In Massachusetts, ACA Marketplace enrollees with income up to 500% FPL get affordable platinum coverage

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A rickety but serviceable connector

In a two-year pilot program beginning in 2024, Massachusetts has extended eligibility for ConnectorCare, the state’s alternative to a standard ACA marketplace that features standardized plans with low out-of-pocket costs, to applicants with incomes up to 500% of the Federal Poverty Level (FPL), or $72,900 for an individual in 2024. Since the ACA marketplace’s 2014 inception, ConnectorCare has been the (only) option for applicants with income ranging from 138% FPL, the Medicaid eligibility threshold, to 300% FPL. The extension means that almost all subsidy-eligible marketplace enrollees will get a standardized ConnectorCare plan, at least through 2025.

All insurers who offer plans in Massachusetts’ regular ACA exchange (available through this year to enrollees with income over 300% FPL) will be required for the first time to offer ConnectorCare plans in 2024. Importantly, since ConnectorCare plans are in a single risk pool with the insurer’s offerings in the higher income marketplace, extending eligibility to 500% FPL should not cannibalize the Health Connector market plans offered to enrollees with income above that threshold. That is, the extension should not drive up premiums for those who get no subsidy or minimal subsidy.

The Massachusetts legislature included such an extension in its budget passed in August 2022, but Republican Governor Charlie Baker vetoed it. Last month, Democratic Governor Maura Healy, inaugurated this past January, signed the eligibility extension into law. 

The case for Medicaid-like coverage at high-middle incomes: Alex Sheff of Health Care For All Massachusetts

Line up those ducks for ConnectorCare expansion

My last post focused on a plan in Massachusetts to extend eligibility for ConnectorCare, the state's unique low-cost health insurance program for marketplace enrollees with income up to 300% of the Federal Poverty Level, to residents with income up to 500% FPL. This past July, the state legislature passed a budget provision funding the eligibility extension for a two-year pilot period, but  Republican Governor Charlie Baker vetoed it.

Yesterday I spoke to Alex Sheff, policy director at nonprofit Health Care Access for All Massachusetts, a prime mover of the proposal, about the rationale for focusing new state spending on a relatively affluent income segment -- those with household income ranging from $40,770 to $67,950 for an individual and from $83,5250 to $138,750 for a family of four. HCFA commissioned an actuarial study, conducted by Gorman Actuarial Associates, that sketched out the proposal's parameters. HCFA provides phone help to Massachusetts resident who need help enrolling in health coverage and stresses that its policy proposals derive from trends gleaned from the call line.

To keep background as short as possible here (see the last post for more): ConnectorCare features a standardized benefit design (varying somewhat by income bracket) with zero deductibles, low copays, and annual maximum out-of-pocket (MOOP) cost limits lower than those generally available in a conventional state ACA marketplace. Those costs are modestly lower than in the ACA marketplace at the lowest incomes, but much lower at the 200-300% FPL level.* ConnectorCare premiums range from $0 at incomes up to 150% FPL** to $130 per month for a solo enrollee with income in the 250-300% FPL range.