Massachusetts law about health insurance

A compilation of laws, regulations, cases, and web sources on health insurance law by the Trial Court Law Libraries.

Table of Contents

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.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

Massachusetts regulations

956 CMR Commonwealth Health Insurance Connector Authority

958 CMR 3.000 Health insurance consumer protection
Establishes requirements for carriers in administering their internal grievance procedures.

Federal law

Families First Coronavirus Response Act, P.L. 116-127 (2020)
This law responds to the COVID-19 (i.e., coronavirus disease 2019) outbreak by providing paid sick leave, tax credits, and free COVID-19 testing; expanding food assistance and unemployment benefits; and increasing Medicaid funding.

Patient Protection and Affordable Care Act, PL 111-148 (HR 3590) 
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
Title one of the act prohibits changing insurance contribution amounts due to genetic information, or requiring genetic testing for insurance coverage purposes.

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

Federal regulations & executive orders

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

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."

Selected case law

Burwell v. Hobby Lobby Stores, Inc., 573 US 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 US 473, 135 S.Ct. 2480 (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, 923 F.3d 209 (May 2, 2019)
Reversing a US District Court opinion (301 F.Supp.3d 248) that had dismissed the case, Court of Appeals ruled that Massachusetts has standing to challenge to Federal regulations that allow employers to use a "moral exemption" to deny insurance coverage for birth control.

National Federation of Independent Business v. Sebelius, 567 US 519 (2012). Individual mandate is legal. “The federal government does not have the power to order people to buy health insurance...The federal government does have the power to impose a tax on those without health insurance.”

Web sources

COBRA
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.

Consumer alert: National health care reform: What does it mean for Massachusetts?
Information about consumer issues regarding health care reform

Consumer guide to understanding health care coverage, Mass. Division of Insurance
Extensive resource details who has to have insurance, types of plans, costs, finding a provider, and more

FAQs about Affordable Care Act Implementation Part 51, Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act implementation, US Depts. of Labor, Health and Human Services, and the Treasury
On December 2, 2021, President Biden announced that the Departments would issue guidance by January 15, 2022, to clarify that individuals who purchase over the counter COVID-19 diagnostic tests during the public health emergency will be able to seek reimbursement from their plan or issuer.

Frequently asked questions about COBRA continuation health coverage, US Dept. of Labor
Includes information on eligibility and more

HealthCare.gov
Gateway to federal health insurance programs. You can get information about how the federal law affects you and much more. Massachusetts residents can explore plans and sign up using the Massachusetts Health Connector.

Health care reform for individuals, Mass. Dept. 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. 

Health care resources at the Attorney General’s Office
Information about the Mediation Unit of the Attorney General’s Office that helps people with problems with their health insurance or provider billing.

Health insurance counseling
The SHINE (Serving the Health Insurance Needs of Everyone) Program provides free health insurance information and counseling to all Massachusetts residents with Medicare and their caregivers.

Health insurance plans: Which plan is right for you?Includes information on types of health plans, cost, how to get a health plan and what to be aware of when purchasing a health plan.

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

How to get your at-home over-the-counter COVID-19 test for free, Centers for Medicaid & Medicare Services.

Massachusetts Health Connector
This is the state agency managing mandatory health insurance. Come here to apply for insurance or buy a health plan.

MassHealth
In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined into one program called MassHealth.

Tax penalty for failure to have health insurance in 2020
Listing of penalties for tax year 2020.

Understanding immigrants' eligibility for MassHealth & other subsidized coverage, Mass. Legal Services, 2020
"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."

Print sources

ConnectorCare advocacy guide, Massachusetts Law Reform Institute, May 2019 edition.
Information about the ConnectorCare program done in question/answer format. Explains the difference between ConnectorCare and MassHealth CarePlus.

Health care law sourcebook, Bender

How insurance companies settle cases, James, annual. div

Labor and employment in Massachusetts; 2nd ed. LexisNexis ( loose-leaf) 
Chapter 15: Private Health Care and Life Insurance

Massachusetts divorce law practice manual, 4th ed., MCLE, loose-leaf, Chapter 25. 

The law of life and health insurance, Bender, loose-leaf

What to do about personnel problems in Massachusetts; BLR (currently updated)
Information about Massachusetts and National Health Care laws, regulations and mandated benefits including COVID 19 coverage.

Your rights in the workplace by Sachi Barreiro, Nolo, 2018.

Contact

Online

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Last updated: April 8, 2022
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