The Affordable Care Act (ACA) launched state healthcare marketplaces. In Massachusetts, however, a marketplace had already been set in place. With the launch of the Massachusetts Health Connector in 2006, the state broke ground on healthcare reform.
Reforms under the ACA have paved the way for additional benefits and options for Massachusetts residents, families, and small businesses. The new Massachusetts Health Connector website launched on October 1, 2013. This website provides information on these additional benefits, including:
- small employer tax credits
- benefits that offset the costs of prescription drugs for seniors
- more funds for local health centers
Health Connector has 11 medical carriers and five dental carriers. There is a total of 114 medical plans and 24 dental plans. Medical providers include:
- Ambetter from CeltiCare
- Blue Cross and Blue Shield of Massachusetts
- Boston Medical Center HealthNet Plan
- Fallon Community Health Plan
- Harvard Pilgrim Health Care
- Health New England
- Minuteman Health
- Neighborhood Health Plan
- Network Health
- Tufts Health Plan
- United Healthcare
- Dental providers include:
- Altus Dental
- Blue Cross and Blue Shield of Massachusetts
- Dental Blue
- Delta Dental
- Met Life
All plans must offer the following essential services:
- doctor visits
- preventive care
- chronic disease management
- emergency care
- maternity care
- newborn care
- pediatric services
- laboratory services
- mental healthcare
- rehabilitative care
- substance abuse rehab services
There are four basic plans available through the exchange. These have varying coverage levels:
- bronze (60 percent of expenses paid)
- silver (70 percent)
- gold (80 percent)
- platinum (90 percent)
Lower percentage plans will have lower premiums. The downside is higher out-of-pocket costs. A catastrophic plan, with a high deductible, is available for people under the age of 30.
Many people will want to know how much of a subsidy they qualify for, but the real question is, how much will you pay? Your ultimate decision should be based on your income versus how often you might need to use the coverage.
Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a silver plan. You may even pay less.
For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is 9 percent of your income. This amounts to $2,926 a year, or $244 a month.
The challenge is to compare the costs of each plan and decide which offers the best value. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and overall costs. Additional information about programs and policies is available in this comprehensive guide.
Depending on your income, you may qualify for financial aid to help offset the costs of coverage. This may come in the form of:
- Medicaid coverage
- tax credits
Adults living at or below 133 percent of the federal poverty level (FPL) may qualify for Medicaid. Pregnant women living at or below 250 percent may also qualify. According to the Health Insurance Marketplace, the FPL for 2015 is:
- $11,770 in individual annual wages
- $15,930 for those in families of two
- $24,250 for a family of four
- $40,890 for a family of eight
As of 2015, the annual maximum out-of-pocket is $6,350 for individuals. It’s $12,700 for families. This maximum is the upper limit of the amount you have to pay for medical expenses covered by your plan. If you meet this maximum through deductibles and coinsurance payments, your insurance will kick in and pick up 100 percent of any further costs.
Individuals and families with incomes less than 400 percent of the FPL are eligible for healthcare tax credits. Tax credits are based on the silver plan. This helps you determine any extra out-of-pocket costs if you elect a higher or lower plan. The ACA was designed so the silver plan is more affordable for individuals buying their own insurance. This is regardless of how expensive the healthcare rates are where you live.
Visit www.mahealthconnector.org to learn more about Massachusetts Health Connector. You can also call 1-877-MA-ENROLL (1-877-623-6765).
The website provides lists of plans from providers so you can compare monthly premiums, copays, deductibles, and participating providers.
By comparing all providers, you can find the best coverage possible to cover your needs and fit into your budget. Open enrollment begins November 1, 2015 and ends January 31, 2016. Learning your options before this period can help make the process easier.