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Massachusetts Health Insurance

According to the Center for Disease Control an average 9.6% of Massachusetts residents went without Massachusetts health insurance each year between 2001 and 2003.

Massachusetts Health Insurance Regulations

According to the laws regulating Massachusetts health insurance, no individual can be denied individual Massachusetts health insurance due to health, age or any other factor. All Massachusetts health insurance policies are guaranteed renewable. This means that an individual is guaranteed the right to renew an existing Massachusetts health insurance policy provided the individual has not provided false information and has paid all premiums on time. No employer Massachusetts health insurance plan can deny or limit access of an individual to the Massachusetts medical insurance coverage.

Some Massachusetts health insurance companies can impose pre-existing exclusion periods. A pre-existing condition is one for which the individual was treated or diagnosed within the six month period prior to the beginning of a new Massachusetts medical insurance policy. During the pre-existing exclusion period the Massachusetts health insurance company can deny coverage for the pre-existing condition.

The period cannot exceed six months and cannot be imposed if the individual had a break of continuous Massachusetts health insurance coverage for less than 63 days. Previous Massachusetts health insurance plans can be credited towards new plan pre-existing condition periods.

Elimination riders impose restrictions on medical coverage under health insurance plans and generally permanently exclude coverage for health conditions. Massachusetts medical insurance companies are not allowed to impose elimination riders.

All Massachusetts health insurance plans that cover minors must also cover newborns and adopted and foster children from the time of birth, adoption, or acquisition. Handicapped children can remain under the parent’s Massachusetts health insurance past the age at which dependent coverage usually stops.

Massachusetts Health Insurance Rates

Massachusetts health insurance rates are regulated and an individual cannot be charged more for reasons of health, gender, or occupation. This is called a modified community rating. All Massachusetts health insurance companies must offer standardized policies to consumers looking to purchase individual Massachusetts medical insurance. Policies include:

  • Medical plan option – allows the individual to seek care from any doctor or hospital
  • Preferred Provider Plan – allows the individual to seek care from providers in or out of network
  • Managed care plan - requires the individual seek care only from providers in the network contracting with the HMO

Alternative Massachusetts Health Insurance Options

For individuals unable to afford Massachusetts health insurance the state provides programs that can help:

  • MassHealth is the Medicaid and State Children’s Health Insurance Program designed to provide Massachusetts health insurance to eligible individuals who meet the qualifying criteria.
  • Massachusetts Division of Employment and Training helps unemployed individuals who have lost their Massachusetts health insurance from their previous employer find assistance through COBRA.
  • Massachusetts Free Care helps qualified individuals who meet poverty qualifications find Massachusetts health insurance.
  • Massachusetts Division of Insurance

    Commonwealth of Massachusetts
    Division of Insurance
    One South Station, 5th Floor
    Boston, MA 02110-2208

    Main Telephone Number (617) 521-7794
    Consumer Information Hotline (617) 521-7794 Fax (617) 521-7575
    TTD/TDD (617) 521-7490

    For other Massachusetts Insurance Resources, See:

    Connect With Massachusetts Health Insurance Agents Now By Filling Out The Quick Form At The Top Of The Page.

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