Helpful Information About INDIVIDUAL COVERAGE
In an effort to help you understand the new Health Care Reform Laws for residents of Massachusetts, Health New England (HNE) has put together this Web page. It contains many frequently asked questions. We hope you find it helpful.
Health Care Reform: What does it mean to me?
Health Care Reform: How does this benefit me?
What do I need to do?
Health Care Reform: What does it mean to me?
I’ve heard that there is a new law in Massachusetts and now I have to get health insurance. Is that true?
Yes. Starting July 1, 2007, all Massachusetts residents 18 or older will be required to have health insurance.
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Is there a minimum amount of insurance coverage that I need?
Yes, the new law requires a minimum level of health insurance coverage. This minimum level of coverage is called “creditable coverage.” (Medicare, for example, is considered creditable coverage.) These regulations will go into effect January, 2009.
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What will happen if I don’t get health insurance?
Beginning with the 2007 state income tax return individuals will be required to show proof of health insurance coverage by December 31, 2007. If an individual is not able to show proof, he or she will lose their personal tax exemption which is worth around $200.
Beginning January 1, 2008, if you are not able to show proof of health insurance coverage you will be required to pay a penalty. The penalty or fine will be equal to 50 percent of the premium for the least costly health plan that meets the standard for minimum creditable coverage.
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I’ve heard of the Connector– What is it?
The “Connector” (short for the Commonwealth Health Insurance Connector Authority”) is a new state agency. The Connector was formed to help individuals and small businesses sign up for and buy health insurance.
There are a number of health insurance options for people through the Connector, following is a description of each:
Commonwealth Care is a health insurance program for individuals with a low-income. There is a choice of health insurance plans. The Connector will help individuals choose and sign up for the plan that is best for them. These plans are subsidized.
For more information call 1-877-MA-ENROLL or visit MAHealthConnector.org
Commonwealth Choice is a health insurance program for individuals and small employers. An individual or an employer can choose from a number of commercial health plan options. Enrollment (sign up) in Commonwealth Choice will begin on May 1, 2007 for health insurance coverage beginning July 1, 2007.
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Can I buy health insurance through the Connector?
Commonwealth Care and Commonwealth Choice have specific rules. Commonwealth Care is subsidized and Commonwealth Choice is not.
To meet the requirements for Commonwealth Care:
- The income of your family, before taxes, must be at or below 300% of the federal poverty level. See the chart below:
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FAMILY SIZE
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MONTHLY
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ANNUALLY/ YEARLY
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1
|
$2,553
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$30,636
|
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2
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$3,423
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$41,076
|
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3
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$4,293
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$51,516
|
|
4
|
$5,163
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$61,956
|
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5
|
$6,033
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$72,396
|
|
6
|
$6,903
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$82,836
|
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7
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$7,773
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$93,276
|
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8
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$8,643
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$103,716
|
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For each
additional
person add
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+$870
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+$10,440
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Other requirements for Commonwealth Care:
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You are uninsured
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You are a citizen of the United States or are a national, qualified alien, or alien with a special status;
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You are 18 years of age or older
Commonwealth Choice provides individuals and small businesses the opportunity to buy health insurance on their own. To find out more about the health plans that are available to you visit www.hne.com or www.mass. gov/connector.
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What if I have health insurance that I bought as an individual (not through an employer)?
Now you can find more choices and lower prices through HNE and the Connector. If you are employed, you should also talk to your employer. Your company may provide coverage even if they didn’t before.
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What if I’m enrolled in MassHealth?
If you are covered under MassHealth, you don’t need to make any changes. In addition, after July 1, 2007, certain dental, vision, chiropractic and prosthetic benefits will be covered.
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I am a young adult (aged 18-26). What does the law mean to me?
As a young adult you may be able to remain covered under your parent’s or guardian’s health insurance policy until you are 26 or until two years after you lose IRS dependent status (whichever is first). If you are not eligible for dependent coverage, there are new low-cost policies just for you! These young adult policies are available only through the Connector.
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I am insured through my employer. Will the new laws affect me at all?
Possibly. After July 1, 2007, businesses with fewer than 51 employees will be able to buy insurance through the Connector. Not every employer will choose to do so. If you work for a company with fewer than 51 employees, ask your employer or benefits manager if your health insurance is going to change.
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What if I am retiring but I am not yet eligible for Medicare?
You can buy insurance through the Connector until you are eligible for Medicare.
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I can’t afford health insurance or the penalties! What should I do?
The new law is meant to help people with lower incomes afford health insurance. You may be eligible for help with paying for coverage if you meet certain income guidelines (see chart on page 5). If you do not meet these guidelines and still cannot afford insurance, you can file an appeal with the Connector and asked to be excused from the requirement.
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Health Care Reform: How does this benefit me?
Why does Massachusetts require everyone to have insurance?
The purpose of the law is to make quality health coverage more affordable for all residents. The more people who have health coverage, the more likely it is that they will get preventive care.
Preventive care (regular doctor’s visits, health screenings, etc.) lowers the chances that you will suffer from long term health problems. This should lower the number of costly emergency room visits and hospital stays. In some instances these are paid for by tax-payer supported “free care.”
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I have heard that individuals can buy coverage on a pre-tax basis. What does that mean?
The Connector will make it possible for individuals to buy coverage on a pre-tax basis.
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This means that you’ll save on Federal, State and FICA taxes because your taxable income will be lowered by the amount you pay for your health insurance.
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If you were already buying health insurance on your own, your take home pay may increase since your health insurance premium will be taken out before taxes are taken out. This will help offset the cost of providing health insurance for you and your family.
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What do I need to do?
How do I find a health insurance plan?
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The Connector website, MAHealthConnector.org has information to help you compare and choose from a range of health plans.
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HNE also has several tools on our web site, hne.com to help you figure out what coverage is right for you. You also can get a brochure with more information by calling HNE Member Services at 413-787-4004 or 800-310-2835.
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Where can I find more information?
Stop by HNE 's Health Connector Resource Room
Choosing the right health plan can be confusing. We're here to help!
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