The Massachusetts exchange is one of the most robust exchange in the nation with more participating carriers when compared to other states. Moreover, the state exchange predates the Affordable Care Act by several years. The state utilizes a state-based health insurance exchange called Massachusetts Health Connector and has had its own individual mandate since 2006. For 2022, Massachusetts may see a surge in recalibration of product design, insurance premiums, and contracting among the state's top insurers due to the Tufts Health Plan and Harvard Pilgrim Health Care merger receiving the green light. Aside from the merger, many of the health plans are moving members into alternative payment models.