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.175I through MGL c.176Q cover various types of health insurance, including HMO, PPO, Group, Non-Group, and more.
Two key areas of coverage that have recently been amended:
Opioids and addiction treatment
- Preauthorization for substance abuse treatment not to be required
- Coverage for medically necessary acute treatment or clinical stabilization services
- Filling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity
- Pain management access plans
956 CMR Commonwealth Health Insurance Connector Authority
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.
45 CFR 147.132 Religious exemptions in connection with coverage of certain preventive health services.
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 __, 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.”
Texas v. United States, 352 F.Supp.3d 665 (2018)
Rules ACA unconstitutional. Without a penalty, the individual mandate requiring health insurance is unconstitutional, and "the Individual Mandate is inseverable from the ACA’s remaining provisions" and so the whole law must be thrown out.
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
Eligibility of non-citizens for MassHealth & other subsidized coverage Mass. Legal Services, 2018
"summarizes the current immigrant eligibility rules applicable to pregnant women, children, young adults, and other adults for MassHealth and other subsidized health coverage. It includes Appendices listing different categories of immigrants eligible for different kinds of benefits under health program rules."
Frequently asked questions about COBRA continuation health coverage, US Dept. of Labor
Includes information on eligibility and more
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.
Massachusetts Health Connector
This is the state agency managing mandatory health insurance. Come here to apply for insurance or buy a health plan.
Your rights in the workplace , Nolo, 2018.
Chapter 3: Health insurance "provides information about health insurance coverage for current employees and for former employees in the U.S. as well as the state laws on insurance continuation. It also discusses coverage for dependents and the Obamacare." Requires library card for access.
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.
Employer's guide to health care reform, Wolters Kluwer, annual
Health care law sourcebook, Bender
How insurance companies settle cases, James, annual. div
Massachusetts divorce law practice manual, MCLE, 2019.
Chapter 25, Health Insurance
The law of life and health insurance, Bender, loose-leaf
|Last updated:||November 4, 2019|