Special Enrollment period for those who have lost MassHealth due to post-COVID Redeterminations - The MA Division of Insurance has issued Bulletin 2024-04, which extends the special enrollment period for anyone who lost MassHealth coverage during the redetermination process that began in April 2023, and who has subsequently been determined eligible for a commercial health plan (e.g., Blue Cross and Blue Shield and Health Maintenance Organizations). Those individuals have until November 23, 2024, to enroll and the bulletin instructs insurers to “take all necessary steps” to facilitate the enrollment. Learn more (MGH Community News, February 2024.)
As part of Massachusett's Health Reform, the non-group and small-group markets were combined into the plans collectively known as Commonwealth Choice. Under implementation of the Affordable Care Act (ACA) Commonwealth Choice plans have been phased out to be replaced by ACA compliant plans. Subsidies are available for those with incomes up to 400% of FPL. These plans, for those between 300% and 400% of FPL are known as Qualified Health Plans (QHPs).
Non-Group (non-subsidized) plans now available to all. Prrior to 2014 in Massachusetts, an individual could only purchase non-group coverage (inside or outside the Health Connector) if he or she did not have access to employer-sponsored insurance that met the state’s Minimum Creditable Coverage standards. However, in order to comply with the ACA, the state has changed its laws to allow any resident of Massachusetts to purchase non-group coverage, and anyone who meets Health Insurance Marketplace requirements (must be a U.S. citizen or lawful resident, not incarcerated, and a resident of the state in which the Health Insurance Marketplace is operating) to purchase coverage through the Health Connector for these non-subsidized plans.
In most years, private health insurance is now only available* for purchase in Massachusetts during an annual open enrollment period, which falls on July 1 – Aug 15 each year.
*There are some exceptions for individuals to purchase insurance outside of this open enrollment period (such as within 63 days of losing eligibility for state coverage, moving into the state, moving outside their current insurance plan’s service area or COBRA expiration).
Individuals must be MA residents in order to purchase insurance. This means they live in MA and have a MA address. Purchasers may be asked to prove MA residency using copies of a lease, utility bill, paystub, photo ID card, etc.
Individuals may be undocumented immigrants who live in MA; there is no citizenship requirement to purchase insurance, and a social security number is not required.
How to purchase private coverage:
The easiest way to purchase private insurance is through the state Health Connector.
- Once the website is fully functional, go to www.mahealthconnector.org and click on “Individuals and Families” and “start now.”
- The site will ask questions about income and family size to determine if someone may be eligible for state subsidized coverage. Remember though, undocumented immigrants should skip this section because they are not eligible due to their immigration status.
- The site then allows individuals to browse plans with various cost sharing structures and provider networks.
-Adapted from e-mail correspondence from Kim Simonian, MPH , Associate Director, Patient Access , Partners HealthCare - Community Health , June 28, 2012.
Pre-Existing Conditions Exclusions Have Been Eliminated
Medigap plans -
"No policy for medicare supplement insurance... may contain any waiting period or pre-existing condition limitation or exclusion." (MGL
Chapter 176K: Section 3 )
See also: U.S. Health Reform/Affordable Care Act
