Q&A with the Mass. Health Connector: Federal changes make for a ‘complicated’ open enrollment
Staff at the Massachusetts Health Connector, the state's health insurance marketplace, knew they would need to provide "belt-and-suspenders-levels of support" to the public this open enrollment season, Executive Director Audrey Morse Gasteier said.
As hundreds of thousands of Bay State residents explore their health insurance options on the marketplace over the next two-plus months, they're doing it amid a flood of federal changes — from expiring subsidies to Trump administration-planned coverage losses.
The moment is so uncertain that a single vote from Congress could shift the majority of premiums from their current advertised prices.
"We were hoping to not be in this place where we were opening the doors on Nov. 1 for open enrollment with that uncertainty still looming over these markets," Morse Gasteier said, referencing the federal government shutdown that hinges on Democrats and Republicans' opposing positions on Affordable Care Act subsidies — called enhanced premium tax credits.
Furthermore, large-scale coverage losses resulting from President Donald Trump's hallmark spending and tax bill — signed into law on July 4 — are now taking effect. In Massachusetts, tens of thousands of people who were previously eligible for marketplace coverage are no longer, and that number is estimated to grow to 250,000 in the coming years when combined with Medicaid losses.
In an interview with MassLive this week, Morse Gasteier said the Health Connector is "doing everything we possibly can, appreciating that we know people may see higher costs, to try and keep everybody covered" this open enrollment period.
For people who have lost their health insurance coverage entirely due to federal changes, the state is reaching out about their potential eligibility for MassHealth Limited or the Health Safety Net . The latter is the state's charity fund that pays for emergency health care for low-income, uninsured people at hospitals and community health centers.
'Most complicated' open enrollment in a decade — here's why
Morse Gasteier described this as "the most complicated open enrollment period we've prepared for in probably a decade," citing the numerous federal policy changes affecting who qualifies for different subsidies and coverage through state marketplaces.
Currently, the Massachusetts Health Connector provides health insurance to approximately 400,000 people.
The open enrollment period for the Massachusetts Health Connector began Nov. 1 and runs through Jan. 23, 2026.Hadley Barndollar
Morse Gasteier emphasized the "sticker shock" people may see during this open enrollment period is not a result of state-level decisions.
"Our primary focus has been on helping people understand what's coming and what to get ready for and making sure people understand why this is happening," she said. "This is not a program decision that the Health Connector made. This is not a decision made by the Commonwealth of Massachusetts. It is happening as a result of action taken by Congress and folks in D.C."
Why are premiums increasing?
A recent Kaiser Family Foundation analysis estimated that premiums charged for Affordable Care Act plans will increase by an average of 26% nationwide in 2026.
There are two major reasons behind this year's increases, Morse Gasteier explained.
First, the underlying premiums themselves go up every year in Massachusetts. The Massachusetts Association of Health Plans says prescription drug prices — particularly GLP-1 weight loss medications — are a major current driver of premium increases, for example.
But this year, the federal enhanced premium tax credits — which have helped lower monthly health insurance costs for many people since 2021 — are set to expire on Dec. 31, and Congress has yet to extend them.
The Biden-era tax credits have become a sticking point in the ongoing federal government shutdown that has left Washington, D.C., at a stalemate. Democrats are demanding that Republicans agree to support extending $425 million in ACA tax credits before they will vote to reopen the government. Republicans say they won't negotiate on the matter until the government reopens.
An estimated 22 million of the 24 million ACA marketplace enrollees nationwide currently receive a tax credit to lower their monthly premiums. The Center on Budget and Policy Priorities credits the subsidies with helping to "spur a doubling of enrollment in the ACA marketplaces and contributing to record-low uninsured rates."
According to Morse Gasteier, in Massachusetts, 337,000 of the state's 400,000 marketplace enrollees are slated to see those credits expire.
The impact, she described, is an average of $1,300 per individual in reduced tax credit support annually — but increases can "vary wildly."
Monthly premium costs will more than double for many, particularly older adults in their 50s and 60s. WBUR recently published an example of a 62-year-old couple living in Watertown — earning $86,000 per year — who will see their costs rise by $1,741 per month for the same plan they have now. They'll pay a total of $3,134 per month next year.
Advice for keeping premiums down
Morse Gasteier encouraged consumers to ensure their account information is entirely up to date and to "shop around."
If someone's income changes, they move, get married or have a baby, "that can affect their eligibility for subsidy," she said, "and we want to make sure people are getting the help that they qualify for."
She urged consumers to compare different plans and carriers offered through the marketplace to find the best rates that fit their household's needs and budget.
Who is losing marketplace coverage?
Several categories of people in Massachusetts have already lost or are in the process of losing health insurance coverage under Trump's so-called "Big, Beautiful Bill."
Immigrants were among the first groups affected by these coverage changes.
As of Aug. 25, Deferred Action for Childhood Arrivals (DACA) recipients are no longer considered lawfully present by the federal government for the purpose of enrolling in marketplace coverage. There are approximately 5,000 DACA recipients residing in Massachusetts.
Starting Jan. 1, 2026, more than 34,000 Massachusetts immigrants living in the U.S. legally will lose coverage with the elimination of the ConnectorCare Plan Type 1. ConnectorCare plans have $0 or low monthly premiums, low out-of-pocket costs and no deductibles.
The ConnectorCare Plan Type 1 currently covers immigrants who are not yet eligible for MassHealth Standard because of their immigration status (they must have been in the country legally for 5 years) and have incomes below 100% of the federal poverty level.
To maintain coverage, their income would need to rise, qualifying them for higher income plan types. Changes to their immigration status and household size could also affect their continued eligibility for coverage.
In light of the federal policy changes, the state has also ended the special enrollment period for low-income people, which allowed individuals making less than $22,590 annually to enroll in health insurance throughout the year — not just during open enrollment.
Contingency plans in place if Congress extends tax credits
Congress may still vote to extend the tax credits, which could change forecasted premiums mid-enrollment season.
The Health Connector will deploy contingency plans if that happens, Morse Gasteier said.
"We would essentially rerun everybody's eligibility," she said. "And we would recommunicate with our current enrollees and the general public to make sure that people know that something changed, and changed for the better, and that they should come back in and take a look."
They are "operationally ready to implement changes should D.C. take action."
How to get health insurance in Massachusetts
Massachusetts residents who need health insurance coverage for 2026 through the marketplace can visit mahealthconnector.org to complete an application and explore available coverage and plans.
For coverage to start on Jan. 1, 2026, enrollment must be completed by Dec. 23. The open enrollment period ends on Jan. 23, 2026.
Free in-person assistance with applications and plan selection is available at more than 50 "navigator locations" across the state, where trained staff help people find insurance in more than 30 languages. Residents can find a navigator in their community by clicking the "Help Center" button at the top of the Health Connector's homepage.
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