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).
Massachusetts Health Connector
The Massachusetts Health Connector is the state’s marketplace for health and dental insurance.
Federal changes
- Stay informed about federal changes, MA Health Connector.
The federal government has made changes to who qualifies for help paying for health insurance that could affect your coverage and costs. Some of these changes may have impacted your health coverage for 2026. There are more changes coming for plan year 2027. - What to know about MassHealth and ConnectorCare changes, 413Cares.
The federal government's changes to Medicaid and subsidized insurance are expected to impact over 200,000 people in MA who have ConnectorCare (subsidized insurance). These changes will restrict eligibility and add work and renewal requirements.
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 Mandated 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
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
Recent update: Governor Healey announces final regs that eliminate prior authorization requirements for routine and essential health care, May 14, 2026.
"Updated regulations eliminate prior authorization requirements for cancer scans and medications for chronic conditions like asthma, diabetes and heart disease."
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 (PDF), 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 (PDF), 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 (PDF), 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:
Regulations
26 CFR Part 54 Pension excise taxes
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)
Several provisions of this rule were stayed nationwide (August 22, 2025) and later vacated in part (June 12, 2026) in City of Columbus v. Kennedy, No. 1:25-cv-2114 (D. Md.); the litigation is ongoing.
- 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."
Transparency in Coverage (26 CFR Part 54)
In response to a presidential order issued February 25, 2025, the Trump administration has overhauled the rules requiring health insurers to disclose the prices they negotiate with hospitals, doctor’s offices and other providers, with the goal of making those costs clearer and more usable for the public. On October 5, 2026 the HHS, Labor and Treasury departments issued a final rule that fixed gaps in the price transparency requirements, standardized file formats, and increased accountability for insurers. Refer to the press release for more information.
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."
Office of Patient Protection
Helps Massachusetts residents appeal a denial of health insurance and apply for a waiver to buy health insurance outside open enrollment.
Selected cases
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.
Noncitizens
Federal changes to noncitizen eligibility coming to the Health Connector MA Health Connector
Due to changes to federal law, changes to eligibility for subsidized coverage for noncitizens are coming to Health Connector and MassHealth coverage.
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 2026, 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.
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., loose-leaf, updated by supplements.
Labor and employment in Massachusetts, 2nd ed., LexisNexis, loose-leaf, updated by supplements. (eBook available with library card)
Chapter 15: Private Health Care and Life Insurance.
Massachusetts divorce law practice manual, 6th ed., MCLE, 2026.
Chapter 25: Health Insurance.
The law of life and health insurance, Matthew Bender, loose-leaf, updated by supplements. (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)
Contact
Online
| Last updated: | October 22, 2026 |
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