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Massachusetts law about health insurance

A compilation of laws, regulations, cases, and web sources on health insurance law.

Massachusetts laws

MGL c.111M Individual Health Coverage
The Massachusetts Mandated Health Insurance Law, added by St. 2006, c.58, which also amended many other sections. 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.

St. 2012, c.224 An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation. Health Care Cost Reduction. Signed Aug. 6, 2012. Various sections effective 2013-2017. See sections 281A-308 for specific effective dates.

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

Massachusetts regulations

956 CMR Commonwealth Health Insurance Connector Authority

Federal law

Patient Protection and Affordable Care Act, PL 111-148 (HR 3590) (see additional resources below)
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.

Additional Resources

Selected case law

  • National Federation of Independent Business v. Sebelius, 567 US __ (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.”
  • 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 __ (June 25, 2015) (see additional resources below) 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."
  • Burwell v. Hobby Lobby Stores, Inc., 573 US __ (2014) (see additional resources below)
    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.

Additional Resources

Other health insurance issues

Web sources

  • Eligibility of Non-Citizens for MassHealth & other subsidized coverage Mass. Legal Services, 2015
    "summarizes the current immigrant eligibility rules applicable to pregnant women, children, young adults, and other adults for MassHealth and other subsidized health coverage and includes tables listing different categories of immigrants eligible for different kinds of benefits under health program rules."
  • Massachusetts Health Connector
    This is the state agency managing mandatory health insurance. Come here to apply for insurance or buy a health plan.
  • Consumer Guide to Health Care Coverage, Mass. Office of Consumer Affairs
    Extensive resource details who has to have insurance, types of plans, costs, finding a provider, 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, above.
  • The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, Democratic Policy Committee
    Includes summary and analysis of the federal law, including an explanation of immediate benefits, section-by-section analysis, and an implementation timeline
  • Tax Information on Health Care Reform, Mass. Dept. of Revenue
    Includes information on the tax implications of health care reform, with forms and more, for individuals, employers, and insurance carriers
  • What the Health Care Law Means for Massachusetts, Boston Globe, March 22, 2010
    Lists key provisions of the federal law and differences with Massachusetts law
  • The 2006 Massachusetts Health Care Reform Law: Progress and Challenges After One Year of Implementation, Blue Cross/Blue Shield (see additional resources below) Foundation of MA, Mass. Medicaid Policy Institute, and Mass. Health Policy Reform, May 2007
    Outlines progress made to date, including implementation, infrastructure, community outreach, and more. Also projects future issues and challenges.
  • Re-Forming Reform: What the Patient Protection and Affordable Care Act Means for Massachusetts, Robert W. Seifert and Andrew P. Cohen, Center for Health Law and Economics, University of Massachusetts Medical School, June 2010 (see additional resources below)
    Detailed report explains positive and negative effects of the federal law on Massachusetts residents
  • Your Guide to Managed Care in Massachusetts, Mass. Division of Health Care Finance and Policy (DHCFP) and the Mass. Office of Patient Protection (OPP) (see additional resources below)
    93-page guide "that will help you: Learn the differences between different types of health insurance and how those differences affect you, Choose a health plan that best meets your needs, File an appeal or complaint with your health plan if the need arises, and Find additional information on health plans."

Additional Resources

Employer's Guide to Health Care Reform, Wolters Kluwer, annual

Health Care Reform: Yesterday and Tomorrow, Center for Advanced Legal Studies, 2010

Law of Life and Health Insurance, Bender,loose-leaf

Last update: January 22, 2018

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