Massachusetts Small Business
Health Insurance Plans 2022

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MA Small Business Health Insurance Plans

Massachusetts Small Business Health Insurance Plans

Massachusetts Small Business Health Insurance Plans 2022. The following is an overview of the rules that govern small group health insurance plans in the State of Massachusetts.

The information that is discussed below includes the laws that have been mandated by the Affordable Care Act (ACA or "Obamacare"), as well as the laws that are required by Massachusetts State government.

If you own and operate a MA small business and you already offer small group health insurance or you're thinking about offering small group health insurance - this guide can help you better understand the regulations, requirements and available Massachusetts small business health insurance plans available.

Learn how to get Massachusetts small business health insurance plans for 1 to 50 employees. The best small business health insurance providers in MA offer affordable rates, flexible coverage options and access to a large network of medical providers.

Below are some answers to commonly asked MA small business health insurance plan questions:


How Much Does Massachusetts Small Business Health Insurance Cost?

The average price of a standard Massachusetts small business health insurance policy ranges from around $583 to over $1706 per employee per month based on; single or family, location, coverages offered, deductibles and more.

What Are The Small Business Health Insurance Regulations In Massachusetts?

Massachusetts Small Business Health Insurance Plans

In Massachusetts, there are specific laws that related to small business health insurance. All Massachusetts-based small businesses are eligible to purchase small group health insurance plans.

Additionally, small businesses that employ more than 2 but fewer than 50 employees must be offered the same health insurance policies with similar benefits as those policies that are offered to other businesses.

As per Massachusetts law, companies that offer small business insurance may require business owners to meet minimum enrollment requirements in order to purchase a small group plan, and if the business fails to meet those requirements, the plan can legally be canceled.

If a health insurance company instills a minimum enrollment requirement, a certain number of a business' eligible employees must purchase the policy, otherwise the policy can be terminated. Another condition that health insurance companies can impose on Massachusetts small business owners is a pre-set premium requirement.

This means that the health insurance company can require business owners to contribute a certain amount of their employees' premiums.

Despite the above-mentioned conditions, it is unlawful for health insurance companies to charge more for a small group health insurance policy because of the health status of the group. With that said, however, it is legal for health insurance companies to base premiums on certain factors, such as the age and family size of the group.

It is also illegal for health insurance companies to cancel existing Massachusetts small business health insurance plans if a policy holder of the group develops an illness or is involved in an accident that requires medical care.

According to Commonwealth of Massachusetts, The Patient Protection and Affordable Care Act of 2010 was signed into federal law on March 23, 2010. Now known as the Affordable Care Act (ACA), this law has since made health insurance accessible to millions of uninsured people.

Section 1104 of the Administrative Simplification provisions of the ACA builds upon the Health Insurance Portability and Accountability Act of 1996 (HIPAA) by establishing several new, expanded, or revised provisions that will enhance the usefulness of existing HIPAA transactions and reduce administrative costs.

Does Massachusetts Participate In The Affordable Care Act?

Affordable Care Act Massachusetts

In 2010, the Affordable Care Act (ACA or "ObamaCare") was passed by the United States Congress and was signed into law by Obama. Following its passage, provisions of the law have continued to be phased in, and as of January 1, 2014, the majority of American citizens and legal residents of the United States are required, by law, to have qualifying health care coverage.

If they fail to have coverage, they are responsible for paying an annual tax penalty for each month they aren't insured, which is known as the "individual mandate".

The cost of the penalty for failure to have qualifying coverage is $95 per adult and $47.50 per child, or 1% of your total taxable income; whichever amount is higher - as much as $285 per family. In 2017, the penalty increased, and has continued to increase thereafter.

Qualifying Exemptions For The Individual Mandate

Individuals who meet one of the following are exempt from the individual mandate and the associated tax penalties in MA:

  • Illegal aliens
  • Jailed individuals
  • Religious objections
  • The cost of health insurance coverage is higher than 8% of your household income
  • Those who aren't covered for less than three months during the calendar year
  • Those who have hardship waivers
  • Your income level is blow the 100% poverty level

What Are The Affordable Care Act Requirements For Massachusetts Small Businesses?

Massachusetts Small Business Health Insurance Plans Claim Form

If you're a small business owner in Massachusetts, you must provide your employees with insurance. This is a requirement that was put into place by the Affordable Care Act.

Referred to as the Employer Shared Responsibility provision, all employers must offer their employees at least one of the ACA-compliant Massachusetts small business health insurance plans, otherwise then can face fines of up to $2,000 per employee.

Massachusetts small business owners can purchase coverage for their employees through the state's Small Health Option Program (SHOP) exchange, or from a private insurance agent or broker.

Affordable Care Act Standardized Essential Health Benefits

As per the ACA, all qualifying health insurance plans must offer 10 standardized essential benefits.

Depending on the state, additional benefits may also be required. The 10 ACA standardized essential benefits are as follows:

  1. Ambulatory patient services (medical care that is offered without being admitted to a hospital)
  2. Emergency services
  3. Hospitalizations, such as overnight stays and surgical procedures
  4. Lab services
  5. Mental health and substance abuse disorder services, including behavioral health treatments, such as psychotherapy and counseling
  6. Pediatric health care services, including vision and oral care; however, adult vision and dental coverage aren't essential health benefits under ACA
  7. Pregnancy, maternity, and newborn care, including before and after birth
  8. Prescription pharmaceuticals
  9. Preventative and wellness services, as well as management for chronic diseases
  10. Rehabilitative and habilitative services and devices, including services and devices for injuries, disabilities, and chronic health conditions

Additional Health Benefits Mandated In Massachusetts

In addition to the 10 standardized essential health benefits that are required by the ACA, Massachusetts law requires all health insurance policies to offer the following benefits:

  • Bone marrow transplants for the treatment of breast cancer
  • Cardiac rehabilitation
  • Clinical trials
  • Congenital anomaly - cleft lip/palate
  • Diabetes care management, including services and supplies
  • Early intervention services
  • Emergency transportation/ ambulance coverage
  • Hearing aids
  • Home health care services
  • Hormone replacement therapy
  • Hospice care
  • Human leukocyte antigen testing
  • Hypodermic syringes or needles
  • Infertility treatments
  • Off-label prescription pharmaceuticals
  • Outpatient rehabilitative services for speech, hearing, and language disorders

Standardized Massachusetts Small Business Health Insurance Plans
ACA Metal Levels

In order to make it easier to compare costs and benefits, the Affordable Care Act has designated all qualifying Massachusetts small business health insurance plans to be one of four metal colors, including Bronze, Silver, Gold, and Platinum.

Each of these designations is based on the average amount of health care costs that the plan will cover, which is illustrates at percentages of how much the insurance company will cover for health care, as well as the amount the insured will have to pay out-of-pocket.

All insurance companies that are participating in the federal or state health care exchange program must offer at least the Silver and Gold Massachusetts small business health insurance plans.

All four of the metal plans have a shared maximum out-of-pocked amount that the insured can be charged during any calendar year. The following table illustrates this information:

Metal Plan Insurer Pays / Insured Pays
Bronze60% / 40%
Silver70% / 30%
Gold80% / 20%
Platinum90% / 10%


Guaranteed Issue

As per the ACA, individuals cannot be denied coverage or charged higher premiums because of their past health history, or their gender.

Additionally, look-back and waiting periods cannot be imposed. Additionally, policies are effective when they are issued and all coverage is renewable if the individual chooses to renew the policy.

However, plans can be canceled if the individual fails to pay their premiums or commits fraud.

How Are MA Health Insurance Premiums Determined?

A premium is the amount the insured must pay out-of-pocket in order to maintain their health insurance policy. The premiums that are charged for any of the qualifying metal plans can be based on the following:

  • Age of the individual
  • Whether or not the individual uses tobacco
  • Where the individual lives, based on a rating area
  • The number of family members who will be enrolling

What Types Of Health Insurance Plans Are Available For Massachusetts Small Businesses?

Health Insurance Plan Types

While there are several types of health insurance plans to choose from, the following plans are the most popular among MA small business owners:

Health Maintenance Organization - Simply known as an "HMO", this type of plan offers a variety of health-related services via a network of health care providers and hospitals that exclusively contract with the HMO, or who agree to offer their services to members of the HMO. Employees who participate in this type of plan usually have to choose a primary care physician (PCP), and receive most of their care from this physician. If a specialist is needed, the PCP will recommend one that is affiliated with the HMO.

Preferred Provider Organization - More commonly referred to simply as "PPO", this type of health insurance plan is the most common among Massachusetts small business owners. The insurance company provides a preferred list of health care providers, and employees must receive their medical care from the doctors and hospitals on that list for their claims to be paid at the highest level possible - but they also have the flexibility to see any other provider anywhere in or out of state.

Point-of-Service Plan - Known as a (POS), this type of health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Members can access care from in-network or out-of-network providers and facilities, but coverage is better when you stay in-network. POS plans may vary, but generally, plans are considered a blend of HMO and PPO plans - offering more flexibility than HMOs, but less than PPOs.

Health Savings Account - A health savings account (HSA) is a special type of bank account that allows participants in the insurance plan to save money that can be used specifically for the medical care they require in the future. HSA-qualified health insurance plans are usually PPO plans that are specifically designed to be used with an HSA.

Indemnity Health Insurance - This type of health insurance plan allows members to control their own health care and to visit any doctor or hospital they choose. The insurance company would then pay a pre-determined percentage of the total charges for the services that were rendered. Employees may have to pay for some types of services up-front and then they can submit a request for reimbursement with the insurance company.

Massachusetts Small Business Health Insurance Plans - The Bottom Line

We strongly advise business owners to speak with a CPA and a MA health insurance broker before jumping in and getting any type of the Massachusetts small business health insurance plans available.

Make sure that you know exactly what each option can do for your company and the potential drawbacks associated with it.

Massachusetts Economic Data, Regulations And Limits On Commercial Insurance

Made In Massachusetts

If you are thinking about starting a business in the Massachusetts, it's important that you have an understanding of the economic trends and commercial insurance requirements in the state before you set up shop.

Economic trends are important, as they indicate whether or not the area offers a strong economy that will be able to support your business. You also need to know what type of commercial insurance you'll need to carry so that you can plan accordingly and ensure that you are complaint with the law.

To help you determine if the Bay State is the right location for the business you are thinking about opening, below, you'll find an overview of MA's current economic trends, as well as the types of insurance policies you'll need to carry.

Economic Trends For Business Owners In Massachusetts

Unemployment rate is a good indicator of a state's economy. The lower the rate, the more job opportunities there are, which is direct reflection of the health of businesses.

As per the Bureau of Labor Statistics, the unemployment rate in Massachusetts was 2.8% in December, 2019. That's 0.7% lower than the national average, which was 3.5% in December, 2019. This indicates that the state offers a strong workforce and that there are enough jobs to support the residents of the state.

While regions throughout the area are seeing business growth, there are certain areas in particular that are seeing more growth than others. This includes large metropolitan areas and the regions that surround them, including:

  • Boston
  • Brockton
  • Cambridge
  • Lowell
  • New Bedford
  • Newton
  • Quincy
  • Springfield
  • Worcester

Several industries are doing very well in the state of Massachusetts; however, there are particular sectors that are seeing more growth than others and are truly thriving in this part of the country. These industries include:

  • Advanced manufacturing
  • Commercial fishing
  • Education
  • Financial services
  • Hospitality tourism
  • Information technology
  • Medicine and life sciences

If you are thinking about starting a business in any of these industries, chances are good that you will find the success you are looking for in the state of Massachusetts.

Commercial Insurance Requirements In Massachusetts

The Massachusetts Division of Insurance regulates insurance in MA. Massachusetts mandates very few forms of insurance coverage by law. They enforce worker's compensation.

Massachusetts requires you to have worker's compensation insurance if you hire even one employee on a regular basis. This includes part-time employees, family members, minors, and immigrant employees. It is not required for independent contractors, but employees in domestic service must be covered if they work at least 16 hours a week.

Massachusetts also requires all business-owned vehicles to be covered by commercial auto insurance. Other types of business insurance that business owners should carry depend on the specific industry.

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Also find MA local small businesses by General Liability Class Code and learn about Massachusetts small business insurance requirements for general liability, business property, commercial auto & workers compensation including MA business insurance costs. Call us (617) 902-0099.

Small Business Health Insurance Plans By State

You can find more state specific small business health insurance information including requirments and coverage by clicking on the state below:


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