Massachusetts law about health insurance

Laws, regulations, cases, and web sources on health insurance law.

If you are unable to find the information you are looking for, or if you have a specific question, please contact our law librarians for assistance.

Best bets

Health care, Mass. Division of Insurance.
Find the information you need on purchasing health insurance, coverages, provider networks, mandatory benefits and more.

Healthcare.gov, U.S. Department of Health & Human Services.
Federal resource for information on Health Insurance under the ACA. It helps people find and enroll in affordable health insurance plans, including those who may qualify for subsidies or other cost-saving programs. The site also provides information about Medicaid and the Children's Health Insurance Program (CHIP). 

MassHealth and Massachusetts Health Connector
In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined into one program called MassHealth. The Massachusetts Health Connector is the state’s marketplace for health and dental insurance. Use the MyServices web tool to find out what benefits from MassHealth or the Massachusetts Health Connector you may qualify for and how to apply.

Massachusetts laws

MGL c. 111, § 228 Advance disclosure of allowed amount or charge for admission, procedure or service
Health providers have to give patients advanced notice of any charges that will be the responsibility of the patient.

MGL c. 111M Individual health coverage
The Massachusetts Mandated Health Insurance Law. Key provisions of the law include subsidized health insurance for residents earning less than 300% of the Federal Poverty Level and low-cost insurance for all other residents who are not eligible for insurance through their employers.

MGL c. 149, § 189 Employer medical assistance contribution

MGL c. 32A and c. 175I through MGL c. 176Q cover various types of health insurance, including HMO, PPO, Group, Non-Group, and more.

• c. 32A Contributory group general or blanket insurance for persons in the service of the commonwealth
• c. 175I Insurance information and privacy protection
• c. 175J Administrative supervision and hazardous financial conditions of insurities
• c. 175K Interstate insurance compact
• c. 175L Certificate of insurance
• c. 175M Family and medical leave
• c. 176 Fraternal benefit societies
• c. 176A Non-profit hospital service corporations
• c. 176B Medical service corporations.
• c. 176C Non-profit medical service plans
• c. 176D Unfair methods of competition and unfair and deceptive acts and practices of insurance
• c. 176E Dental service corporations
• c. 176F Optometric service corporations
• c. 176G Health maintenance organizations.
• c. 176I Preferred provider arrangements
• c. 176J Small group health insurance
• c. 176M Nongroup health insurance
• c. 176N Portability of health insurance
• c. 176O Health insurance consumer protections
• c. 176Q Commonwealth health insurance connector

MGL c. 176X Dental benefit plans
Enacted by the people as Question 2 on November 8th, 2022 and is applicable to all dental benefit plans issued, made effective, delivered or renewed on or after January 1, 2024.

Massachusetts regulations

211 CMR 52.00 Managed care consumer protections and accreditation of carriers
Rules that health plan providers must follow to get and keep their accreditation.

211 CMR 156.00 Dental insurance

956 CMR Commonwealth Health Insurance Connector Authority

958 CMR 3.00 Health insurance consumer protection
Establishes requirements for carriers in administering their internal grievance procedures.

Federal law

Laws

Patient Protection and Affordable Care Act, PL 111-148 (2010)
The federal Health Care law is over 900 pages long. Changes include increased protection for those with pre-existing conditions, heightened penalties for certain employers who don't provide insurance, additional availability of insurance for children up to age 26, closure of the Medicare "donut hole" for prescription drug coverage, and more.

Genetic Information Nondiscrimination Act (GINA), PL 110-233 (2008)
Title one of the act prohibits changing insurance contribution amounts due to genetic information, or requiring genetic testing for insurance coverage purposes.

Mental Health Parity and Addiction Equity Act, PL 110-343, Title V, Subtitle B (2008)
Requires that insurance coverage for mental health and substance use disorders be no more restrictive than coverage for other types of medical conditions.

No Surprises Act, PL 116-260, Division BB, Title I
This law is designed "… to protect health care consumers from surprise billing practices…"
See also:

• Ending surprise medical bills provided by the Centers for Medicare & Medicaid Services
• Federal No Surprises Act Resources and Consumer Disclosures, Mass.gov

FY2025 Budget Reconciliation Bill, PL 119-21 (2025)

• Health Provisions in the 2025 Federal Budget Reconciliation Bill, KFF.org (July 2025)
  Describes the law's health care provisions in four categories: Medicaid, the Affordable Care Act, Medicare, and Health Savings Accounts (HSAs). It also compares the provisions to an earlier draft of the bill passed by the House.

Regulations

45 CFR 147.132 Religious exemptions in connection with coverage of certain preventive health services

Rules

Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability (45 CFR Parts 147, 155, and 156)

• Factsheet: 2025 Marketplace Integrity and Affordability Final Rule, Centers for Medicare & Medicaid Services (CMS), June 20, 2025.
  "The Centers for Medicare & Medicaid Services (CMS) issued the 'Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability Final Rule,' setting standards for the Health Insurance Marketplaces, which connect millions of consumers to Affordable Care Act (ACA) coverage. The rule finalizes additional safeguards to protect consumers from improper enrollments and changes to their health care coverage, as well as establishes standards to ensure the integrity of the ACA Exchanges."

Executive orders

Executive Order on promoting competition in the American economy, July 9, 2021.
"(p) The Secretary of Health and Human Services shall: (iii) to ensure that Americans can choose health insurance plans that meet their needs and compare plan offerings, implement standardized options in the national Health Insurance Marketplace and any other appropriate mechanisms to improve competition and consumer choice."

File a complaint

File a health care complaint, Mass. Office of the Attorney General.
"If you have a problem with health insurance claims or medical bills, or think you might be the victim of a scam, the Attorney General's Health Care Division may be able to help." You can call the Health Care Helpline at [phone] or file a complaint using the online form.

Selected cases

Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682 (2014)
Under the Religious Freedom Restoration Act of 1993, closely-held corporations are not required to follow the Affordable Care Act's mandate that insurance cover contraceptives, if to do so would violate their sincere religious beliefs.

Finch v. Commonwealth Health Insurance Connector Authority, 461 Mass. 232 (2012)
Coverage for legal immigrants. "Section 31(a) [of St. 2009, c. 65] cannot pass strict scrutiny. The discrimination against legal immigrants that its limiting language embodies violates their rights to equal protection under the Massachusetts Constitution."

King v. Burwell, 576 U.S. 473 (2015)
Under the Affordable Care Act, taxpayers are eligible for a tax credit "for insurance purchased on any Exchange created under the Act," including both Federal and State Exchanges. " Those credits are necessary for the Federal Exchanges to function like their State Exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid."

Massachusetts v. U.S. Dep't of Health and Human Services, 513 F. Supp. 3d 215 (2021)
The Final Rules adopt the IFRS, which expanded the religious exemption to the contraceptive mandate of the Affordable Care Act (ACA) and created a new "moral exemption" to that mandate. See also: the 2019 U.S. Court of Appeals opinion (923 F.3d 209) that reversed the U.S. District Court dismissal (301 F.Supp.3d 248) of the case.

Web sources

Consumer protection

Avoiding health insurance scams, Mass. Office of the Attorney General.
Unlicensed health plans that do not meet Massachusetts standards for insurance coverage may attempt to take advantage of you. Learn how to avoid these scams.

Consumer advisories and alerts, Mass. Division of Insurance.
Important tips to be a safe consumer when buying health insurance.

Ending surprise medical bills, Centers for Medicare & Medicaid Services.
Provides updated policies, FAQs, tips, and insurance payment dispute resources for consumers.

Shopping for health insurance? What consumers need to know when purchasing coverage through an online website, Mass. Office of Consumer Affairs and Business Regulation.
Explains how to find a legitimate health insurance plan and offers tips on how to approach the insurance purchasing process.

Dependents and seniors

How to get or stay on a parent's plan, HealthCare.gov.
Includes information on staying on a parent's insurance until the age of 26.

Health insurance counseling, Mass. Executive Office of Aging & Independence.
The SHINE (Serving the Health Insurance Needs of Everyone) Program provides free health insurance information and assistance for Medicare eligible adults and their caregivers.

Immigrants

Understanding immigrants' eligibility for MassHealth & other subsidized coverage, Mass. Legal Services, 2025.
"Summarizes the current immigrant eligibility rules that MassHealth and the Health Connector use in making decisions about what kinds of coverage non-citizens with different kinds of status can receive."

Insurance mandate and tax penalties

The Massachusetts Health Care Reform Law requires that most residents over 18, who can afford health insurance, must be enrolled in available coverage for the entire year or pay a penalty through their tax returns.

Health care reform for individuals, Mass. Department of Revenue.
Provides detailed information about tax implications of health insurance requirements and information about staying on a parent's insurance until the age of 26.

Individual mandate penalties for tax year 2025, Mass. Department of Revenue.
Technical guidance on penalties for individuals who fail for comply with the requirements of the Mass. Healthcare Reform Act.

Unemployment insurance

Continuation of health coverage (COBRA), U.S. Department of Labor.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102% of the cost to the plan. See also FAQs about COBRA.

Learn about the Employer Medical Assistance Contribution (EMAC), Mass. Department of Unemployment Assistance.
Each employer subject to unemployment insurance is also subject to Employer Medical Assistance Contribution (EMAC) reporting requirements. EMAC is used to help fund health insurance programs in the Commonwealth.

Other

Health Savings Account (HSA), Healthcare.gov
A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.

U.S. Department of Health and Human Services, Affordable Care Act
Information regarding pre-existing conditions, cancelations, and appeals.

Print sources

Health care law sourcebook, Matthew Bender. (eBook available with library card)

How insurance companies settle cases, James Publishing, Inc., annual.

Labor and employment in Massachusetts, 2^nd ed., LexisNexis (loose-leaf). (eBook available with library card)
Chapter 15: Private Health Care and Life Insurance.

Massachusetts divorce law practice manual, 5^th ed., MCLE, 2023.
Chapter 25: Health Insurance.

The law of life and health insurance, Matthew Bender, loose-leaf. (eBook available with library card)

Surprise billing handbook: A guide for lawyers and providers by Joseph R. Rivet, American Bar Association, Health Law Section, 2025. (eBook available with library card)

What to do about personnel problems in Massachusetts, BLR, loose-leaf.
Information about Massachusetts and National Health Care laws, regulations and mandated benefits including COVID-19 coverage.

Your rights in the workplace by Sachi Barreiro, 11^th ed., Nolo, 2018.

Last updated:	August 4, 2025