Health Coverage Opportunities Under The Affordable Care Act
Below is a summary of the health coverage programs that can make the cost of health insurance affordable to Massachusetts residents under national health reform.
Ecu-Health Care, located at 99 Hospital Avenue, Suite 208 on the Northern Berkshire Campus of Berkshire Medical Center in North Adams, has been designated as the area’s health coverage Navigator, helping area residents apply for all health coverage programs. Please call Ecu-Health Care at 663-8711 for assistance applying for all of these programs:
The new plans under national health reform and the changes in the current Massachusetts plans include the following:
Qualified Health Plans
Qualified Health Plans are health plans that offer all required benefits specified under national health reform. They are offered by private insurance companies and are sold through the Massachusetts Health Connector.
- Individuals with incomes up to 400% of the Federal Poverty Level (Fpl)https://betterhealthconnector.com/help-center-answers/federal-poverty-level-fpl may be eligible for advanced premium tax credits, which is money that the federal government pays directly to insurance companies every month so that individuals have lower monthly premiums - this will significantly reduce the cost of their health insurance. If individuals qualify for premium tax credits, they may be able to use some of the tax credit towards the purchase of dental insurance as well.
- ConnectorCare plans are qualified health insurance plans for individuals and families with incomes up 300% of the Federal Poverty Level (Fpl)https://betterhealthconnector.com/help-center-answers/federal-poverty-level-fpl. In addition to advanced premium tax credits, individuals and families will also receive state subsidies to further reduce the cost of their health insurance in addition to help paying out-of-pocket cots, such as co-pays and deductibles.
Massachusetts is now offering stand-alone dental plans for children and adults through the state's Health Connector.
Qualification for the above programs is contingent on individuals not qualifying for health insurance that is considered minimal essential coverage (such as coverage under a government-sponsored program, or an employer sponsored plan). If they qualify for coverage through an employer, they may still qualify for a QHP, if the health insurance is unaffordable, or does not meet minimum value requirements.
- Affordable: Individuals share of the premium for an individual health plan is less than 9.5% of the family’s income.
- Minimum value: If the plan offered by the employer covers less than 60% of the health care costs, they would also qualify for the above programs.
Massachusetts residents should be aware there are certain open enrollment periods to enroll in Qualified Health Plans. The next open-enrollment period will be from November 1, 2016 to Januray 31, 2017, but there are certain exceptions and quailifying events that will allow individuals to enroll outside of the open enrollment periods.
Please contact us to understand if you qualify for an exception and/or qualifying event.
Individuals eligible for MassHealth can enroll thoughout the year.
MassHealth CarePlus is a MassHealth coverage type for adult citizens and qualifying noncitizens under age 65 with incomes no greater than 133% of the federal poverty level. The new MassHealth qualification rules use a 133% fpl income limit and a 5% income disregard. In effect, this makes the income limit to 138% of the fpl.
Changes for individuals ages 19 and 20
Individuals ages 19 and 20 with incomes up to 150% of the federal poverty level, who previously did not qualify for MassHealth Standard, because they had reached their 19th birthday, may now qualify for a MassHealth coverage that is equivalent to MassHealth Standard.
College Students Who Qualify for Qualified Health Plans with Premium Tax Credits
Massachusetts residents who attend college in Massachusetts and who meet the above guidelines, may qualify for Masshealth or a Qualified Health Plan with premium tax credits, as long as the insurance plan offered by the college is not self-funded.
How to Apply for Health coverage
Individuals in North Berkshire are able to apply for health overage three ways:
- At Ecu-Health Care, located at 99 Hospital Avenue, Suite 208 on the Northern Berkshire Campus of Berkshire Medical Center in North Adams. Please call us for an appointment at 663-8711.
- Through the MAhealthconnector.org web-site.
- By telephone at 1-877 MA ENROLL (1-877-623-6765)