Thursday, 4:30 PM
Outline for new insurance plan proposed
By Alice Dembner, Globe Staff
Struggling to balance protection from catastrophic medical expenses with affordability, a state panel today outlined for the first time the essential requirements for health insurance coverage to meet the mandate that all Massachusetts residents obtain insurance. The price tag is far higher than the panel had anticipated -- approximately $380 a month on average for an individual.
The minimum plan would have to cover roughly 50 percent of all medical costs and include prescription drug coverage, according to the proposal that will be voted on Monday by the full board of the Commonwealth Health Insurance Connector Authority.
The plan could have a deductible no higher than $2,000 per individual, $4,000 per family, and would have to limit out-of-pocket expenses to no more than $5,000 for an individual and $7,500 for a family. Before the deductible kicks in, the plan would also have to include some preventive medical visits and coverage of at least generic drugs.
For the uninsured who do not qualify for state-subsidized plans -- an estimated 160,000 people -- this would likely be the least expensive plan they could buy. Some of the premiums would likely be subsidized by employers.
To meet the state mandate, at least 40,000 people who now have health insurance would also likely have to buy new plans, since their coverage would not meet the new standards, Connector officials said. Under the state's universal health insurance law, everyone in the state must obtain insurance coverage by July 1 or pay a penalty.
The recommendations of the five-member Policy Committee of the Connector board were not unanimous on all the issues, as members argued about how prescriptive the rules should be. After the full 10-member board votes on the requirements Monday, there will be a public hearing on Feb. 16, after which the rules could be revised again.