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An Overview on Medical Insurance in Massachusetts

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Medical Insurance in Massachusetts

Medical Insurance in Massachusetts

Introduction: The health insurance situation in Massachusetts (MA) is much better than the health insurance situation in other states of United States. Between the years 2001 and 2003, the Center for Disease Control conducted a survey on health insurance situation of the state. According to the survey report, 9.6% of the total MA residents were uninsured for Massachusetts medical insurance per year.

In this abstract, we have talked about some important rules and regulations of Massachusetts health insurance. A complete list of top Massachusetts health insurance companies along with a brief discussion on Massachusetts state health insurance alternative options are also included in this abstract. The entire discussion will let the Massachusetts residents know the current health insurance situation of their state.

Regulations for Massachusetts Medical Insurance

The Massachusetts state health insurance department has introduced some important rules and regulations to regulate the overall health insurance situation of the state as well as to monitor activities of Massachusetts health insurance companies. The Massachusetts medical insurance provides should strictly follow the rules. The rules are as follows:

  • Every Massachusetts health insurance companies should have a guaranteed provision for renewal. This guaranteed renewability provision lets an individual renew his or her existing Massachusetts health insurance plan; provided he or she has provided no fake information to the health insurers during the course of existing medical insurance policy and disbursed all the premiums, on time.
  • As per state laws, Massachusetts health insurance companies can't refuse to provide personal Massachusetts health insurance coverage to an individual; depending on his or her age, health status and other related conditions.
  • An individual, who is seeking for Massachusetts health insurance through an employer, can't be refused. Moreover, he or she can enjoy unlimited Massachusetts health insurance coverage.
  • Massachusetts health insurance companies have right to implement a waiting period for a pre-existing medical condition.
  • A pre-existing medical condition may be considered as an illness for which an individual has been diagnosed or otherwise treated previously, within 6 months before commencement of new Massachusetts health insurance plan.
  • An individual is not entitled to get coverage during pre-existing medical condition waiting period.
  • Massachusetts health insurance companies can not extend the pre-existing medical condition waiting period for more than 6 months.
  • Massachusetts health insurance companies can't impose a waiting period, if there was no breakage in coverage for 63 days or more; during the term of existing Massachusetts medical insurance policy.
  • Existing Massachusetts medical insurance policy can be credited to new Massachusetts medical insurance policy for pre-existing medical condition waiting period.
  • Some of the Massachusetts medical insurance companies issue elimination riders to individuals with pre-existing medical condition. It does mean that the insurance companies have right to refuse offering Massachusetts insurance coverage to an individual, even permanently, for his or her pre-existing medical condition.
  • Massachusetts health insurance companies that offer dependant coverage must include newborns and adopted children to their parent's insurance plans from the time of birth or adoption.
  • Handicapped dependants should be covered under their parents' health insurance plans, even if they cross the decided age limit.

Massachusetts Medical Insurance Costs

  • Modified Community Rating is a specialty of Massachusetts health insurance that helps the state to regulate the cost for Massachusetts health insurance.
  • Massachusetts health insurance companies should strictly abide by the Modified Community Rating.
  • Massachusetts medical insurance organizations can not hike the rate of premiums for a Massachusetts health insurance plan, on basis of health status, occupation and gender of an individual.
  • Massachusetts health insurance companies should offer standardized health insurance plans to the individual seeking for individual Massachusetts health insurance. The standardized health insurance policies conclude:
    • Medical Plan Option: This option helps the individuals, who are seeking for health care from doctors as well as hospitals.
    • Managed Care Plan: This plan is exclusively designed for the individuals who are looking for health care only from the Massachusetts health insurance providers in the network dealing with the HMOs.
    • Preferred Provider Plan: This plan helps individuals getting medical care from the providers in the network or out of the network.

Massachusetts Health Insurance Alternative Options

There are some state-funded health insurance alternative programs available in Massachusetts. Massachusetts residents, who are considered as “uninsurable” or otherwise unable to pay for Massachusetts medical insurance, can, opt for these state-funded health insurance alternative programs. The programs are discussed, below:

  • MassHealth: This is actually Massachusetts Medicaid and State Children's Health Insurance Program. It provides Massachusetts medical insurance to the qualified individuals as well as children and teens.
  • Massachusetts Free Care: This state program is especially created for the individuals who meet entire poverty qualifications. The program helps them getting Massachusetts health insurance.
  • Massachusetts Division of Employment and Training: This program helps unemployed Massachusetts residents, who have been dropped from getting Massachusetts health insurance by previous employer; to get assistance via COBRA.

Massachusetts Health Insurance Companies

According to Massachusetts Department of Insurance, the top Massachusetts health insurance companies that offer individual Massachusetts health insurance are as follows:

  • Aetna Life Ins. Co.
  • Aetna Health Inc.
  • Blue Cross and Blue Shield of Massachusetts, Inc.
  • Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.
  • Connecticare of Massachusetts, Inc
  • Fallon Community Health Plan, Inc.
  • Harvard Pilgrim Health Care, Inc.
  • Health New England, Inc.
  • John Alden Life Ins. Co.
  • The MEGA Life and Health Ins. Co.
  • Mid-West Life Ins. Co. of Tennessee
  • Neighborhood Health Plan, Inc.
  • New England Life Ins. Co.
  • Tufts Associated Health Maintenance Org., Inc. (DBA Tufts Health Plan)
  • Tufts Ins. Co.
  • United HealthCare Ins. Co.
  • UnitedHealthcare of New England, Inc.

According to Massachusetts Department of Insurance, the major licensed Massachusetts medical insurance HMO providers are as follows:

  • CIGNA HealthCare of Massachusetts, Inc.
  • Aetna Health Inc.
  • Fallon Community Health Plan Inc.
  • Great-West Healthcare of Massachusetts Inc.
  • ConnectiCare of Massachusetts
  • Harvard Pilgrim Health Care, Inc.
  • Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.
  • Harvard Pilgrim Health Care of New England, Inc.
  • Neighborhood Health Plan, Inc
  • Health New England, Inc.
  • United HealthCare of New England, Inc
  • Tufts Associated Health Maintenance Organization, Inc./ Tufts Health Plan

Massachusetts Department of Insurance

For more information on Massachusetts health insurance, you can contact at the office of Massachusetts Department of Insurance at the following address:

Commonwealth of Massachusetts
Division of Insurance
One South Station, 5th Floor
Boston, MA 02110-2208
Maine Phone Number: 617-521-7794
TTD/TDD: (617) 521-7490
Fax No: (617) 521-7575
Consumer Information Hotline: (617) 521-7794


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