Massachusetts residents are in luck when it comes to health care options. According to a study by US News, MA has the fifth best health care in the nation. The state ranked high in health care access, quality, and good public health.
Health insurance options in Massachusetts
According to the MA Division of Insurance, there are multiple ways for residents to access health insurance:
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Where do most Massachusetts residents get their health insurance coverage?
|Individual or family||6%|
|Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population|
Only three percent of Bay State residents are uninsured. This falls below the national average, which is a good sign for policyholders. A high amount of uninsured people often leads to higher rates for insured people.
Massachusetts health insurance costs and rate factors
Massachusetts residents spend an average of $10,559 per year on health care. That's a few thousand more than the national average. What factors determine your health insurance price tag? Costs vary quite a bit depending on the person, but here's what insurance companies look at to price your policy:
Health insurance plan type
Marketplace plans divide coverage into metal tiers: bronze, silver, gold, and platinum. The more coverage you want, the more you'll pay in monthly premiums.
How much should you expect to pay for health care in Massachusetts? These are the average monthly premiums for a 40-year-old Bay State resident in 2020 :
|Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier|
There's a 50 percent price jump from a bronze plan to a gold plan. This is because gold plans cover 80 percent of medical care costs, whereas bronze plans cover 60 percent.
You may qualify for a catastrophic plan, available to people under 30 or with certain exemptions. These plans have low monthly premiums but a high yearly deductible of $8,150. Investing in a bronze or silver plan may save you money if you need to use your health insurance.
Body mass index
According to the CDC, a high BMI can lead to several serious health conditions. That's why insurers will analyze your BMI to determine your risk-level. A high BMI often leads to higher insurance rates.
In 2018, Massachusetts had a 25.7 percent obesity rate, the fourth lowest rate in the country. Out of the many MA residents who use QuoteWizard to compare health insurance plans, 21 percent have a BMI in the obese range.
It's no secret that substantial risks come from smoking. About 13.7 percent of Massachusetts residents are smokers, the fifth lowest rate in the country.
Health insurance tends to cost more for older people than younger people. On average, Massachusetts residents who use QuoteWizard to shop for health insurance are 43 years old.
The unique laws, regulations, and insurance providers in your state play a big role in insurance costs.
Rates also depend on the people around you. Insurers often use community ratings to determine your costs. That means that your monthly premiums are based in part on the combined claims everyone files. If your neighbor files a high number or claims, for example, your costs could reflect that.
That means that living in a health-conscious state could keep your premiums low. Good news for Massachusetts residents, yours is the healthiest state in the country.
Massachusetts health insurance companies
MA residents have many options when it comes to health insurance companies. These providers offer individual and family plans in your state:
BMC HealthNet Plan
BMC HealthNet Plan has several plan types. Qualified health plans cover prescriptions, hospital stays, mental health and substance use services, and more. Plan types are organized into metal tiers: bronze, silver, gold, and platinum. The company also offers discounts on eyeglasses, money back for participating in some health clubs, and nutrition coaching.
BMC HealthNet Plan is a non-profit health plan. Established in 1997 by Boston Medical Center, the company serves 330,000 members across MA.
Fallon Community Health Plan
Fallon Community Health Plan offers plenty of group and non-group health plans. These include: HMO, POS, PPO, Medicaid, and Medicare Advantage plans. Most Fallon Health plans require no copayment for preventive services, eye exams, hospital care, chiropractic care, and more. Also, plans cover costs for medications prescribed by in-network doctors. Members enjoy benefits like a new parent program, a smoking cessation program, fitness discounts, and more.
Fallon Health was founded in 1977 and ranks as one of the nation’s highest-rated health plans. The company’s mission is, “making our communities healthy.”
Health New England
Health New England offers health care plans through the MA Health Connector. Members can access care management programs through New England Health. These programs focus on behavioral health, disease management, complex care management, and care coordination. Members can also speak to a doctor online or over the phone 24/7. You can log into your member portal to estimate the price of medical services to plan your costs.
Health New England was founded in 1985. The company has a network of 23 hospitals and 11,000 providers. Health New England provides service in these MA counties: Berkshire, Franklin, Hampden, Middlesex, Norfolk, and Worcester.
Allways Health Partners
Allways is a local health insurance provider that offers a variety of HMOs and PPOs. Specific benefits vary between plans, but policyholders benefit from pharmacy benefits and discounts through CVS. The company offers family support for expecting moms, help quitting tobacco, health coaches and more.
Tufts Health Plan
Tufts Health Plan offers two different plans for individuals and families: Direct and Premier. These plans are sold on the MA Health Connector. Direct offers low-costs plans and, if you qualify, federal premium tax credits. Members with Premier have access to the Tufts Health Plan standard network. The plans affect the network of doctors you have access to, so some doctors may be available in one network but not the other. Plan benefits include gym membership rebates, a stress management program, vision correction and eye wear, and more.
Tufts Health Plan offers service to 1.1 million members and has a network of more than 100 hospitals and 51,000 providers.
Harvard Pilgrim Health Plan
Harvard Pilgrim Health Plan has several plan options. Plans come in metal tiers: bronze, silver, gold, and platinum. Plan types include HMO, PPO, and Connector. Individual and family plans also come with several benefits. Benefits include personal health coaching, $0 copayment for annual physical exams and annual flu shots, gym discounts, and more. All plans cover emergency services, hospitalization, prescriptions, and more.
Harvard Pilgrim Health Plan has been serving MA residents for 50 years. The company has a network of over 70,000 doctors and 182 hospitals.
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of MA offers six plan types for individuals and families. These plans are: HMO, PPO, Access Blue, Blue Options HMO, Blue Options PPO, and Blue Select HMO. There are also several out-of-network options. Deductibles for BCBSMA plans are typically between $500 and $2,000. Member resources include a 24/7 nurse advice line and an online tool that allows live video chats with doctors. BCBSMA also offers programs that focus on overcoming insomnia and pregnancy and postpartum care.
BCBSMA was founded in 1937 and employs 3,700 people. The company’s vision is, “making quality health care affordable.”
Use the MA Health Connector to apply for exchange and non-exchange plans. Also, find out how your zip code affects your coverage.
Massachusetts health insurance laws
The Affordable Care Act mandates that insurance companies cannot use certain factors to price your policy.
- Pre-existing conditions: Providers used to charge people with pre-existing conditions significantly more for health care coverage than those without. Insurance companies can no longer charge you more if you have a pre-existing condition.
- Gender: According to a study by Health Services Research, women tend to pay more for health care. But the ACA prohibits providers from charging women and men different prices for the same policy.
- Insurance and medical history: Before the ACA, people with previous medical conditions or lapses in insurance coverage paid higher rates. This type of activity is now illegal.
Marketplace plans have out-of-pocket maximums. For 2020, the out-of-pocket limit is $8,150 for an individual plan and $16,300 for a family plan.
MA law requires that insurance companies provide at least some coverage for these services:
- Hospice care
- Emergency services
- Maternity health care
- Speech, hearing, and language disorders
- Clinical trials
- Prosthetic devices
- Speech therapy
- Mental health care
There are more services that Massachusetts insurers are required to provide.
The Bay State has a mandate that requires most adults to carry health insurance. Find out more about the health insurance mandate on the Massachusetts Health Connector.
Medicare and Medicaid in Massachusetts
Medicare and Medicaid are government-funded programs that aid different groups of people find affordable health care. Medicare helps senior citizens, and Medicaid helps low-income families and children.
Medicare is available to people 65 years and older. There are several coverage options within the program, including supplemental coverage plans and parts A, B, C, and D. As a Massachusetts resident, you may also qualify for state-specific Medicare Savings Programs:
- Single individual: Monthly income at or below $1,755 and assets at or below $15,720.
- Married couple: Monthly income at or below $2,371 and assets at or below $23,600.
Massachusetts is a state with expanded Medicaid called MassHealth. These are the state'sMedicaid financial requirements:
|Household Size||Maximum Yearly Income|
Massachusetts Division of Insurance
- Insurance Commissioner:
- Gary Anderson
- Insurance Hotline:
- (877) 563 – 4467
- Office Hours:
- Monday - Friday
8:45 am to 5:00 pm
- File a Consumer Insurance Complaint
- Insurance Complaint Page
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