Massachusetts Health Plan Coverage & Reporting Requirements: What Employers Need to Know

MA Health Plan Coverage — MCC Background

The Massachusetts’ health care reform law, enacted in 2006, requires most residents of the state (who are over 18) who can afford health insurance to have coverage for the entire year, or pay a penalty through their tax returns. These state residents must be enrolled in health insurance plans that meet MA Minimum Creditable Coverage (MCC) requirements. MA residents without MCC may face a tax penalty for each month of noncompliance; however, there is a grace period that allows lapses in coverage of three or fewer consecutive months.^[1]

Generally, MCC-qualified health plans must cover four core areas of physician services, inpatient acute care, day surgery, and diagnostic procedures and tests. These core services must encompass coverage of a broad range of services, including:

• Ambulatory patient services, including outpatient, day surgery, and related anesthesia;
• Diagnostic imaging and screening procedures, including x-rays;
• Emergency services;
• Hospitalization (including, at a minimum, inpatient acute care services);
• Maternity and newborn care, including prenatal care, post-natal care, and delivery and inpatient services for maternity care;
• Medical/surgical care, including preventive and primary care;
• Mental health and substance abuse services;
• Prescription drugs; and
• Radiation therapy and chemotherapy.

MCC Plan Cost-Sharing Limits

An MCC-compliant plan for MA residents must adhere to the following plan cost-sharing limits for 2026 (captured in the table below):

Federally qualified high-deductible health plans (HDHPs) offered with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA) will satisfy MCC standards.^[2]

Supplemental health plans, including accident only, limited scope vision or dental benefits, and hospital indemnity insurance policies, are generally not considered MCC-compliant plans.

Employers can apply for MCC certification if they sponsor a comprehensive health plan that does not satisfy all MCC requirements.

MA Form 1099-HC

Massachusetts taxpayers must indicate if they maintained MCC health plan coverage when completing their MA personal income tax returns using MA Form 1099-HC. MA taxpayers who do not maintain MCC for themselves and their dependents throughout the year and who do not qualify for an exception will be subject to a state tax penalty.

Group health plans covering MA residents are required to:

1. Provide those individuals with MA Form 1099-HC by January 31 of the following year indicating whether the coverage was (or was not) MCC.
2. Report this information to the MA Department of Revenue (DOR).

Employers that fail to provide Form 1099-HC to covered individuals or to complete the required reporting to the MA DOR may be subject to a penalty of $50 per individual to which the failure relates, up to a maximum of $50,000.

Employer Considerations

Although employers are not obligated to provide MCC for their MA resident employees, many employers will ensure that their employment-based health plans satisfy the MCC requirements to help their MA resident employees avoid this state tax penalty.

• Fully Insured Plans: Plan sponsors of fully insured plans can typically rely on their insurance carriers to provide MA Form 1099-HC to MA residents covered under the plan and complete the required reporting to the MA DOR.
• Self-Funded Plans: Plan sponsors of self-funded plans generally have to negotiate with their third-party administrators (TPAs), as part of their administration fees, to provide MA Form 1099-HC to covered MA residents and complete the required reporting to MA DOR.

Multistate employers sponsoring health plan coverage with MA resident employees are advised to take the following steps with their insurance carriers/TPAs:

1. Determine if the plan(s) offered satisfies MCC requirements;
2. Confirm that the insurance carrier or TPA will send Form MA 1099-HC to MA resident employees by January 31^st after the end of a plan year; and
3. Confirm that the insurance carrier or TPA will complete the required MCC reporting to the MA DOR.

Communications: Employers with MA resident employees are advised to communicate whether their group health plan coverage is MCC (or non-MCC) during annual enrollment. Employers should also communicate to their MA resident employees the potential state tax penalty risk of enrolling in the non-MCC group health plan coverage.

Reporting Rules — MA Health Insurance Responsibility Disclosure (HIRD)

The Health Insurance Responsibility Disclosure (HIRD) form is a state reporting requirement in Massachusetts, launched in 2018. The HIRD form collects employer-level information^[3] about employer-sponsored group health plans, which assists MassHealth in identifying its members with access to employer-sponsored group health plan coverage who may qualify for the MassHealth Premium Assistance Program. The MA DOR administers HIRD reporting through the MassTaxConnect web portal, which is the portal for employer taxpayers to file returns and forms, as well as make tax payments.

The HIRD form requires employers to provide details related to coverage availability and eligibility, plan terms, contributions, wellness credits, and MCC status, among other items.

Employers with multiple health plans or substantive variations must report information about each plan offered to Massachusetts employees.

HIRD Employer Requirements

Employers (both in-state and out-of-state) who employed six or more employees within Massachusetts during the past 12 months are required to complete the HIRD form.

An individual is considered to be an employee if the employer included this individual in their quarterly wage report to the Department of Unemployment Assistance (DUA) during the past 12 months. Employers are required to complete the HIRD form if they reported six or more employees (includes all employment categories) in any DUA wage report during the past 12 months.

For out-of-state employers that are not required to file a quarterly wage report to the DUA, an individual is considered to be an employee if they are hired for a wage or salary in Massachusetts to perform work, regardless of full-time or part-time status.

Employers must complete the form even if they do not offer health coverage. Employers that are no longer in business are not required to file the HIRD form.

Click here for HIRD FAQs from the MA webpage for additional information.

Risk Strategies is here to help. Contact your Risk Strategies account team with any questions or contact us directly here.

[1] The penalty does not apply to individuals with incomes less than 150% of the Federal Poverty Level (FPL), and the penalty amounts vary by age, income, and family size.

[2] As well as certain health arrangements provided by an established religious organization (under prescribed conditions).

[3] The HIRD form does not collect any personal information about employees.