Alison Kuznitz
STATE HOUSE, BOSTON, Sept. 14, 2026…..Residents who get insurance coverage through the Massachusetts Health Connector will need to navigate plan disruptions, higher premiums and the potential loss of federal subsidies as they gear up for open enrollment next month.
The complex landscape, fueled by escalating healthcare cost pressures and policy shakeups in Washington, follows last year’s tumultuous open enrollment cycle when the Healey administration had to inject $250 million into heavily subsidized plans to stanch premium hikes from expired federal tax credits.
For 2027, residents enrolling in unsubsidized non-group plans will see an average 12.4% premium increase after taking into account “member aging,” according to a presentation Thursday from Connector program and product specialist Monica Smolinski. At a board meeting, she framed that rate hike in the broader context of the merged market, where many individuals and small businesses get coverage, after the Division of Insurance in July approved an average premium jump of 10.4%.
The escalating premium costs will pose a “really difficult and huge impact” on Connector enrollees, Connector board member Becca Gutman said.
Under the state’s individual mandate, residents must have adequate health insurance coverage or face a tax penalty. But surging premiums and high-deductible plans with steep out-of-pocket costs are forcing Bay Staters to delay seeking care, and Gov. Maura Healey’s Health Care Affordability Work Group has rolled out initial ideas to mitigate the affordability crisis.
Open enrollment launches Oct. 23 and runs through Jan. 23, 2027. Nearly 350,000 Bay Staters are currently enrolled in individual Connector coverage, said director of policy Signe Flieger.
About 30,000 to 35,000 lawfully present noncitizen enrollees are expected to lose their eligibility for federal advance premium tax credits on Jan. 1, which in turn will disqualify them from heavily subsidized ConnectorCare plans, Flieger said. That cohort will be allowed to purchase Connector plans “at full cost,” she said.
Flieger said other categories of immigrants — including Green Card holders, Cuban-Haitian entrants and COFA migrants from Micronesia, the Marshall Islands and Palau — will remain eligible for federal subsidies. Connector board member Jonathan Gruber suggested developing targeted outreach for those groups to “highlight that they are not being kicked off.”
“I worry we’re going to lose a lot of those folks who think they’re being kicked off when they’re not,” Gruber, an MIT economics professor, said. He added, “There’s a huge body of evidence that past efforts of this type have scared off people who didn’t need to be scared off.”
Connector members began receiving preliminary eligibility notices last month alerting them to changes, such as the loss of federal subsidies. Beyond changes linked to income level and immigration status, some members will need to respond to insurers discontinuing plan offerings.
Michael Katzman, the Connector’s director of plan management and carrier relations, said “notable” changes for 2027 include Fallon Health reducing its service area to focus on central Massachusetts, a shift that will affect 15,200 enrollees. About 4,800 Tufts Direct enrollees will be affected as the insurer exits Berkshire County, where it’s the cheapest carrier.
“In the coming months, we will be coordinating with the two carriers and conducting extensive outreach to impacted members to make sure they are aware of the changes and assisting them in selecting a new carrier that best meets their needs,” Katzman said.
The Connector plans to automatically assign those members to a comparable plan at the lowest cost available, though they can also shop for other options, he said.
Fallon proposed the largest rate increase — 25.7% — for the merged market in 2027, which state insurance regulators initially rejected. The insurer agreed to reduce its service area as part of the rate-setting process, Katzman said.
Blue Cross Blue Shield of Massachusetts will no longer offer a PPO plan in the merged market, affecting about 1,740 Health Connector for Business members, according to Katzman’s presentation. Harvard Pilgrim Health Care is also discontinuing an HMO plan that impacts about 840 non-group enrollees and 19 Health Connector for Business enrollees.
Blue Cross PPO enrollees will be transferred to a Blue Cross HMO plan, Smolinski said. Connector board member Eric Gulko, who’s president of Innovo Benefits Group, warned that strategy may not work for all families — particularly those with college students living out of state.
“Let’s say you’ve got a family in Massachusetts who has a 23-year-old kid who happens to live in Washington state. They’re covered under the plan now because they can be,” Gulko said. “If we map them to an HMO, that 23-year-old in Washington state shouldn’t be eligible for the plan, right?”
Smolinski said Gulko was correct and that the student would need to shop for a different plan and carrier. Gruber suggested the Connector directly reach out to affected members and highlight their next cheapest PPO option to maintain out-of-state coverage.
Group Insurance Commission Executive Director Matt Veno, who sits on the Connector board, asked fellow members to reflect on marketplace pressures driving the discontinued plans. Connector Executive Director Audrey Morse Gasteier said insurers “don’t make decisions like this lightly” but are grappling with an “incredible number of cost pressures.”
“As those changes start to pick up in frequency, I think it’s fair of us to assume it’s a signal,” Morse Gasteier said. “It’s a representation of the fact that carriers may be feeling like they need to make harder choices and are more willing to pull the trigger on disruption.”
Alison Kuznitz is a reporter for State House News Service and State Affairs Pro Massachusetts. Reach her at akuznitz@stateaffairs.com.
