- Division of Insurance
Open Enrollment, which runs from November 1, 2024 through January 23, 2025 for Massachusetts residents, is the period when consumers can change their health insurance coverage for any reason. Outside of Open Enrollment, residents can only enroll in or change their individual health insurance if they have a qualifying event, such as getting a divorce or losing a job, or if they newly qualify for certain subsidies through the Health Connector.
The Division of Insurance offers the following tips to keep in mind while shopping for a new health plan:
How does someone purchase a health plan during Open Enrollment?
Consumers can purchase comprehensive health plans by contacting a licensed insurance carrier, through a licensed broker, or by going through the Health Connector, the Commonwealth’s official health insurance exchange or “marketplace” at www.MAhealthconnector.orgThere are 9 licensed insurance carriers approved to sell insured health plans to Massachusetts-residing individuals.
Why consider a plan through the Health Connector?
If you do not have health care coverage through your employer and are not eligible for Medicare or Medicaid (referred to as MassHealth), plans offered on the Marketplace are a great option.
What will a Marketplace plan cover?
Every fully insured, comprehensive health insurance plan, whether sold directly from a licensed carrier or purchased on the Connector, in Massachusetts includes:
- Essential health benefits, including prescription drugs, emergency services, hospitalization, laboratory services, and mental health and substance use disorder services.
- Free preventive health services at no cost to you when delivered by a doctor or provider in your plan’s network.
- Coverage for pre-existing conditions.
- Pregnancy, maternity, and newborn care (both before and after birth).
It is very important that consumers fully and carefully review any health plan to ensure it is compliant with both state and federal requirements. Websites that reference “ObamaCare or ACA plans” or have website URLs that suggest you can purchase plans may look like the state’s exchange but are not. These websites connect consumers with individuals, who may or may not be licensed insurance agents, in order to help sell other types of insurance or wellness plans, such as hospital indemnity insurance, limited benefit health plans, discount health plans, health care sharing ministries, or other non-comprehensive health plans. Many such plans may or may not be legal and do not offer the same consumer protections as a comprehensive insured health plan and will not guarantee payments for most medical services and expenses and may result in a resident facing a tax penalty for not carrying Minimum Creditable Coverage.
What to look for when enrolling in a plan?
First, always look for disclaimers on the website or policy documents such as “this is not insurance” or “does not meet Minimum Creditable Coverage.”
Then check that the plan features work for you. Plans sold on the Connector are broken down by how costs are shared between you and your insurer. Pay attention to your cost-sharing responsibilities such as co-pays and deductibles. The more that you share in the costs for the care you receive, the lower your monthly premium will be. It is also smart to confirm that the doctors and hospitals you and your family use are in the plan’s networks. Some health plans may require prior authorization, or approval to receive certain proposed care. Prior authorization allows the health plan to decide if the care is medically necessary, safe, and cost effective. Without prior authorization, your health plan may not pay for your treatment or medication. (Emergency care does not need prior authorization.)
Consumers with questions or concerns about the legitimacy of a health insurance plan or company are urged to visit the Division’s website at www.mass.gov/doi, or to contact the Division’s Consumer Services Unit at (617) 521-7794 or by email at CSSComplaints@mass.gov.
For information on purchasing a health insurance plan from the Health Connector, please call 1‑877-MA-ENROLL or visit www.MAhealthconnector.org.
