Health Insurance Frequently Asked Questions

I need health insurance. Why can’t I enroll at any time during the year?

Due to state and federal regulations, individuals and families (known as “non-groups”), can only purchase health insurance during the open enrollment period. In past years, the enrollment period was between November 1st – January 23rd.

Are there any exceptions?

Yes, there are exceptions. If you have experienced a “qualifying event,” you may be able to get health insurance outside of the designated open enrollment period.

Define “qualifying events.”

If you’ve lost health coverage within the last 60 days because you:

1. Lost your job and coverage from your employer’s plan and you do not qualify for another employer’s plan or government-subsidized plan.
2. Became ineligible for your government-subsidized plan and do not have other coverage.
3. Have a subscriber who exhausted all COBRA benefits, and the coverage is ending or already ended within the past 60 days.
4. Moved into the state within the last 60 days.
5. Have a primary subscriber who became Medicare-eligible, but you are not eligible for Medicare.
6. Married within the last 60 days.
7. Divorced within the last 60 days.
8. Adopted a child within the past 60 days.
9. Gave birth to a child within the past 60 days
10. Have a primary subscriber who passed away within the past 60 days.
11. Are a child who turns 19 and no longer qualify for a child-only plan.
12. Have a former employer who stopped contributing to your COBRA coverage within the past 60 days.

Do self-employed people and businesses have to sign up during open enrollment as well?

No. Businesses and self-employed clients can get health insurance at any time during the year.

I am self-employed/a business owner. Do I have to wait until my annual renewal period to switch my plan to another provider?

No. Businesses and self-employed people can change to another healthcare provider at any time.

Are there any fees for canceling or changing to another carrier before your renewal date?

No, businesses can cancel your health insurance plan or switch to another carrier without any fees. Non-groups are allowed to cancel their plan at any time without incurring any fees as well. However, non-groups cannot switch to another carrier until their renewal date.

Do I have to have health insurance?

Yes, the state of Massachusetts has issued a mandate that all Massachusetts residents have to have a qualified health insurance plan or risk being fined when you file your tax return.

What is a qualified health insurance plan?

A qualified plan is one that meets all the minimum requirements set by the state of Massachusetts for healthcare coverage.

How do I know my health insurance plan meets the state requirements?

Dealing with a licensed agent/broker, with offices in Massachusetts and North Carolina, will most likely ensure you are enrolling in a qualified plan. Requesting a plan that is qualified and compliant with Massachusetts requirements will help as well. Check the summary of benefits for your plan and make sure you see this statement “This health plan meets Minimum Creditable Coverage standards and will satisfy the individual mandate that you have health insurance”.

Can I purchase a health insurance plan from a carrier who is out of state?

If you do, there is a high probability that your plan, and that carrier, do not meet the requirements set by the state, and your plan will not be qualified. This will subject you to fines and penalties by the state at tax return time.