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Massachusetts Health Insurance

Massachusetts Individual Health Insurance Information

In Massachusetts, medical underwriting is not allowed. There is a 6 month look back and exclusionary period limit for preexisting conditions for those without prior health coverage. There is a no high risk pool in Massachusetts. All individuals are guaranteed at least three health insurance options.

Massachusetts Group Health Insurance (Small Business: 1-50 employees)

In Massachusetts, premiums are based on community ratings based on age, industry, group size, family composition, participation rate, wellness program participation, participation in the small employer reinsurance plan, and geography. There is a 6 month look back and exclusionary period limit for preexisting conditions for thoe without prior healthcare.

For more information on small group plans for this state please see our Massachusetts Small Group page.

Massachusetts COBRA Individual Health Coverage

Massachusetts offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce.

Medicaid and Medicare in Massachusetts

Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.

Income requirements

Children
Children (ages 1-5)-150% of the Federal Poverty Level
Children (Ages 6-19)-150% of the Federal Poverty Level

Pregnant Women and Infants
Pregnant Women-200% of the Federal Poverty Level
Infants (ages 0-1)-200% of the Federal Poverty Level

Parents
Non-Working Parents-133% of the Federal Poverty Level
Working Parents-133% of the Federal Poverty Level

Other populations
Supplemental Security Income Recipients- 74% of the Federal

Poverty Level
Aged, blind, and disabled- 100% of the Federal Poverty Level

Covered Services
Doctor visits, hospital stays, rehabilitation and therapeutic services, and behavioral health and substance abuse services.

Co-Payments

$1 for generic prescriptions, $3 for brand name prescriptions, $3 for emergency room use when not an emergency, $3 for acute inpatient stays. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

You may learn more about Massachusetts Medicaid by clicking here.

Click here for information about Medicare in Massachusetts.

Other Massachusetts Health Insurance Programs

Massachusetts offers the Children's Medical Security Program (CMSP) to children under the age of 19 who are Massachusetts residents, who have no other insurance, and who family incomes are up to 400% of the Federal Poverty Level. Please visit the CMSP website for more detailed information.

More Massachusettes Health Insurance Information

Massachusetts: 45,000 Now Enrolled In Health Insurance Coverage Massachusetts Insurers Set Out to Enroll Working Poor