As of January 1, 2025, thousands of Massachusetts residents will lose health insurance coverage at UMass Memorial Health and Boston Children’s Hospital due to the termination of in-network coverage with Tufts Health Direct.
Tufts Health Direct, one of the most affordable plans offered through the Massachusetts Health Connector, will no longer include UMass Memorial Health or Boston Children’s Hospital in its network. The change affects approximately 17,000 patients at UMass Memorial Health and 5,000 patients at Boston Children’s Hospital.
Point32Health, the parent company of Tufts Health Direct and Harvard Pilgrim Health, informed members of the change in October. According to Point32Health, efforts to negotiate a new contract with UMass Memorial and Boston Children’s were unsuccessful. A spokesperson stated that the hospitals declined to accept the rates offered for Tufts Health Direct plans, MassLive.com reported.
UMass Memorial Health and Boston Children’s Hospital have indicated that the proposed reimbursement rates were not financially sustainable. Negotiations are ongoing between Point32Health and Tenet Healthcare Corp., which owns Saint Vincent Hospital in Worcester and MetroWest Medical Center in Framingham and Natick. The outcome of those discussions has not yet been determined.
Open Enrollment Options
The coverage change coincides with the open enrollment period for 2025 coverage, which runs through January 23 on the Massachusetts Health Connector. During this time, residents can select new insurance plans or providers. Tufts Health Direct will offer a 30-day continuity of care period for primary care through January 30, 2025.
Tufts Health Direct plans have been noted for their affordability. For 2025, individual plans through Tufts Health Direct range from $346 to $668 per month, while competitors such as Blue Cross Blue Shield of Massachusetts offer plans ranging from $570 to $1,067 per month, depending on zip code and income.
Statements from UMass Memorial Health
UMass Memorial Health, which operates multiple facilities including UMass Memorial Medical Center in Worcester, HealthAlliance-Clinton Hospital, and Marlborough Hospital, confirmed that the contract for Tufts Health Direct plans through the Massachusetts Health Connector was not renewed. A spokesperson stated that patients were notified of the change and informed about alternative insurance options available through the Connector.
UMass Memorial is continuing to negotiate a separate commercial contract with Point32Health for private insurance coverage, which expires on December 31. Medicare Advantage plans offered by Point32Health, such as Tufts Medicare Preferred and Harvard Pilgrim Stride, remain unaffected.
In an earlier statement, UMass Memorial CEO Eric Dickson said the proposed reimbursement rates for Tufts Health Direct plans would have resulted in financial losses for the health system.
Statements from Boston Children’s Hospital
Boston Children’s Hospital, a pediatric training and research hospital affiliated with Harvard Medical School, also confirmed that it could not reach an agreement with Point32Health to renew its Tufts Health Direct contract. A spokesperson said the hospital has contacted affected patients to assist them with alternative care options.
Patients who remain enrolled in Tufts Health Direct may be eligible for out-of-network treatment at Boston Children’s with prior authorization, if alternate care is unavailable within the network.
