City, state officials urge residents to seek coverage, even with federal policy changes

When it comes to health insurance, 2025 has been a year of rapidly shifting policies.

Federal laws have shifted concerning who can access Medicaid or subsidies that help pay for insurance under the Affordable Care Act, and this fall, the country’s longest shutdown hinged on a discussion around health care subsidies.

Despite the shifting federal landscape, Massachusetts health officials are urging residents to get health insurance coverage during the open enrollment period, which began Nov. 1.

“Obviously we think it’s really important for everyone in Massachusetts to have health insurance,” said Jason Lefferts, senior director of external affairs at the Massachusetts Health Connector. “We want people to be able to have coverage, to be able to go to the doctor, to lead their healthiest lives possible.”

Dr. Bisola Ojikutu, Boston’s public health commissioner, touted the state’s efforts to increase access to affordable care and the city’s resources to connect residents with that coverage.

“Health insurance is the most powerful tool that we have to ensure access to primary care, emergency care and treatment for chronic diseases,” she said in an email.

Open enrollment marks the period during which residents who access care through the Affordable Care Act Marketplace — in Massachusetts, called the Massachusetts Health Connector — can sign up for a plan.

Enrollees are limited to the about-two-month period, with the exception of “qualifying life events” like changes in a household, changes in place of residence or loss of other coverage.

This year’s open enrollment period is complicated by a federal debate about the future of enhanced Affordable Care Act subsidies, which are set to expire at the end of the year and are at the center of the shutdown of the federal government.

Those subsidies, tax credits that help individuals receiving coverage pay their monthly premiums that allow them to receive health insurance coverage, were raised in the COVID-19 pandemic-era American Rescue Plan Act and extended in the Biden-era Inflation Reduction Act.

Those changes expanded who was eligible for the tax credit. Previously, individuals who made between 100% and 400% of the federal poverty level — which is calculated based on household size — were able to receive the subsidy.

The enhanced credits raised the subsidy amount for recipients making between 100% and 400% of the federal poverty level and expanded who was eligible for a subsidy by opening the subsidies to households making over 400% of the federal poverty level and capping premium contributions at 8.5% of their income.

Those increased subsidies are set to expire at the end of the year, which could lead to decreases in tax credits available and exclude households making more than 400% of the federal poverty level.

Those changes would restrict access for middle-income individuals. Households that remain subsidized could see their payments at least double.

For almost a month-and-a-half Democrats in Congress refused to negotiate an end to the shutdown, the longest in the country’s history, without an extension of the enhanced subsidies. Republicans said they wouldn’t debate the subsidies until the government was reopened.

On Nov. 9, seven Democrats and Maine independent Angus King who caucuses with the Democrats, voted alongside all but one Republican senator to advance a compromise deal that would reopen the government with protections for federal workers who were laid off during the shutdown and guarantee back pay for furloughed workers. The Democratic senators also cited a promise from Senate Majority Leader John Thune, a Republican from South Dakota, that they would receive a vote on the Affordable Care Act tax credits extension sometime in December.

According to a statement released by the Massachusetts Health Connector, more than 300,000 residents will lose some or all of the help they get paying for health care premiums, with estimated total premium costs of $25,000 per year, if the enhanced subsidies are extended.

The shutdown and related tax credits isn’t the only factor in a shifting federal landscape. Also impacting residents are changes in the Trump administration’s budget reconciliation package, passed in July and called the “One Big Beautiful Bill” for much of its legislative journey. Under that law, lawfully present immigrants living under the federal poverty line are no longer eligible for those same subsidies.

Lefferts said those subsidies meant that immigrant families, who were not yet eligible for Medicaid programs like MassHealth [some types of immigration status include restrictions that individuals can’t access Medicaid benefits for five years after arriving in the United States] could still access coverage.

He said that those changes could mean those residents could expect to pay hundreds of dollars more, when some currently have to pay no monthly premiums.

But officials said that despite the changes, residents should still seek insurance during this year’s open enrollment period and that it’s better to do so sooner rather than later.

“Do it now; don’t wait,” he said.

“The deadline to pick a plan and enroll in that plan for next year is December 23. Don’t wait until December 22 to reach out.”

He clarified that the December deadline is for coverage starting at the beginning of the new year, when he said most people begin coverage. The hard deadline for open enrollment is Jan. 23, 2026.

Lefferts said residents can hold off on paying until the deadline but should reach out to make a plan now.

He said residents who get insurance through the Massachusetts Health Connector and are concerned about the shifts in federal policy should go into their account to make any updates necessary and ensure they’re in the right eligibility category.

“If you’ve had an income change, maybe you’ve had a baby during the course of the year that you know that you need to add — something’s happened at home, where you should update your account and make sure that you are in the right eligibility for next year,” Lefferts said.

Also, residents should seek help to get the right coverage. Lefferts said people can call the Massachusetts Health Connector’s customer service line at 1-877-623-6765 or get assistance from a network of certified navigators at 24 organizations across the state.

The city, in its press release, pointed residents to the Mayor’s Health Line at 617-534-5050, which provides free, multilingual and confidential health information to all residents, regardless of immigration status. The Boston Public Health Commission is a certified navigator organization with the Massachusetts Health Connector.

“There’s plenty of knowledgeable, trained, wonderful people who are ready to help guide you through this,” Lefferts said. “We know this is a very confusing and stressful time.”