'Difficult discussions' coming on Mass. health insurance front

BOSTON — The state's health insurance marketplace is in the thick of notifying tens of thousands of members who either will or could lose subsidized coverage through the Health Connector due to changes in federal law, and staff are also preparing contingency plans should Congress choose to extend tax credits that could prevent rising premiums.

The Massachusetts Health Connector, which offers a blend of subsidized and unsubsidized medical and dental plans, in late August began sending out preliminary notices to members about their expected eligibility for the upcoming open enrollment period, said director of policy Signe Flieger. Those notices will be sent out through mid-September, with open enrollment starting on Nov. 1 and ending on Jan. 23, 2026.

Disruptions from the One Big Beautiful Bill Act are expected to initially impact 36,000 members who are noncitizens but lawfully present here, said Health Connector Executive Director Audrey Morse Gasteier. Those members, whose income is below 100% of the federal poverty level and have qualified for heavily subsidized ConnectorCare coverage, will lose eligibility for federal advance premium tax credits starting Jan. 1, 2026.

"At the Health Connector, we will do everything humanly possible to help support this population as these federal changes get rolled out and their eligibility for subsidized care coverage changes for Jan. 1," Morse Gasteier told the Connector Board. "And we look forward to earnest, and I'm certain, difficult discussions with our stakeholder partners and other state leaders in the coming months, as we collectively seek to figure out how here in Massachusetts we can best support these individuals that the federal government is walking away from."

Health Connector officials anticipate another 19,000 members earning between 400% to 500% of the federal poverty level could become disqualified from their ConnectorCare plans starting on Jan. 1. But the population could regain tax credits if they are extended by the federal government.

The landscape for subsidized plans is complicated by uncertainty over the fate of enhanced premium tax credits, which are slated to expire at the end of the year. Massachusetts stands to lose more than $425 million in federal aid if Congress does not extend those tax credits.

"We are urging a solution by Sept. 30 to reduce confusion and anxiety for members who will see starkly higher premiums for 2026 without the tax credits extended," Morse Gasteier said.

The exchange has launched a webpage to help explain the federal policy shifts to members and what type of coverage is in jeopardy. State law requires most residents to have health insurance coverage for an entire year or face a tax penalty.

Marketing efforts this open enrollment season will target 27 "priority outreach communities," which include Gateway Cities and regions like Cape Cod, said Senior Director of External Affairs Jason Lefferts.

"In all, this is more than 100,000 uninsured residents in these 27 communities. It's probably close to half of the state's uninsured population, based on published uninsured rates," Lefferts said.

The Connector plans to advertise on digital platforms, work with local non-English media outlets, participate in community events and place flyers in takeout restaurant orders, Lefferts said.

ConnectorCare members losing access to plans featuring low co-pays and no deductibles — plus other members who receive only a federal subsidy and have incomes that are 500% above the federal poverty level — are being alerted about their loss of financial help, Flieger said. Their notices will indicate updated eligibility for unsubsidized care.

"We are working to improve our open enrollment data monitoring to enable us to better track member movement in response to these federal policy changes," Flieger said, adding the data will enable the Connector to "support members to update their accounts and provide needed documentation to ensure that their 2026 program eligibility accurately reflects the individuals' circumstances."

The Connector is also preparing strategies to handle the scenario of Congress extending tax credits later this fall, potentially after open enrollment kicks off.

"It will require quick implementation timeframes to ensure members can obtain access to the best coverage possible," Flieger said. "If this occurs, it could be an as-is extension of enhanced premium tax credits in their current form, or a modified approach that may require additional systems changes."

The Connector Board on Thursday approved coverage options for 2026, encompassing 48 individual plans, 56 small group plans, and 12 individual and small group dental plans. Carriers include Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health care, Mass General Brigham Health Plan, UnitedHealthcare and WellSense Health Plan.

In the merged marketplace, the average rate increases are 11.5%, said Michele Yakovee, director of plan management and carrier relations. That compares to 13.7% for unsubsidized medical plans.

Yakovee said all carriers decided to stop covering GLP-1 drugs that have helped many people to lose weight but which have also contributed to rising insurance premiums.

The change prompted Board Vice Chair Nancy Turnbull to abstain from voting in support of the 2026 plans. Still, Turnbull noted the rollback was not due to a Health Connector policy. The Group Insurance Commission has also stopped covering the drugs for state employees unless medically necessary.

"I think the exclusion continues an ugly history in health insurance of allowing adverse social judgments against certain groups to be allowed, and enable discrimination and medically unsupported policies that are wrong and will damage health for many people, including the people who could most benefit from these drugs," Turnbull said. "It reminds me very much of my early years as an insurance regulator, where in the early days of AIDS, insurers tried to deny treatments for people who they believed got AIDS in certain ways — so that innocent people who got AIDS through blood transfusion should have treatment, but gay men should not."