Massachusetts ConnectorCare: Eligibility, Premiums, and Carriers

Massachusetts ConnectorCare is a subsidized health insurance program run through the Massachusetts Health Connector for residents whose incomes fall between 100% and 400% of the Federal Poverty Level. Plans have no deductibles, low copays, and monthly premiums starting at $0. For the 2026 plan year, a single person earning up to roughly $63,840 or a family of four earning up to about $132,000 can qualify, as long as they aren’t eligible for MassHealth, Medicare, or an affordable employer plan.¹

Who Qualifies

Three things determine eligibility: you live in Massachusetts, your household income sits between 100% and 400% of the Federal Poverty Level, and you don’t have access to other affordable coverage. The 2026 federal poverty guidelines start at $15,960 for a single person, $21,640 for a household of two, and $33,000 for a family of four. At 400% of those numbers, the upper limits work out to roughly $63,840 for one person, $86,560 for two, and $132,000 for a family of four.²

People with incomes under 100% of the poverty level are generally directed to MassHealth rather than ConnectorCare. Anyone who qualifies for MassHealth or Medicare, or whose employer offers a health plan that meets the federal affordability standard, cannot enroll. Medical history and pre-existing conditions play no role: eligibility rests entirely on income, residency, and insurance status.¹

Plan Types and Monthly Premiums

The Health Connector assigns you to one of five plan types based on where your income falls relative to the poverty level. Each tier has its own minimum monthly premium per person:¹

Plan Type 2A (100–150% FPL): $0 per month
Plan Type 2B (150.1–200% FPL): $53 per month
Plan Type 3A (200.1–250% FPL): $103 per month
Plan Type 3B (250.1–300% FPL): $152 per month
Plan Type 3C (300.1–400% FPL): $235 per month

These are the lowest-cost premiums available in each tier. The exact amount depends on which insurance carrier you pick, and some plans within the same tier cost slightly more. For a single person, Plan Type 2A covers incomes from $15,960 to $23,940, while Plan Type 3C reaches up to $63,840. For a family of four, 2A runs from $33,000 to $49,500 and 3C extends to $132,000.³

What Plans Cover

Every ConnectorCare plan covers the same core benefits regardless of tier: primary care, specialist visits, emergency care, mental health and substance use treatment, and prescription drugs. Preventive care like annual physicals and immunizations carries no out-of-pocket cost, and none of the plans have an annual deductible, so insurance pays from the first visit.¹

Copays by Plan Type

Covered services are the same across all five tiers, but copays differ. Plan Types 2A and 2B share one schedule; 3A, 3B, and 3C share a slightly higher one:³

Primary care visit: $0 across all plan types
Specialist visit: $18 (2A/2B) or $22 (3A/3B/3C)
Emergency room: $50 (2A/2B) or $100 (3A/3B/3C)
Generic prescriptions: $10 (2A/2B) or $12.50 (3A/3B/3C)
Preferred brand drugs: $20 (2A/2B) or $25 (3A/3B/3C)
Non-preferred brand drugs: $40 (2A/2B) or $50 (3A/3B/3C)

Routine sick visits and follow-ups with a primary care provider cost nothing.

Free Prescriptions for Chronic Conditions

ConnectorCare members can fill certain prescriptions at no cost for chronic conditions including asthma, diabetes, high blood pressure, coronary artery disease, and opioid addiction. There’s no separate enrollment step. If your medication is on the covered list, the copay is automatically waived at any in-network retail or mail-order pharmacy. Some medications may require prior authorization from your insurer.⁴

What’s Not Included

ConnectorCare plans do not include adult dental or vision benefits. The Health Connector sells dental plans as a separate product you can add alongside your medical coverage, and pediatric dental is handled separately as well.⁵

Employer Coverage and the Affordability Test

Having access to a job-based plan doesn’t automatically disqualify you. The question is whether that plan counts as affordable under federal rules. For 2026, an employer plan is affordable when the lowest-cost employee-only option costs less than 9.96% of your household’s monthly income.⁶ If your share of the premium exceeds that threshold, the plan is unaffordable and you can qualify for ConnectorCare.

The test works differently for family members. If your employer also offers coverage to your spouse or dependents, the affordability calculation uses the premium for the full family plan rather than just the employee-only rate. When the family premium exceeds 9.96% of household income, family members can seek ConnectorCare even if your own employee-only plan is technically affordable.⁷ The employer plan must also meet a “minimum value standard,” meaning it covers at least 60% of average medical costs. Failing either test opens the door to ConnectorCare.

Available Carriers

ConnectorCare plans are sold by private insurers, and the options depend on where you live. For 2026, participating carriers include Blue Cross Blue Shield of Massachusetts, Fallon Health, Harvard Pilgrim Health Care, Health New England, Mass General Brigham Health Plan, Tufts Health Plan, UnitedHealthcare, and WellSense Health Plan.¹ Not every carrier serves every county. Once you enter your address during the application, the system shows only the plans available in your area.

How to Apply

You can apply online at mahealthconnector.org, by phone at 1-877-MA-ENROLL (1-877-623-6765), or by paper application mailed to the Health Connector Processing Center. Before you start, have these ready:

Social Security numbers for each applicant who has one, with limited exceptions⁸
Immigration documents, if applicable
Income documentation, such as federal tax returns and pay stubs
How you plan to file your taxes for the current year
Employer information, including any workplace plan offered to you

After you submit, you’ll get an eligibility notice showing your plan type and available subsidies. From there you pick a carrier and plan from the options available in your area.

Open Enrollment and Special Enrollment Periods

Most people enroll during annual open enrollment. For the 2026 plan year, open enrollment ran from November 1, 2025 through January 23, 2026. Outside that window, you can only enroll if a qualifying life event triggers a special enrollment period, which gives you 60 days to apply.⁹ Qualifying events include:

Losing existing coverage through job loss, aging off a parent’s plan at 26, or losing MassHealth eligibility
Getting married, having or adopting a child, or losing coverage through divorce
Moving to a new ZIP code or county in Massachusetts, or moving to the state
Becoming a U.S. citizen, leaving incarceration, or being affected by a natural disaster

Voluntarily dropping coverage generally doesn’t qualify; the change has to be involuntary. If you lose Medicaid or CHIP coverage, the window extends to 90 days.⁹

The First-Payment Rule

Enrollment isn’t final until you make your first premium payment. Premiums are due by the 23rd of the month before your coverage start date. Pay by January 23 and coverage begins February 1. Miss that deadline and your earliest start date pushes to the first of the following month.¹⁰ The same rule applies to special enrollment: payment by the 23rd, coverage on the 1st.

Premium Reduction for Hardship

If you qualify for ConnectorCare but still can’t afford the monthly premium, you can apply separately for a premium reduction or full waiver. The Health Connector considers hardship in these situations:¹¹

Homelessness (no documentation required)
Domestic violence (no documentation required)
Utility shut-off or eviction notices, with the relevant notices
Major illness or sudden caregiving responsibilities, with related bills
Natural disaster or fire damage, with insurance or utility documentation
Bankruptcy filed within the past 12 months, with proof of filing

You submit the hardship application by mail, fax, or through your Health Connector account. It’s separate from the main enrollment application and can be filed at any point while you’re enrolled.

Appealing an Eligibility Decision

If the Health Connector denies eligibility, assigns you to the wrong plan type, or calculates your subsidy incorrectly, you can appeal within 30 days of receiving your notice. Appeals can be filed online through your account, by calling 1-877-MA-ENROLL, or by mail.¹² You can appeal decisions about eligibility to buy a plan, subsidy amounts, whether you can enroll outside open enrollment, and premium reduction requests. You may appoint a family member, advocate, or attorney as your representative, and the Health Connector provides interpreters and accommodations at no cost.

The Massachusetts Mandate Penalty

Massachusetts enforces its own individual mandate. If you go without qualifying coverage and your income sits above 150% of the poverty level, you face a tax penalty on your state return. The 2026 amounts scale with income:¹³

150% FPL or below: no penalty
150.1–200% FPL: $26 per month ($312 per year)
200.1–250% FPL: $51 per month ($612 per year)
250.1–300% FPL: $76 per month ($912 per year)
300.1–400% FPL: $117 per month ($1,404 per year)
Above 400% FPL: $211 per month ($2,532 per year)

A coverage gap of 63 consecutive days or less doesn’t trigger a penalty. The penalty also cannot exceed 50% of the minimum monthly premium you would have paid through the Health Connector.¹³ For anyone in the ConnectorCare income range, the penalty often runs close to what you’d pay in premiums for actual coverage.

Renewing Coverage

Eligibility is redetermined each year. Before your coverage end date, the Health Connector mails letters explaining your options for the next plan year, including whether your current plan is still available and what plan type you qualify for based on updated income. If your plan continues and you want to keep it, just keep paying your monthly premium.¹⁴ If your plan is discontinued, the Connector matches you to a new one automatically, though you can pick a different plan during open enrollment. Read the renewal letter closely, because income changes during the year can shift your plan type or subsidy.

1
Massachusetts Health Connector. ConnectorCare Plans
2
ASPE. 2026 Poverty Guidelines
3
Massachusetts Health Connector. ConnectorCare Health Plans Shopping Guide 2026
4
Massachusetts Health Connector. Guide to Medications with No Co-Pays for ConnectorCare Members
5
Massachusetts Health Connector. Dental Coverage
6
Internal Revenue Service. Rev. Proc. 2025-25
7
Massachusetts Health Connector. Employer-Sponsored Health Insurance
8
Mass.gov. Massachusetts Application for Health and Dental Coverage and Help Paying Costs
9
HealthCare.gov. Getting Health Coverage Outside Open Enrollment
10
Massachusetts Health Connector. How To Pay
11
Massachusetts Health Connector. Application to Reduce or Waive Your Premium
12
Massachusetts Health Connector. What to Expect – Your Right to Appeal
13
Mass.gov. TIR 26-1 – Individual Mandate Penalties for Tax Year 2026
14
Massachusetts Health Connector. Your Coverage End Date and Renewing Your Coverage