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April 14, 2025

2026 Massachusetts MCC Standards Issued

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Massachusetts has issued the minimum creditable coverage (MCC) standards for the 2026 tax year. As a reminder, Massachusetts requires most state residents to maintain minimum creditable coverage, otherwise they are subject to a state tax. The law does not impose an obligation on employers to offer minimum creditable coverage, but it does require health plans to provide a 1099-HC that reflects whether the coverage offered meets minimum creditable coverage standards.

The 1099-HC must be provided no later than January 31 of the following year. The 1099-HC only needs to be provided to the primary subscriber and can be sent by mail or, if the subscriber consents, electronically.

Cost-of-Living Adjustments

An MCC-compliant health plan may impose varied levels of co-payments, deductibles, and coinsurance (see table below for limits), as long as the plan discloses to the insured the relevant deductible, co-pay, and co-insurance amounts applicable to both in and out-of-network services.

 In-network covered services Individual Family
Maximum deductible limit  $3,200

(indexed for 2026)

$2,950

(indexed for 2025)

 $6,400

(indexed for 2026)

$5,900

(indexed for 2025)

Maximum out-of-pocket*

 

$10,150

(indexed for 2026)

$9,200

(indexed for 2025)

$20,300

(indexed for 2026)

$18,400

(indexed for 2025)

Separate prescription drug coverage
Maximum deductible  $400

(indexed for 2026)

$360

(indexed for 2025)

 $800

(indexed for 2026)

$720

(indexed for 2025)

*Note: Calculation of out-of-pocket maximums must include deductibles, co-insurance, co-payments, or similar charges on behalf of an enrollee with respect to essential health benefits.

An HSA-compatible high deductible health plan can qualify as minimum creditable coverage if the plan covers core services and a broad range of medical benefits, as well as facilitates access to a health savings account (HSA). I.e., the plan sponsor and/or insurer must provide information to individuals explaining how to establish and fund an HSA.

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