Health Insurance in Massachusetts

The good news is that being a resident of Massachusetts means that it’s easier than ever before to find the comprehensive health care coverage you need. But there are still some extra challenges that Massachusetts residents face, including a statewide individual mandate which has survived the elimination of the federal mandate. Working around this mandate and the other issues which are inherent to the state of Massachusetts can make shopping for insurance seem complex and burdensome – but with our help, you should be able to make a decision soon. 

Major Medical Insurance in Massachusetts

The reason you’re likely shopping for health insurance right now is thanks to the Patient Protection and Affordable Care act – otherwise known as Obamacare or the ACA, among other names. The law has changed several times over the years (most notably with the elimination of the federal mandate), and you should know what these changes in the law are as well as how they apply to you as both a citizen and a consumer. Open Enrollment is the time during the year which most Americans will apply for major medical coverage. The easiest way for Massachusetts residents to do this is to go to MAHealthConnector.org, which is the main website for the Massachusetts state exchange.

Why is it so important to sign up for major medical coverage, as opposed to all the other options available to you? For starters, despite the dissolution of the individual mandate on the federal level, the state of Massachusetts still has an individual mandate on the state level. This means that if you accidentally sign up for the wrong insurance plan, you could end up paying a hefty tax penalty the next time you file. Secondly, major medical insurance has three major advantages over all other types of coverage: being guaranteed issue, covering the Essential Health and Wellness Benefits, and offering you cost-saving subsidies off your monthly premiums. Guaranteed issue policies are superior to most other forms of insurance because insurance providers are legally prohibited from rejecting you for coverage if you apply. They’re also legally prohibited from charging you more on your monthly premiums, unless one of the following four factors means you require more expensive care:

• Your age 
• Your location
• Your use of tobacco products
• Whether you are applying for an individual policy or a family policy

The guaranteed Essential Health and Wellness Benefits are another important part of major medical coverage. This comprehensive collection of benefits ensures that most Americans get the health care they need not just for their acute maladies, but also for long-term and preventative care. The long-term and preventative care is important for avoiding catastrophically expensive health problems and improving your health to lower medical costs over time: 

• Ambulatory/outpatient services
• Emergency services
• Hospitalization
• maternity/newborn care
• Mental health and substance abuse
• Prescription drugs
• hab/rehab services and devices
• Lab tests
• Preventive and wellness services and chronic disease management
• Pediatrics (including oral and vision)

For most health insurance consumers, the next important question is: how are you going to pay for your major medical coverage? If you make less than 400% of the federal poverty limit, you will likely qualify for some sort of federal or state tax credit that lowers the cost of your monthly premiums. If you take a look at the chart below, it will clearly show you whether or not you fall above or below the 400% threshold. If your household income (based on size) is less than what you see in the chart, then you will likely qualify for valuable financial assistance.

The state of Massachusetts was also an early adopter of the Medicaid expansion. This means that even households and individuals who don’t qualify for a federal tax credit will likely still qualify for the state Medicaid program, MassHealth – provided they meet certain criteria. You can learn more about MassHealth and even apply online at their website. 

Short Term Health Insurance in Massachusetts

Short-term health insurance companies don’t actually offer any coverage within the state of Massachusetts – and they haven’t for many years now. Believe it or not, it has nothing to do with the Affordable Care Act. Because most short-term health insurance companies don’t want to negotiate or change their business practices based on the laws they would have to obey in order to operate in Massachusetts, they claim they cannot offer short-term plans due to an inhospitable business environment.

Massachusetts has actually had individual mandate laws since the late 1990s, and most short-term health plans didn’t qualify as major medical coverage back then because of these laws. Things haven’t changed much in the decades since. Furthermore, Massachusetts laws require that qualifying coverage which satisfies the mandate be guaranteed issue. By definition, short-term health insurance must involve medical underwriting, which gives short-term health insurance companies the option to reject people for coverage or charge more based on pre-existing conditions. So those are the main reasons why it is impossible to find short-term health insurance in the state of Massachusetts. 

Christian Health Plans/Health-Sharing Plans in Massachusetts

Unlike some other parts of the country, Christian health plans are still fairly popular in the state of Massachusetts due to the long-standing tradition of an individual mandate. But just because you can get a religious exemption with one of these religion-based health sharing plans doesn’t mean that they meet the same legal requirements as major medical coverage in Massachusetts. So you should brush up on exactly what these plans are and familiarize yourself with what you’re getting into before you choose to purchase one of these plans. 

Let’s start by talking about all of the reasons why someone may want to choose a health share plan over qualifying major medical coverage:

• Their “monthly share amount” can cost as much as 1/3 less than a monthly premium for major medical insurance
• They may promote and encourage lifestyle habits which coincide with their preferred religious faith
• They meet the requirement for the individual mandate so that they won’t have to pay a tax penalty

However, there are also some things about health share plans which may not be so appealing for others. If any of the following options seem like a less attractive choice to you, then going back to your state Health Insurance Marketplace and finding a major medical plan might be the better way to meet your needs:

• Consumer protections – there’s technically no legal contract between you and your health share plan provider, so you can’t take them to court or dispute a decision if they don’t pay out your benefits
• Lifetime and annual caps – health-share plans typically impose lifetime and annual caps on the financial benefits you’re allowed to receive; there are no caps, however, on your total out-of-pocket costs
• Participation guidelines – health share plans typically impose participation guidelines on their members in order to promote health, wellness, and their chosen faith. If you aren’t particularly religious or if you personally cannot meet the participation guidelines, this may not be the plan for you 
• Medical underwriting – health share plans are not guaranteed issue, which means you will be subject to medical underwriting and can be rejected for coverage based on your medical history and any/all pre-existing conditions

Now that you know the pros and cons associated with Christian health plans, it can help you make a better decision when it comes to the healthcare needs of you and your family. Some people may be eager to sign up for one of these plans due to their frustrations with the individual mandate. Others may find legitimate financial value in the benefits they offer. Yet still some individuals and families might not get as much of a financial bargain based on their own personal circumstances or lack of faith. It all depends on what’s best for you and your loved ones. 

Fixed Indemnity Plans in Massachusetts

Fixed indemnity plans are optional, supplemental forms of health coverage that do not legally qualify as replacements for major medical coverage. But they can help take the edge off of your out-of-pocket costs. These plans will vary depending on where you live and what your needs are, but you could get your benefits paid out per day, per week, per month, per visit, or per event. The plan you sign up for may help pay for hospital benefits, doctor benefits, or possibly even dental depending on what you need and the company you sign up with. There are caps on benefits just like with a Christian health plan, and no limit on how expensive your out-of-pocket costs can get. But they still do have their place in the health insurance world today.

You should also know that fixed indemnity plans, like many of your other options outside of the ACA, are not guaranteed issue. You will have to subject yourself to medical underwriting, and you may even be rejected for coverage or charged substantially more for your monthly premiums based on your medical history. It is strongly recommended that people purchase indemnity plans if they already have major medical coverage or a comprehensive equivalent. This is because the maximum benefits you can get from an indemnity plan usually don’t cover the majority of your medical costs the way a silver plan from the exchange would, for example. But if an indemnity plan is the best you can afford, and you’d rather have that than no coverage at all, it makes sense to look into some of these plans. 

Discount Cards in Massachusetts

Medical discount card programs operate under the same rules in Massachusetts that they do pretty much anywhere else. You join a discount card provider, usually for a small monthly or annual fee, and then you receive your card shortly thereafter in the mail. When you present this card at participating retailers and medical facilities, you can get a discount at the point of sale. They work similarly to something like AAA or the AARP. You won’t be filing claims, but you won’t be waiting for reimbursements either; they simply help take the edge off your out-of-pocket costs as you make purchases and receive certain medical services.

But not all medical discount cards are created equal. There are popular companies like GoodRx which offer limited options (they only cover prescription drug discounts, for example) but are very well known and have a good reputation. On the other hand, there are discount card providers who make exaggerated claims about the amount of discounts you could receive, or lie about which providers are in their discount card club. You as a consumer need to be your own advocate and do your homework before you sign up for one of these cards. If the discounts and the providers they advertise all check out, then adding a discount card to your major medical coverage could be a great way to keep your total medical costs and check.