ConnectorCare health insurance

To qualify for ConnectorCare:

• You must live in Massachusetts.
• You must be a U.S. citizen or a “lawfully present” non-citizen.
• Your income must be 5 times the federal poverty level for your family size or lower. See the ConnectorCare Upper Income Limits table. The Health Connector counts:
  • your federal taxable income for the year, and
  • some income like your social security income, even if it is not taxable.
  • Your family size is based on the people you include on your federal tax return. See more about the ways the Connector counts income and family size.
• You must be unable to qualify for other kinds of health coverage like:
  • Premium-free Medicare Part A,
  • Any kind of MassHealth, except MassHealth Limited, or
  • Insurance you can get through your employer that ConnectorCare counts as affordable.
  • See more about how other kinds of health coverage may affect your eligibility for ConnectorCare.
• You must agree to file a federal tax return for the year in which you get ConnectorCare.
  • Even if you do not make enough money to have to file taxes, you must file a tax return to get the “tax credit” that the government uses to pay for your ConnectorCare HMO.
  • See more about ConnectorCare and tax filing.
• If you are married and will file taxes as “married filing separately,” you only qualify for ConnectorCare if you need to file separately because of abuse or abandonment.
• You must enroll in one of the HMOs that offer ConnectorCare plans:
  • Choose an HMO, and
  • Pay any premium that is due by the 23d of the month so you can start coverage on the 1st of the next month. Not everyone will have a premium.
• You can apply at any time of year, but you must enroll:
  • within 60 days of the date you are found eligible for ConnectorCare, or
  • for coverage in 2024, you can enroll anytime during “open enrollment” that began Nov 1, 2023 and ends Jan. 23, 2024
  • If you miss the enrollment deadline, you may have to show the Connector that you qualify for a “special enrollment period.” See more about special enrollment periods in the ConnectorCare Advocacy Guide.

All ConnectorCare HMO plans cover benefits like doctor visits, prescription medicines, hospitalization, behavioral health and emergency care.

Connector Care plans have:

• low monthly premiums,
• low copays, and
• no deductible.

See a list of the benefits and copayments that ConnectorCare covers in 2024.

Each insurer’s plan may have different doctors or hospitals in their provider networks. Use the Connector’s Plan Finder Tool to see if your health care providers are in a plan’s network before you enroll.

In 2024, the 8 ConnectorCare HMOs are:

• Tufts Health Plan Direct
• Wellsense Health Plan (formerly called BMC Health Net Plan)
• Fallon Health, Community Care Network HMO
• MassGeneral Brigham Health Plan (formerly called Allways Health Plan)
  • Complete
  • Select
• Health New England, HMO
• Blue Cross Blue Shield
• Harvard Pilgrim Health Care
• United Health Care

Once you qualify for ConnectorCare, you have a deadline to enroll. Enrolling means you

• pick an HMO and
• pay the first month’s premium by a deadline. Not everyone has a premium. 
• When you apply, you can choose to allow the Health Connector to automatically enroll you into a plan if you qualify for a plan with no premium.

Important:

If you miss the deadline to enroll, you may only be able to enroll later if you can show a special exception. See more information on enrollment into ConnectorCare.

You pay monthly for your HMO. This monthly charge is called a "premium." Sometimes when you visit your doctor or health care provider, you may also have to pay a “copayment.”

Premiums

You have to pay the first month premium by the 23rd of the current month in order to enroll by the 1st of the following month. Then the Health Connector will bill you every month. The premium is the same every month.

If your situation changes and you report the change to the Health Connector, your premium can change.

The cost of your premium depends on your plan type and the HMO you pick. Your plan type is based on your income. See where your household income is on this table and which Plan Type applies to you.

• If your income is 150% of the federal poverty level or less, you can choose an HMO that has no premium. 
• If your income is more than 150% of poverty level you have to pay a premium. If you have an extreme financial hardship, you can apply for a temporary premium waiver.

Answer a few questions about your household and the Health Connector’s Get an Estimate tool will will show you what plans are available and what your estimated premium will be.

Copayments

After you enroll, you may have to pay a copayment for some visits to your doctor or other health care provider. You pay the copay to the health care provider. This copayment is in addition to the monthly premium you pay to the Health Connector.

The amount of your copayment is based on your Plan Type. And your Plan Type is based on your income. For Copayments there are 3 Plan Types: Plan Type 1 copayments are the lowest, and Plan Type 3 are the highest.

ConnectorCare HMO plans all cover the same services and charge the same copayments for people in the same Plan Type.

See a list of the copayments that ConnectorCare charges for Plan Types 1, 2 and 3 in 2024.

You can apply for ConnectorCare in many ways:

• Create an account and submit an application online.
• Get help applying in person or over the phone from trained community organizations. See the Enrollment Assister Search for a list of organizations near you. State-wide assistance is available from Navigators and the Health Care for All Helpline.
• Complete a paper application form. Send it to the mailing address or fax number shown on the form or drop it off at a Health Connector walk-in center. You can get it in English or Spanish.
• Call the Health Connector Customer Service at 877-623-6765 and apply over the phone.
• Get help applying from a Health Connector walk-in center in Worcester, Boston, or Springfield. See locations and office hours here.

With one application you can apply for

• any MassHealth program you or your family members may qualify for, and
• any ConnectorCare plan or other Health Connector Plan with Advance Premium Tax Credits you may qualify for.

Important

The application will ask if you want help paying for health insurance. Answer "Yes" if you want to apply for MassHealth, ConnectorCare or a discount on the premium for a Health Connector Plan. Learn more about MassHealth.

If you qualify for ConnectorCare, you will get a notice in the mail from the Health Connector. You will also get a notice from MassHealth saying you do not qualify for full MassHealth. Learn more about what happens if you qualify for ConnectorCare.

You can get help applying, enrolling or solving a problem from the Health Connector:

• Check the Health Connector website.
• Call customer service 877-623-6765.
• Visit a Health Connector walk-in center in Worcester, Boston, or Springfield. See locations and office hours here.
• If you still have a problem, complain to the Health Connector Consumer Ombuds Office.

Get help from trained community organizations. See the Enrollment Assister Search for a list of organizations near you. State-wide assistance is available from Navigators and the Health Care for All Helpline. These people are trained to help with application and enrollment problems.

If your problem is a decision the Health Connector or your HMO made you can file an appeal.

Get help with your appeal from free or low cost legal services programs.

Get more information and help from MLRI’s ConnectorCare Advocacy Guide.