The people of Massachusetts have new options for purchasing health insurance as a result of the Affordable Care Act (ACA), also known as ObamaCare. Prior to the ACA, Massachusetts already had a state-run marketplace, Massachusetts Health Connector. Although Health Connector has existed for several years, the program was changed to meet ACA requirements.  In addition, the state is also expanding its Medicaid eligibility guidelines, allowing thousands of low-income Bay State residents to obtain health insurance through state coverage.

From its launch in early October 2013, the Health Connector website was plagued by technical issues. As a result, thousands of Massachusetts citizens who applied for coverage through the state-run marketplace did not receive confirmation of their policies. In some cases checks were sent but payment was never received. In other instances, payment was not linked to the individual policy as purchased online, leaving some Massachusetts residents without coverage despite having submitted payment. The Massachusetts legislature scheduled hearings in February 2014 to discover and address the specific issues with the system.

In November 2014, the state redesigned and re-launched the Health Connector website. On its first day, the site did not crash and the average response time was under one second. As a result, nearly 6,000 Massachusetts residents were able to use the site to determine what level of financial assistance they could receive and 60 residents were able to pay for their insurance and waiting to receive confirmation from their provider.

Purchasing Health Insurance in Massachusetts

The Health Connector site allows Massachusetts citizens to fill out an application that will be reviewed for eligibility for financial assistance with insurance, as well as for Medicaid or Children’s Health Insurance Plan (CHIP) eligibility under the state’s new, expanded guidelines. Massachusetts residents who earn between 100 – 400 percent of the federal poverty level will be eligible for assistance with insurance premiums, and those who earn between 100 – 250 percent of the federal poverty level will also be able to receive assistance with cost-sharing, such as copayments and deductibles. In 2013, the federal poverty level was $23,550 for a family of four.

On October 1, 2014, Massachusetts became the first state to require that health insurance providers publicly offer residents prices for individual medical services in real time. Massachusetts residents who have private health insurance have the added benefit of being able to visit their insurance provider’s website and view the price of individual services, such as a blood test or MRI.

This new transparency of health services pricing also reveals that pricing structures vary from insurer to insurer. This is because each insurer negotiates their own rates with hospitals and individual doctors. Pricing on services also fluctuates on a regular basis and there is no industry standard for the cost of a specific medical procedure.

When choosing a plan, Bay Staters should be sure to understand the whole picture of costs and benefits. The lowest premium plan may not be the best deal in the long run, as it may have higher cost-sharing amounts or a narrow provider network. As many marketplace policies do not offer out-of-network coverage, before purchasing a plan it’s also important for citizens to contact their health care providers to be sure the physicians participate in a plan. By choosing the best coverage based on premium, cost-sharing, network, and prescription coverage, Bay Staters will be well-protected in the event a health emergency should arise.

Uninsured Massachusetts residents must obtain coverage to avoid a tax penalty. Those who have job-based health insurance, Medicare, or other qualified coverage are considered covered under the ACA and will not need to purchase additional insurance. Bay Staters who cannot obtain coverage (due to cost or other circumstance) may seek an exemption to avoid the tax penalty. In general, insurance purchased on the 15th of the month will go into effect on the 1st of the next month.

MassHealth: Medicaid and CHIP Coverage in Massachusetts

Bay State residents can apply for Medicaid coverage through the Massachusetts Health Connector or by directly contacting the state office. With the new guidelines in effect, citizens of Massachusetts may qualify for Medicaid even if they have been denied coverage under the program in the past.

MassHealth, a public program unique to the state of Massachusetts, provides low- and medium-income citizens with a range of health care services. Both Medicaid and the Children’s Health Insurance Program (CHIP) are grouped into one service offering under MassHealth.  MassHealth provides routine check-ups, doctor visits, immunizations, and more for uninsured Bay State children (as well as the parents and guardians of children), unemployed, disabled, or elderly adults, and other Massachusetts residents with a defined set of health care needs.

The state of Massachusetts is adapting to a big change in the way its residents purchase health insurance. While the Health Connector site has had technical difficulties, the state government is taking action to remedy the significant problems Massachusetts residents had encountered in applying for insurance.