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Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health plans they regulate (fully insured group health plans and individual health plans), so your protections may vary if you leave Massachusetts. Massachusetts has enacted comprehensive reforms to expand your access to health insurance and to guarantee fair pricing of policies. Neither federal nor state laws protect your access to health insurance in all circumstances. So please read this guide carefully.

The following information summarizes how federal and state laws do – or do not – protect you as a Massachusetts resident.

How am I protected?
In Massachusetts, your health insurance options do not depend on your health status.

• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.

• All health plans in Massachusetts must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.

• You cannot be turned down for an individual health plan because of your health status, age, or any other factor that might predict your use of health services. This is called guaranteed issue.

• If you are buying an individual health plan, you cannot be charged more for your health insurance due to health status, gender, or occupation. This is called modified community rating.

• Your individual or group health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable. Note, however, that the precise definition of guaranteed renewable may vary based on what type of insurance you have.

• If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA continuation coverage or state continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage.

• If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All health plans for small employers must be sold on a guaranteed issue basis.

• If you are a small employer buying a group health plan, you cannot be charged more due to the health status or gender. This is called modified community rating.

• If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The MassHealth programs offer free or subsidized health coverage for pregnant women, families with children, elderly and disabled individuals with low-incomes among others. Other programs that offer free or subsidized health coverage include the Medical Security Plan and the Children’s Medical Security Plan.