Who Is the Marketplace for?
Health Connector is Massachusetts' Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone. In Massachusetts, the Marketplace is run by the state government. The Marketplace, also called an Exchange, is mainly for people who:
- Don’t have insurance
- Aren’t insured by their employer
- Aren’t included in their spouse’s employer insurance
- Have pre-existing conditions and may have had trouble getting insurance before
- Have private insurance but want something less expensive
- Own a small business
In 2006, Massachusetts became the first state in the U.S. to guarantee health care to its residents when state health care reform was signed into law. While its system is different from the Affordable Care Act, it also shares many features: It covers people who don’t qualify for the state’s Medicaid program, people who are self-employed or work part time, and people who don’t get insurance through their workplace. It also sets premium subsidies and requires all residents to carry health insurance or pay a fine.
Massachusetts has made several changes to comply with the Affordable Care Act. The changes include increasing subsidies for individuals with incomes up to 400% of the federal poverty level; eliminating copays for preventive services; increasing tax credits for small employers; and expanding dependent coverage for people up to age 26 who are covered under their parents’ insurance plans.
Massachusetts has run its own health insurance Marketplace, called the Health Connector, since it passed health care reform, and it will continue to do so. The Health Connector can sell standalone dental, vision, catastrophic, and child-only plans.
The Affordable Care Act requires that most Americans have health insurance starting in 2014. Generally, you don't need to buy insurance through the Marketplace if you are currently covered by Medicaid, Medicare, TRICARE, or an employer-sponsored plan.
When You Can Enroll: Until March 31, 2014. You must sign up by then if you want insurance in 2014 and to avoid paying a tax penalty.
The next enrollment period will be from Nov. 15, 2014, to Jan. 15, 2015.
If you have a life-changing event -- such as the birth of a child, losing your job, or moving to a new state -- you don't have to wait for the next enrollment period. You can sign up or change coverage within 60 days of the event.
Plans and Costs
Companies can offer four levels of plans: bronze, silver, gold, and platinum. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers. Here’s how it works:
- Bronze Plan: You pay 40% and the plan pays 60%
- Silver Plan: You pay 30% and the plan pays 70%
- Gold Plan: You pay 20% and the plan pays 80%
- Platinum Plan: You pay 10% and the plan pays 90%