Health Insurance Plans in Massachusetts

Massachusetts mandates health insurance coverage for all residents with few exceptions. Insurance in the state must cover state-ordered minimum coverage requirements, which individuals and businesses can purchase from a state health insurance exchange. Some low- to middle-income Massachusetts residents even qualify for state government assistance in acquiring medical insurance coverage through government subsidies and entitlement programs.

State Law

• Massachusetts was the first U.S. state to require its residents to purchase health insurance. As of July 1, 2007, all residents over age 18 must acquire the minimum required coverage for themselves and their dependents or else pay a tax penalty. Only individuals and families that claim a financial hardship or religious exemption do not have to carry minimum coverage. According to the Massachusetts Department of Health and Human Services, minimum coverage includes a health plan with a family deductible that does not exceed $4,000 annually. Health plans must also provide coverage for prescription drugs, as well as payment for six family doctor visits per year before applying a plan deductible.

Private Health Insurance

• Massachusetts residents can purchase private health insurance through an employer's group plan or through the state's Commonwealth Health Insurance Connector Authority. Known in short as "The Health Connector," this government organization regulates a health exchange from which individuals and small businesses can purchase affordable health insurance that meets minimum coverage requirements. All health plans available through The Health Connector comply with state insurance mandates.

Subsidies and Entitlements

• The Health Connector can also help Massachusetts residents find out if they qualify for government-subsidized health insurance, such as MassHealth or CommonwealthCare. MassHealth is the combination of the Massachusetts Medicaid and CHIP Programs that provide free or low-cost health benefits to certain low-income residents. Income eligibility for MassHealth varies by categories that include individuals, families, children and senior citizens, as well as individuals with chronic medical needs. Commonwealth Care, on the other hand, offers partial government subsidies to help individuals and families with incomes too high for MassHealth, but below 300 percent of the federal poverty level afford health insurance premiums.

Federal Law

• Beginning in January 2014, The Patient Protection and Affordable Care Act of 2010 will require all Americans to purchase health insurance or else face federal tax penalties. Although Massachusetts residents already submit to a similar law in their state, the federal law will expand the coverage requirements of health insurers to include benefits for preventive care and cancer screenings. The federal law also prohibits insurers from charging a higher premium to applicants with existing medical conditions, nor will they be allowed to limit coverage for such conditions.