must get health insurance
- what the available plans cover
- how much coverage will cost
- how to sign up for a plan
- how to get help if you need it.
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 penalty amounts for the 2021 tax year 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 2022 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 2023 begins next fall.
If you’ve lost your job or significant income in the past 60 days, whether due to the COVID-19 pandemic or for any other reason, 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 plan 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.
Last year, President Biden signed the American Rescue Plan Act (ARPA). The law provides $1.9 trillion of federal aid to Americans struggling with the COVID-19 crisis. The relief measures include additional premium subsidies for those who purchase health insurance through Massachusetts Health Connector. People who apply for 2022 coverage under a special enrollment period can access these subsidies, but the additional ARPA benefits are available only through the end of 2022. (This may change if Congress passes the Build Back Better act.) Also, Massachusetts offers its own financial assistance programs. Here's a summary of the available programs:
Federal tax credits. Until the passage of ARPA, the ACA provided premium subsidies only to those whose income fell between 100% and 400% of the federal poverty level. For example, the cutoff for a family of four in Massachusetts used to be $104,800. For an individual, it was $51,040.
Now, 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 when you purchase a plan through Massachusetts Health Connector.
The new subsidies will be available only through 2022 unless Congress enacts legislation to extend them.
Cost-sharing subsidies. More than half of the people who purchase coverage through Massachusetts Health Connector receive assistance in the form of 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 2021 health plans, that means a family of four in Massachusetts can't earn more than $65,500 and an individual not more than $25,520.) But they are available only on silver plans. If you think you may qualify, look carefully at costs for the 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. For 2022 in Massachusetts, average health insurance premiums increased by almost 8%.
In Massachusetts, nine insurers are offering plans on Massachusetts Health Connector for 2022 and average annual costs are expected to go up by 6.9%. The better news is that, for most people who purchase health insurance through Massachusetts Health Connector, premium increases will be more than offset by the available subsidies, discussed just above.
5. You can get help signing up if you need it.
The Biden administration is significantly increasing enrollment assistance plans, 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.