Massachusetts Health Insurance Guide

From historic cobblestone streets in Boston to scenic hikes in the Berkshires, Massachusetts remains a desirable place to live — and understanding your health insurance options here is key to protecting your health and finances.
As of 2025, the uninsured rate in Massachusetts reflects steady enrollment and robust state-level coverage mandates. If you’re currently without coverage, here’s what you need to know about getting insured in Massachusetts.

Health Insurance Options in Massachusetts

Massachusetts offers a range of health insurance options tailored to residents’ needs, depending on age, income, employment, and family size. Here are the most common coverage types available:

Employer-Sponsored Insurance

Many Massachusetts residents receive health insurance through their employer. If your workplace offers coverage, this is usually the most cost-effective and convenient option.

ACA Marketplace Plans

The Affordable Care Act (ACA) allows individuals and families to buy health insurance through federal or state Marketplaces. These plans offer essential health benefits, free preventive care, and protection for preexisting conditions.

If you don’t have employer coverage, you may qualify for subsidies to lower your premiums. Use our ACA Subsidy Calculator to check your eligibility.

Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce the ACA subsidies by $5 per month for individuals who are automatically re-enrolled in fully subsidized plans without verified eligibility.

ACA Plan Types

ACA marketplace plans are available in four tiers: Bronze, Silver, Gold, and Platinum, each with distinct coverage levels. Plans also vary by provider networks and out-of-pocket expenses, so compare carefully to find what fits your needs.

Marketplace Plans:

• Bronze: Low monthly premiums, higher out-of-pocket costs; ideal for minimal healthcare usage.
• Silver: Moderate costs; eligible for cost-sharing reductions (CSRs).
• Gold: Higher monthly premiums with lower out-of-pocket costs; best for frequent healthcare users.
• Platinum (if available): Highest premiums, lowest out-of-pocket costs.

Metal Tier Breakdown:

Medicaid

MassHealth, Massachusetts’ Medicaid program, provides free or low-cost coverage for eligible low-income residents. Medicaid plan benefits typically include preventive care, hospital visits, mental health services, prescriptions, and more.

Short-Term Plans

Short-term medical (STM) plans are not permitted in Massachusetts. State regulations prohibit underwritten STM plans, so this type of temporary coverage is not available.

Children’s Health Insurance Program (CHIP)

Known as the Massachusetts Children’s Health Insurance Program (MassHealth), this program helps children and pregnant women in families that earn too much for Medicaid but need affordable insurance.

Student Health Insurance

College students in Massachusetts have multiple health insurance options, including staying on a parent’s plan until age 26, enrolling in a school-sponsored plan, or applying for coverage through the ACA Marketplace. Depending on your income and location, you may also qualify for Medicaid, CHIP, or other options—making Massachusetts student health insurance accessible and flexible for a wide range of needs.

Medicare

Medicare plans are available for residents aged 65+ and younger individuals with qualifying disabilities. Options include:

• Medicare Advantage (Part C): An alternative to Original Medicare offered by private insurers to those enrolled in Parts A and B. These plans often include extra benefits and cost protections but typically require using a specific network of providers.
• Prescription Drug Plans (Part D): Provides prescription drug coverage for anyone with Medicare. Offered by private insurers, these plans vary in coverage and can be joined during specific enrollment periods.
• Medicare Supplement (Medigap): Helps cover the out-of-pocket costs that Medicare Part A and Part B don’t pay. Since Original Medicare lacks an out-of-pocket maximum, these plans can limit your expenses for medical services.

COBRA Coverage

If you’ve recently lost job-based insurance, COBRA allows you to continue your employer coverage temporarily—typically at full cost.

Massachusetts also offers Mini-COBRA, which extends similar continuation rights to employees of small businesses.

Enrollment Periods in Massachusetts

Open Enrollment for 2026 Coverage:
November 1, 2025 – January 23, 2026
Massachusetts offers an extended enrollment window compared to many states.

Special Enrollment Period:
Available year-round for those experiencing qualifying life events (QLE), such as:

• Loss of coverage
• Marriage or divorce
• Birth or adoption of a child
• Relocation
• Major change in income

You typically have 60 days from the event to enroll.

Health Insurance Providers in Massachusetts

As of 2025, these insurers typically offer individual and family plans through the Massachusetts Health Connector:

• Blue Cross and Blue Shield of Massachusetts
• Boston Medical Center Health Plan
• Harvard Pilgrim Health Care
• Tufts Health Plan
• Health New England
• Fallon Health
• UnitedHealthcare
• ConnectiCare of Massachusetts

Plan availability may vary by county or zip code.

Understanding Health Insurance Costs

When selecting a plan, be sure to understand these common cost terms:

• Premium: Monthly payment to maintain your plan.
• Deductible: What you pay before insurance covers services.
• Copayment (Copay): Fixed amount per visit/service.
• Coinsurance: Shared costs with your insurer after the deductible.
• Out-of-Pocket Maximum: Your yearly cost cap for covered services.
• In-Network vs. Out-of-Network: Staying in-network helps you avoid higher charges.

This glossary offers clear definitions of key health insurance terms to help you choose wisely.

Bottom Line

Health insurance in Massachusetts comes with many choices—whether from your employer, through the ACA marketplace, or public programs like Medicaid and Medicare. By staying informed and comparing plans during the right enrollment periods, you can secure reliable coverage that supports your well-being and financial goals.

Need help choosing a plan? Use our ACA Subsidy Calculator to see if you’re eligible for financial assistance or speak with a licensed insurance agent about your options.