Are you covered?
On July 1, 2007, state law requires every adult to have health insurance if affordable coverage is available. Not meeting this requirement can result in paying a penalty. Find out how you are affected by this law change by answering some simple questions.
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Do you already have an insurance through work?
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Does your employer offer insurance coverage?
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Your coverage will be for...
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Is your annual income above $30,360?
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Is your annual household income above $41,070?
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Is your annual household income above $61,950?
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You have following two choices:
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You have following three choices...:
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You should be eligible for
Free or subsidized coverage through Commonwealth Care or Medicaid
Commonwealth Care
State-subsidized insurance program offering comprehensive coverage including preventive and primary care, emergency services, hospitalization benefits, mental health services, and prescription drug coverage.
Eligibility
- Income no greater than
- $30,630 for one,
- $41,070 for a couple, or
- $61,950 for a family of four.
- Uninsured and no access to insurance through employer
- Age 19 and up
- US citizen or legal resident
Monthly Premiums
Based on income, location, and plan chosen.
Example for single person:
| INCOME | PREMIUM |
|---|
| $0 - $15,315 | $0 |
| $15,316 - $20,420 | $35 - $91 |
| $20,421 - $25,525 | $70 – $144 |
| $25,526 - $30,630 | $105 – $179 |
Other costs
Copayments for medicines, doctor’s visits, outpatient surgery, and hospitalization, which vary by income level and plan chosen.
Options
Choose one of four managed care organizations that offer this coverage:
- Boston Medical Center (BMC) HealthNet Plan
- Fallon Community Health Plan
- Neighborhood Health Plan
- Network Health
Cautions
Coverage restricted to doctors, hospitals, and health centers affiliated with the managed care organization chosen. Children are not covered under Commonwealth Care, but can get free healthcare through Medicaid if their parents qualify for Commonwealth Care.
To apply or get more information
Go to www.macommonwealthcare.com or call 1-877-623-6765
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You can apply for...
A hardship exemption from penalties
If the monthly premium for the least expensive insurance plan costs more than the amount below, based on income, people would be automatically exempted from penalties — under a proposal expected to be finalized by a state agency. Others can apply to the Commonwealth Health Insurance Connector for individual hardship waivers.
Single person:
| INCOME | PREMIUM |
|---|
| $0 – $15,315 | $0 |
| $15,316 – $20,420 | $35 |
| $20,421 – $25,525 | $70 |
| $25,526 – $30,630 | $105 |
| $30,631 – $35,000 | $150 |
| $35,001 – $40,000 | $200 |
| $40,001 – $50,000 | $300 |
Families:
| INCOME | PREMIUM |
|---|
| $0 – $25,755 | $0 |
| $25,756 – $34,340 | $70 |
| $34,341 – $42,925 | $140 |
| $42,926 – $51,510 | $210 |
| $51,511 – $70k | $320 |
| $70,001 – $90k | $500 |
| $90,001 – $110k | $720 |
However, you may be denied an exemption. In this case, consider private insurance or Commonwealth Choice in order to avoid penalties.
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You can buy
Private insurance or Commonwealth Choice
Commonwealth Choice
New private insurance plans with below market-rate premiums that cover preventive and primary care, emergency services, hospitalization, and mental health services. Some also include prescription drug coverage.
Eligibility
- Young Adult Plans open to those ages 19 to 26 without access to work-based insurance.
- Other plans open to all adults and families unless they work for a company with more than 50 employees that offers insurance.
Options
Choose among four levels of coverage…
- Young Adult Plans offer slim coverage targeted to healthy individuals.
- Bronze coverage is basic.
- Silver and Gold plans offer more comprehensive coverage for a higher premium.
…Provided by six insurers:
- Blue Cross Blue Shield of Massachusetts
- Fallon Community Health Plan
- Harvard Pilgrim Health Care
- Health New England
- Neighborhood Health Plan
- Tufts Health Plan
Monthly Premiums
Based on insurer and plan chosen, age, location, and occupation.
Example for single person, age 29, living in Boston:
- Premium for Bronze plan with drug coverage ranges from $182 to $255 a month.
Example for family of four, parents age 40, in Framingham:
- Premium for Silver plan ranges from $887 to $1,452.
Cost can be cut up to 40 percent if employer allows payroll deduction of premiums on pretax basis.
Other costs
Many plans have deductibles before full coverage kicks in. Plans with lower premiums typically require higher copayments for medicines, doctor’s visits, and hospitalization.
Cautions
Some plans restrict coverage to certain doctors and hospitals.
To buy insurance or get information
Go to mahealthconnector.org or call 1-877-623-6765; or contact individual insurers.
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If you don't have insurance on Dec. 31, 2007...
You have to pay a one time penalty of $219
Then, if you don't have insurance by Dec. 31, 2008, you pay monthly penalty up to $200
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If you have insurance through work, you're in good shape until January 2009
At that point, however, you must have coverage that meets new state standards. Check your current policy against those requirements. If it doesn't match up, you will have to get more comprehensive insurance on your own or through your employer.
If you have any of those insurance plan, you meet the new state standards:
- Commonwealth Care plans
- Young Adult Plans
- College student plans
- Medicare (even without drug coverage)
- Medicaid (MassHealth)
- Plans sponsored by religious groups
- Federally sanctioned high-deductible health plans with health savings accounts
Required coverage by January 2009
- Prescription drugs
- Hospital and emergency services
- Primary care
- Mental health care
- No limits on benefits per year, per disease, or injury
ANNUAL DEDUCTIBLE
- No more than $2,000 for an individual, $4,000 for a family
- Coverage for some preventive office visits before the deductible takes effect
- Drug deductible not more than $250 for an individual, $500 for a family
ANNUAL OUT-OF-POCKET SPENDING
- No more than $5,000 for an individual, $10,000 for a family, including deductible and copayments over $100, but not premiums.
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For more information and help:
Commonwealth Health Insurance Connector A state agency overseeing new insurance rules and plans. For information and to enroll in Commonwealth Choice or Commonwealth Care plans, go to mahealthconnector.org or call 1-877-623-6765
gethealthcoverage.net Information on new health insurance options, compiled by the Massachusetts Hospital Association, the Massachusetts League of Community Health Centers, and Health Care For All. gethealthcoverage.net
Health Care for All helpline
Boston-based advocacy group that offers assistance getting coverage. 800-272-4232.
The Mayor's Health Line
800-847-0710 - For Boston residents.
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