Overview of Massachusetts Health Insurance Exchange
With the launch of the Massachusetts Health Connector in 2006, the state broke ground on healthcare reform. The program offers a marketplace where residents can buy readily buy insurance at affordable rates. Prior to the launch of state healthcare marketplaces nationwide on October 1, 2013, 250,000 Massachusetts residents were already signed up for insurance via Health Connector. National reforms have paved the way for additional benefits and options for Massachusetts residents, families, and small businesses.
The new Health Connector website launched on October 1, 2013. Some of the benefits of national legislation that residents will receive include small-employer tax credits, benefits that offset the costs of prescription drugs for seniors, and more funds for local health centers
The Massachusetts Health Connector features 10 medical carriers and five dental carriers offering 114 medical plans and 24 dental plans in 2014. Medical providers include Blue Cross and Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Tufts Health Plan, Fallon Community Health Plan, Boston Medical Center HealthNet Plan, Neighborhood Health Plan, Network Health, Ambetter from CeltiCare, Health New England, and Minuteman Health (a new carrier for 2014).
2014 marks the first year that the Health Connector is offering dental coverage. Dental providers include Aldus Dental, Blue Cross and Blue Shield of Massachusetts Dental Blue, Delta Dental, Guardian, and Met Life.
As of October 1, 2013, you can start shopping for a plan via the new website. Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014.
When users visit the website, they are able to input their information and find a list of plans they can consider and compare. Information regarding monthly premiums, co-pays, deductibles, participating providers and other information is available. These factors allow consumers to make apples-to-apples comparisons of plans.
According to the Affordable Care Act, all plans have to offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
There are four basic plans available, all with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). Lower plans have lower premiums, but higher out-of-pocket costs. A catastrophic plan is available for folks under the age of 30. This plan has a high deductible.
Adults living at or below 133 percent of the federal poverty level (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), or pregnant women living at or below 250 percent of the FPL, can qualify for Medicaid in Massachusetts, based on eligibility standards that take effect January 1, 2014.
Additional federal financial protections will start in 2015 that include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chances of bankruptcy.
Tax credits are based on the Silver Plan, so you can easily determine what your additional out-of-pocket costs will be if you elect a higher or lower plan compared to the Silver. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
Individuals and families with incomes less than 400 percent of the federal poverty level (and who are covered by an exchange plan) are eligible for healthcare tax credits. The payment of credits will begin in 2014.
People want to know how much their subsidies are, but the real question is how much will you pay? 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 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 look at the costs of Bronze, Silver, Gold, and Platinum, and decide which plan offers the best value for you. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.
As part of the new automated system, full summaries of benefits and coverage for each of the plans are available on the Summary of Benefits & Coverage page of the Health Connector website, and a comprehensive FAQ answers many of consumers' further questions.
Information on Subsidies
For more information about subsidies and other financial assistance, see pages 7-9 of The Massachusetts Consumer’s Comprehensive Guide to National Health Reform.