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Whether you choose a major medical plan, an HMO or a PPP, your plan will probably have some "cost-sharing" features. This means that you share the cost of care by paying part of the charge for each service and the insurance company pays the rest. Pick a plan that works best with the type of health insurance you think you will use. Different cost sharing features are listed below:
In Massachusetts over 70% of all employers offer health insurance as a benefit to their employees. Most of these employers pay part of the premium and also offer a choice of several health plans. You can choose the health plan that is best for you from the choices offered.
Massachusetts residents can buy health plans directly from an insurance company. And the company can't turn you down if you have a health condition. Sometimes the company will direct you to purchase their health plan through an intermediary. An intermediary is a company that takes care of the enrollment and premiums.
You may be eligible for subsidies to help you pay the premiums, depending on your income. Any Massachusetts resident can enroll in a health plan during the annual open enrollment period. Otherwise, you may be able to enroll at other times during the year if you have special circumstances (qualifying events). For example, recently moving to Massachusetts or recently losing your health insurance.
When choosing a health plan, it is important to consider the differences between your options. Some plans provide more generous coverage, while others could leave you responsible for high medical bills. Shopping for health insurance can be overwhelming, but remember, if the plan sounds too good to be true, it probably is.
Do not buy a discount plan as an alternative to health plan coverage. Discount plans charge a monthly fee in exchange for access to health care services at a reduced fee. These plans are not insurance and do not make any payments when you need health care services. Instead, they allow you to get a discount off of some of your medical charges. Discount plans may look like a cheap health plan, but they are not health insurance and they do not meet your Massachusetts "individual mandate" requirement for health coverage. You should check with your doctor or local pharmacist to ask whether you will receive any real savings before you give your money or your personal information to anyone offering health care discounts.
These plans allow groups of people with a religious affiliation to share in the costs of certain specified health care costs. HCSMs are not insurance and not supervised by state insurance departments. Members typically pay a monthly fee that allows them to submit qualifying medical expenses for sharing with other HCSM members. There are not specific consumer protections that apply to these plans. They may not guarantee any payments, and they do not necessarily pay expenses for the same kinds of services that health insurance covers.
Do not be fooled by bogus health plans selling on the internet or through unsolicited faxes or phone calls. You should always be careful when surfing the web. Review any website carefully and look for disclaimers such as "this is not insurance" or "not available in Massachusetts."
When you do find a health plan that looks like it meets your needs, check the Division of Insurance website or call to find out if the company is licensed to sell that type of insurance in Massachusetts before you commit to buying the product. Be careful not to give out personal information or make a payment in response to an unsolicited fax or without checking it out first.
eHealthInsurance works with Massachusetts insurance providers that offer health insurance for individuals and families. Compare Massachusetts individual and family health plans from various providers and select the plan best suited for your health care needs. Learn more about individual and family health insurance plans in Massachusetts and get free health insurance quotes to find the right plan for you.
If both you and your spouse or domestic partner are looking for a new health insurance plan, we recommend that you look up health insurance quotes both together and separately to find the plan that is most affordable for you.
Depending on the health insurance company, Massachusetts individual and family health insurance rates for couples can be based on the age of the youngest person on the policy. Some couples with an age difference of several years may find they save money by applying for the same plan rather than individually. Couples that are only a few years apart might be able to reduce their total costs by applying for separate health insurance plans. If you decide to apply for a health insurance plan as a couple, make sure the plan you choose covers the benefits both of you need.
Most people who have health insurance in Massachusetts sign up for coverage through their employer. If you do not have access to health insurance coverage through an employer, you may be eligible for publicly funded insurance plans, like MassHealth or Medicare.
One way to get individual coverage is to buy a health plan directly from an insurance company. You can call a health insurance company directly to enroll in a plan designed for individuals, families, or small groups. Many self-employed Massachusetts residents obtain health coverage this way. You can find a list of the companies that offer these plans at the Division of Insurance website. You can also purchase insurance through the Massachusetts Health Connector.
To apply or learn more about your options, visit the Getting Started Guide or contact the Massachusetts Health Connector for assistance. You can also contact Enrollment Assisters for free support in understanding the coverage options available to you. Enrollment Assisters are trained and certified to help you from application through enrollment into new health insurance plans. Click here to search for an enrollment assister near you.
The INTERFACE Referral Service has a guide for families and individuals seeking mental health services that can help you understand various aspects of mental health insurance coverage. It offers ideas about how to get started, questions to ask an insurance company, and a glossary of insurance terms.
Subsidies are financial assistance from the Federal government to help you pay for health coverage or care. The amount of assistance you get is determined by your income and family size. There are two types of health insurance subsidies available through the Marketplace: the premium tax credit and the cost-sharing subsidy.
Medicaid is a comprehensive, free health insurance program (offered through a partnership between states and the Federal government) for people when they have limited income. Eligibility for Medicaid is based on your current income (vs eligibility for marketplace subsidies, which is based on your estimated total annual income for 2023.) Medicaid programs vary from state to state, but most health care services are covered at little or no cost and no premium is charged. If you are eligible for Medicaid, then you would not be eligible for subsidies in the Marketplace and would instead need to sign up for Medicaid.
In most states, older people will still pay more for health insurance than a younger person. The ACA requires that people aged 64 and older can be charged no more than 3 times that of a 21-year-old. Children under age 21 have slightly lower premiums and families with more than three children under the age of 21 will be charged premiums for no more than three children.
Yes. The cost of health insurance (your monthly premium) varies quite a bit by state, and even within regions of a state. This is because of several factors, such as the cost of living and cost of health care services in your area.
Under the ACA, private insurers can charge tobacco users no more than 50% more per month than those who do not use tobacco. The health law also makes clear that financial help through the Health Insurance Marketplace cannot be used to cover the portion of the premium that is due to a tobacco surcharge.
With most job-based health plans, an employer pays part of your monthly or yearly costs (premiums). In general, people who qualify for health insurance through their job are not able to get financial assistance through the Marketplaces.
Find out how the American Rescue Plan and Inflation Reduction Act have cut marketplace health insurance costs in Massachusetts from Boston, to Providence, Concord and beyond. Enroll during open enrollment (November 1 to January 23 in Massachusetts) or during a special enrollment period if you experience a qualifying life event.
No insurers currently offer short-term health insurance in Massachusetts. This is due generally to guaranteed-issue and rating requirements that apply to all health plans in the state. Read more about Massachusetts short-term health insurance and state regulations.
Massachusetts runs a state-based health insurance exchange called Massachusetts Health Connector. The exchange offers health coverage to individuals and families, and to small businesses with up to 50 people. People who are employed by larger businesses that provide health coverage do not use Massachusetts Health Connector, nor do Massachusetts residents with Medicare, which is run by the federal government.
Massachusetts Health Connector is the only place a Massachusetts resident can obtain financial assistance with their self-purchased health insurance premiums and cost-sharing, with eligibility based on income. People can purchase private coverage outside the exchange (ie, directly from health insurance companies), but without financial assistance.
Massachusetts Health Connector is an active purchaser exchange, which means the exchange determines which plans are offered for sale. The Massachusetts health insurance marketplace is very robust, with several participating insurers. The state exchange predates the Affordable Care Act by several years. (Health reform that took effect in Massachusetts in 2006 was widely considered a blueprint for the ACA). 781b155fdc