Eligibility

Federal Poverty Level (FPL)

The Federal Poverty Level, or FPL, is a measure of income level published each year by the Department of Health and Human Services. Federal poverty levels are used to help determine your eligibility for certain programs and benefits.The 2024 Income Standards and Federal Poverty Levels are used to determine who may be currently eligible for MassHealth programs for 2024.The 2023 Federal Poverty Levels are used to determine who may be eligible for Health Connector or ConnectorCare plans during the 2024 plan year, January 1 through December 31, 2024. 2024 MassHealth Income Standards and Federal Poverty Guidelines Family Size MassHealthIncome Standards 100%Federal Poverty Level 133%Federal Poverty Level 150%Federal Poverty Level 190% Federal Poverty Level   Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly 1 $522 $6,264 $1,255 $15,060 $1,670 $20,040 $1,883 $22,596 $2,385 $28,620 2 $650 $7,800 $1,704 $20,448 $2,266 $27,192 $2,555 $30,660 $3,237 $38,844 3 $775 $9,300 $2,152 $25,824 $2,862 $34,344 $3,228 $38,736   4 $891 $10,692 $2,600 $31,200 $3,458 $41,496 $3,900 $46,800 5 $1,016 $12,192 $3,049 $36,588 $4,055 $48,660 $4,573 $54,876 6 $1,141 $13,692 $3,497 $41,964 $4,651 $55,812 $5,245 $62,940 7 $1,266 $15,192 $3,945 $47,340 $5,247 $62,964 $5,918 $71,016 8 $1,383 $16,596 $4,394 $52,728 $5,844 $70,128 $6,590 $79,080 For each additional person add $133 $1,596 $449 $5,388  $597  $7,164  $673  $8,076 These figures are rounded and may not reflect the figures used in program determination. Institutional Income Standard is $72.80.   Family Size 200%Federal Poverty Level 225%Federal Poverty Level 250%Federal Poverty Level [...]

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How to update your account to apply for subsidies

If you are a Health Connector member and did not apply for subsidies, you can update your account to see if you may qualify for a free or low-cost ConnectorCare plan, MassHealth, or a tax credit that can be used to lower your monthly premiums right away. How to update your information, step-by-step: Step 1: Sign into your account and go to your "My Eligibility" page. You will see "Year 2023" application listed. Step 2: On the "My Eligibility" page, click "Edit Application" under the Actions column. If you don't see this link, skip to Step 3. Step 3: On the next page, you will need to click the "Report a Change" link under the Actions column. Step 4: On the next page, choose "Change application type". Then, click the "Report Changes" button to make your updates. Step 4: You will be taken to the start of your application. Review your profile information and click continue until you get to the question "Do you need help paying for coverage?" Change your answer to "Yes, I want to see if I can get MassHealth or help paying for health care." When you click "Continue", you will need to go through the full application, updating your information as needed and answering questions about your household income. When you sign submit your updated application, this updates your eligibility information. Please be sure to follow instructions on your Eligibility Results page as you may need to shop for a new plan or make a [...]

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Upload Documents (Proof)

When you apply for coverage, renew, or update your information, you may be asked to send proof of some information that could not be electronically verified. Your proof can be sent to the Health Connector and MassHealth By uploading online through your account. By Mail, By Fax, and Bringing documents in-person to a MassHealth Enrollment Center or Health Connector Walk-in Center. Important: If you are sending proof, don't send the same document in more than one way. For example, don't fax and upload the same document for proof. How to upload your documents Step 1 Sign in to your online account. (If you don't have an online account or or locked out, call Customer Service for assistance.) Step 2 In the main menu of your account, go to "Documents." This will take you to the Manage Documents page. Step 3 On the Manage Documents page, click the "Upload Documents" button, which will take you to the upload interface. If you submitted proof before, you may see those documents listed on the page. Step 4 Drag and drop your files, or you can click the "Browse" link and go to where your documents are saved on your computer or mobile phone to upload. If you use the "Browse" link, use your device's file browser to add your documents. While you can submit up to 5 documents at a time, each file must be uploaded one at a time. Supported file formatsBitmap Image File (.bmp)Portable Document Format File (.pdf)Graphical Interchange Format File [...]

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What’s the difference between the Health Connector and MassHealth?

We’ve heard questions from many members over the years who are confused about the difference between MassHealth and the Health Connector. Here’s a quick overview of the differences between these two separate state agencies: Massachusetts Health ConnectorWhere people who don’t get coverage through a job can buy a health or dental plan Where people with any level of income can buy a health plan The only place where people can get access to special programs to save money on health insurance if they qualify MassHealthWhere people can get free and low-cost health coverage if they qualify based on income level, a disability, pregnancy, or chronic (long-term) illness How are the agencies connected?One application for coverageWhen people apply for coverage at MAhealthconnector.org, they fill out one application to find out if they qualify for coverage through MassHealth, the Health Connector, or both. People or families can have a mix of coverage from both agenciesFor example, a family could have parents covered by the Health Connector with children who are covered by MassHealth. Or a person may get temporary benefits from MassHealth (called Health Safety Net) that cover some services before their Health Connector enrollment starts.Who do I call for help?If you need help with MassHealth benefits, call the MassHealth contact center at 1-800-841-2900, or TTY 1-800-497-4648. This is a separate call center from the Health Connector.If you need help with Health Connector coverage, call the Health Connector at 1-877-MA-ENROLL (1-877-623-6765), or TTY 711.

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Your coverage end date and renewing your coverage

When you buy health and dental insurance through the Health Connector, your coverage period ends on December 31 regardless of your coverage start date. But, don’t worry. You have the opportunity to review coverage each year during the Open Enrollment period. Before your coverage end date for the year, you will get letters in the mail that will let you know about your coverage options for the next year. Your plan renewal information will tell you if your plan will be available for the next year, or, if it is not, will give your information about the new plan you are matched to. During open enrollment you can shop for a different plan, even if the plan you have is available. By shopping during open enrollment, you may be able to find plans with lower costs. If your plan is available for the next year and you do not want to change it, then all you have to do is continue to pay your monthly premium. About plan premiums It is important to know that plan premiums change each year. Premiums are calculated based on The ages of covered household members, The number of people covered on the plan, Where you live, and Rates set by health insurers, approved by the Massachusetts Division of Insurance If you are eligible for savings that help lower your monthly premium cost, this may change, too. For example, if you are eligible for an Advance Premium Tax Credit, how much you are eligible for [...]

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Why don’t I qualify for subsidies?

If you completed an application or renewal and are eligible for a Health Connector plan, but were not approved for an Advance Premium Tax Credit to lower your month premium costs, or ConnectorCare plans, this could be for one of the following reasons: You did not select the option to complete an application for coverage and help paying for costs. How to troubleshoot: Sign into your account and update your application by following the steps here and select "Change application type" on the "Change Your Information" page of your application. Your income is not in a qualifying range above 100% the Federal Poverty Level. Note that income can be below 100% FPL if applicant has a certain qualified immigration status. If your income is below 100% FPL and does not have a certain qualified immigration status, member cannot be eligible for subsidies How to troubleshoot: You can, first, check your income with the Federal Poverty level chart. Then, sign into your account and check that your income was reported correctly by reviewing your application summary. If you need update your income, you can find a help guide here and even more details and calculator on how to add different types of income in this guide. To update your income, you can find a guide here. You have access to, or are enrolled, in affordable employer sponsored insurance that meets minimum value standards. How to troubleshoot: If you have access to health insurance [...]

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What is Minimum Essential Coverage?

Minimum essential coverage, or MEC, is any insurance that meets the Affordable Care Act (ACA) requirement for having health coverage. If you have MEC, you don’t have to pay the fee for being uninsured. Examples of health coverage that qualifies as MEC include: Most MassHealth coverage; A Health Connector or ConnectorCare plan; Insurance from a job, including COBRA; Medicare Part A or Part C; Most student health insurance plans; Some other types of coverage recognized by the Secretary of the U.S. Department of Health and Human Services as minimum essential coverage (MEC). See a full list of what coverage qualifies as MEC in the chart below. Minimum Essential Coverage Chart See the original chart and more information on the Individual Shared Responsibility Provision on the IRS website → Coverage Type Qualifies As Minimum Essential Coverage? Employer-sponsored coverage: Group health insurance coverage for employees under – A governmental plan, such as the Federal Employees Health Benefit program A plan or coverage offered in the small or large group market within a state A grandfathered health plan offered in a group market A self-insured group health plan for employees COBRA coverage Retiree coverage Coverage under an expatriate health plan for employees Yes. Qualifies as MEC Individual health coverage: Health insurance you purchase directly from an insurance company Health insurance you purchase through the Health Insurance Marketplace Health insurance provided through a student health plan Catastrophic plans Coverage under an expatriate health plan for non-employees such as [...]

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What if my income changes during the year? How will that affect my eligibility for a tax credit?

It’s common for income to change throughout the year, particularly if you are self-employed, have a seasonal job, or more than one job. To get the most accurate tax credit amount, you should let the Health Connector know if you have any income changes during the year, as they happen. If you expect your income to go up during the year, you may want to consider changing the amount of tax credit that you apply to your monthly premiums, so that you take less than the full amount available to you. If you use your tax credit during the year and your actual income is over the amount that makes you eligible, you may need to pay back some or all of the credit. You always have the option of waiting until you file your taxes next year to take the credit on your tax return, instead of applying it to your premiums in advance. This may make sense for you if you aren’t sure what your income will be for the year, and are concerned about having to pay money back at tax time.

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Do I have to buy through the Health Connector if I want to get help paying for insurance?

Yes, help paying for insurance through tax credits and low-cost ConnectorCare plans is only available through the Health Connector. Even if you enroll in a plan without help paying for it through the Health Connector, if you end up qualifying for a tax credit based on your income for that year, the IRS will let you to claim the tax credit when you file your taxes at the end of the year. But the tax credit is not available for someone who buys a plan outside of the Health Connector. You can also apply through the Health Connector website to see if you qualify for MassHealth coverage.

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