'Difficult' health insurance discussions ahead Tens of thousands to lose coverage due to changes in federal law

State House News Service

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 percent 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 percent to 500 percent 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 web-page 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 percent 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.