Health Insurance: Massachusetts Health Insurance Information

Resources and Contact Information

Health insurance helps patients get the medical care they require
Health insurance helps patients get the medical care they require. Getty Images/PhotoAlto/Frederic Cirou/PhotoAlto Agency RF Collections

This article contains information regarding health insurance in the state of Massachusetts. 

Massachusetts Division of Insurance

The Massachusetts Division of Insurance is responsible for regulating all types of insurance sold in the state of Massachusetts, including health insurance policies.

If you are looking for health insurance coverage, the Division of Insurance can help you find an insurance agent or insurance company that is licensed to do business in Massachusetts.

You can contact them at the phone number listed below, or conduct your own search online.

If you are having trouble resolving a claims dispute with your insurer, you can file a complaint with the Division of Insurance. You can download a complaint form and mail it in, or contact the Division of Insurance by phone at the number listed below for more assistance: 

Massachusetts Division of Insurance
1 South Station, 5th Floor
Boston, MA 02110
Phone: 617.521.7777
http://www.mass.gov/ocabr/government/oca-agencies/doi-lp/

U.S. Department of Labor

If you get your insurance via employment, your plan is also regulated by the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). They make and enforce the rules that your employer must follow when offering health insurance coverage to employees. For example, your employer cannot single out an individual employee to exclude him or her from the plan because he or she has a costly illness.

Also, if there are 20 or more employees at your job, you should be offered COBRA continuation coverage when you leave your job. The EBSA works to make sure that all of this happens and that your rights are protected.

If you have concerns about your employer's practices in administering your job-based health coverage - for example, if you think you should have been offered COBRA continuation coverage, but were not, or if you feel that you were wrongly terminated from your health plan - contact your regional EBSA office.

U.S. Department of Labor Employee Benefits Security Administration
Boston Regional Office
J.F.K. Building, Room 575
Boston, MA 02203
James Benages - Director
Phone: 617.565.9600
Fax: 617.565.9666
https://www.dol.gov/agencies/ebsa

Buying Individual Policies in Massachusetts

Massachusetts recently instituted a mandate requiring all residents to obtain health insurance coverage, either through their jobs or on their own in the private market. Fortunately,insurers in Massachusetts ARE NOT PERMITTED to reject any application for coverage on the basis of health status. However, they may impose a pre-existing condition exclusion period of up to twelve months upon those individuals who do not have prior continuous coverage.

"HIPAA-eligible" individuals are exempt from these pre-existing condition exclusion periods. You may be HIPAA-eligible if you:

  • had at least 18 months of continuous creditable coverage, the last day of which was under a group plan AND
  • you have exhausted all COBRA continuation coverage which was available to you.

    If you are not sure whether you are a HIPAA-eligible individual, your insurance agent or the Division of Insurance can help you find out.

    Massachusetts Children's Medical Security Plan (CMSP)

    The Children's Medical Security Plan provides health insurance coverage for children under age 19 at any income level who are not eligible for Medicaid benefits through MassHealth. The contact information for the Children's Medical Security Plan is below: 

    Children's Medical Security Plan
    Phone: 1.800.909.2677
    CMSP website

    Massachusetts Serving the Health Information Needs of Elders (SHINE)

    Serving the Health Information Needs of Elders, or SHINE, provides free one-on-one counseling for Medicare beneficiaries with questions about any individual aspects of Medicare, including the new Part D prescription drug benefit, or Medigap coverage.

    Telephone contact information for a local Massachusetts SHINE office can be found here. More information regarding SHINE is below: 

    Massachusetts SHINE
    Phone: 1.800.243.4636
    Massachusetts SHINE website

    MassHealth

    MassHealth is the Medicaid program for Massachusetts. Medicaid is a government program designed to help the poor and indigent obtain health care services. Pregnant women and children under age 19 who meet certain income requirements may be eligible for Medicaid coverage, along with aged, blind, and disabled individuals. For more information about MassHealth, including an application for enrollment, contact MassHealth at the number listed below: 

    Masshealth
    Customer Service Center
    55 Summer Street
    Boston, MA 02110
    Phone: 1.888.665.9993
    MassHealth website

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