Here's how health care works in Massachusetts - News - Wicked Local

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Here’s how health care works in Massachusetts By Staff reports Posted Feb 21, 2010 at 12:01 AM Updated Feb 21, 2010 at 9:04 PM

If you are one of the many people without health insurance coverage, you may be eligible to receive benefits from a MassHealth Program. MassHealth provides health-care benefits to certain low-and medium income people living in Massachusetts. According to the Massachusetts State Law, everyone in Massachusetts must have health insurance. Some people have health insurance provided by their employers; some people do not. If you are one of the many people without health insurance coverage, you may be eligible to receive benefits from a MassHealth Program. MassHealth provides health-care benefits to certain low-and medium income people living in Massachusetts. To start the process, you will need to fill out The Medical Benefit Request to determine eligibility. Through this process you may qualify for MassHealth or one of the related MassHealth Programs. There are nine MassHealth related programs that one might be eligible to receive (which are delineated below). Each MassHealth program has certain criteria based on your age, health status, income level, citizenship or alien status, and ethnicity, to name a few. Each program offers certain types of medical coverage, and may or may not have premiums, deductibles and co-pays attached, depending on income guidelines. For those who do not qualify for one of these MassHealth programs, you may be eligible for Commonwealth Care, a program of health-care coverage administered by the Commonwealth Health Insurance Connector Authority (“the Connector”). Currently there are four Network Plans (Neighborhood Health Plan, HealthNet Plan, Network Health, and Fallon Community Heath Plan) that one can choose from based on location of service providers and the particular medical needs, services, and programs of the insured. There are three tiers of coverage based on income and three levels within each tier that determines premiums, co-pays, and deductibles. To qualify for CommCare, a family can make a maximum of $31,212 per year. The following highlight some of the criteria for the nine MassHealth related programs that one might be eligible to receive. MassHealth Standard Full range of health-care benefits: Under age 19 Pregnant Woman under age 65 with breast or cervical cancer Disabled according to standards set by federal law Adult primary caretaker relative living with children under age 19 or 65 and older. Income standards (family’s monthly income before taxes and deductions based on the federal poverty level %) and Premiums charged depend on diagnosis, age of children and/or caretaker, and income: Pregnant and children under age 1 = 200%; Children age 1-18 = 150%; Parents and caretaker relatives of children under age 19 = 133%; Disabled adults [determined by the federal/state guidelines] = 133%) MassHealth CommonHealth Offers health-care benefits similar to MassHealth Standard to disabled adults and children who cannot get MassHealth Standard Disabled child under age 18 Disabled person ages 18 or older who: · Works 40 hours or more a month or · Is under age 65 and not working or · If working meets certain state and federal rules There is no income limit for MassHealth CommonHealth. If your monthly income before taxes and deductions is above 100% of federal poverty level (FPL), you may have to pay a premium ranging from $12 to $84 a month for disabled children or be required to meet a one-time-only deductible. If you are a disabled working adult, you will be billed a monthly premium based on your gross income. There is a certain criteria and formula used for meeting a one-time-only deductible. MassHealth Family Assistance (MFA) Offers coverage to children (ages 1-18), some working adults, and people who are HIV positive who do not qualify for MassHealth Standard or MassHealth CommonHealth and qualified aliens and aliens with special status. Income standards are based on family’s gross income, FPL range of 200-300%, age of children, citizenship status, Insurance Partnership participation, and HIV-positive status. Premiums are partially paid for by MFA program, by employers who participate in the Insurance Partnership, or by individuals. Family premiums range from $12 to $84 a month; however, they are free to American Indian tribes or Alaska Natives. Enrollment is limited in MFA and waiting lists are established according to application dates. MassHealth Basic (MHB) Offers coverage to certain unemployed adults by: · Paying all or part of cost of your other health insurance premiums or · Allowing you to enroll in a health plan through MassHealth if no other insurance You may be eligible for benefits if you are: · Receiving EAEDC cash assistance · Under age 65 and receiving services from Department of Mental Health and: · Currently not working · Have not worked in more than one year and do not have enough to collect unemployment · Not collecting unemployment Your family gross income cannot be more than 100% of the FPL. You may not receive MHB if one has a spouse who works more than 100 hours a month. Premiums are paid monthly. MassHealth Essential (MHE) This coverage type offers coverage to certain unemployed adults who are not eligible for MassHealth Basic by paying for all or part of the premiums: · Under age 65 and · Currently not working · Have not worked in more than a year and not eligible to collect unemployment · Not collecting unemployment · Not eligible for MassHealth Basic, and · You are a US citizen/national or an alien with special status and disabled by MassHealth standards There is an enrollment cap and once amount has been spent, enrollment will seize. College students and a person whose spouse works more than 100 hours a month are not eligible. MassHealth Prenatal (MHP) Offers health-care benefits right away to pregnant women for up to 60 days, while waiting to see if eligible for another MassHealth program. Labor and delivery services are not covered. MassHealth Limited (MHL) Provides emergency health services to people who, under federal law, have an immigration status that keeps them from getting more services: · Pregnant · Under age 19 · A parent living with his/her disabled children under age 19 · Disabled according to the federal standards Income standards depends on age/income/health status. Covers labor and deliver but not organ transplants. Children’s Medical Security Plan (CMSP) Provides primary and preventive care for children and teens who do not have other health insurance coverage. Enrollment capped program. Healthy Start Program (HSP) Offers comprehensive prenatal and postpartum cared for low income pregnant women who are not eligible for any other MassHealth program or have other health insurance. Federal Poverty Levels (Monthly)*

Family Size 100% 133% 150% 200%

1 $ 851 $1132 $1272 $1702

2 $1141 $1518 $1712 $2282

3 $1431 $1904 $2147 $2862

4 $1721 $2289 $2585 $3442

5 $2011 $2675 $3017 $4022

6 $2301 $3061 $3452 $4602

7 $2591 $3446 $3887 $5182

8 $2881 $3832 $4322 $5762

Add’l people: +$290 +$386 +$435 +$580

Family Size 250% 300% 400%

1 $2128 $2553 $3404

2 $2853 $3423 $4564

3 $3578 $4293 $5724

4 $4303 $5136 $6884

5 $5028 $6033 $8044

6 $5753 $6903 $9204

7 $6478 $7773 $10364

8 $7203 $8643 $11524

Add’l people: +$725 +$870 +$1160

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Here's how health care works in Massachusetts - News - Wicked Local

Here’s how health care works in Massachusetts By Staff reports Posted Feb 21, 2010 at 12:01 AM Updated Feb 21, 2010 at 9:04 PM If you are one of the ...

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