Most people who have health insurance in Massachusetts sign up for coverage through their employer. If you do not have access to health insurance coverage through an employer, you may be eligible for publicly funded insurance plans, like MassHealth or Medicare.

Individual Coverage

One way to get individual coverage is to buy a health plan directly from an insurance company. You can call a health insurance company directly to enroll in a plan designed for individuals, families, or small groups. Many self-employed Massachusetts residents obtain health coverage this way. You can find a list of the companies that offer these plans at the Division of Insurance website. You can also purchase insurance through the Massachusetts Health Connector.

Apply

Applications for health insurance through the Health Connector are open during a specific time during the year called the “open enrollment period.” During open enrollment people can buy a new insurance plan or change their current plan.

There are some situations, however, where you can apply for health insurance outside of the open enrollment period. If you have a qualifying life event—such as a change in your household size (like getting married, divorced, or having a child) or a change in income—you may meet the criteria for a Special Enrollment Period (SEP). A Special Enrollment Period is a time outside of the open enrollment period where you and your family have a right to sign up for health coverage through the Health Connector. Please visit the Special Enrollment Period page for more information about qualifying life events.

You can also apply for coverage at any time of the year if:

• You qualify for MassHealth
• You qualify for a ConnectorCare plan through the Health Connector after not having qualified in the past
• You are applying for dental coverage
• You are a member of a federally recognized tribe or Alaska Native shareholder
• You have a waiver from the Office of Patient Protection

To apply or learn more about your options, visit the Getting Started Guide or contact the Massachusetts Health Connector for assistance. You can also contact Enrollment Assisters for free support in understanding the coverage options available to you. Enrollment Assisters are trained and certified to help you from application through enrollment into new health insurance plans. Click here to search for an enrollment assister near you.

Accessing Mental Health and Substance Use Services

To better understand the mental health and substance use benefits covered by your health plan, it is best to visit your health insurance carrier’s website or contact the customer service number on your health insurance card.

The INTERFACE Referral Service has a guide for families and individuals seeking mental health services that can help you understand various aspects of mental health insurance coverage. It offers ideas about how to get started, questions to ask an insurance company, and a glossary of insurance terms.

Accessing Mental Health and Substance Use Services for Children and Adolescents

If you are unsure if your insurance plan covers the behavioral health services your child needs, the Autism Insurance Resource Center (AIRC) can help (even if your child doesn’t have autism). Many Massachusetts private health insurance plans cover certain behavioral health services for children and adolescents like intensive care coordination and in-home therapy. Staff at the AIRC can answer questions about insurance coverage, advise on how to access treatment, and advise on how to get help with making payments. Call 774-455-4056 or visit AIRC’s website for free assistance.