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Health Care Reform:

Health Insurance & Affordable Care Act

Health Connector

Plans and Costs continued...

You must have at least a bronze-level plan to meet minimum requirements for insurance under the Affordable Care Act and avoid the penalty for not having health insurance. 

Catastrophic will be available, especially for those who are under 30 and healthy. These plans cost less up front, but they don’t give you as much coverage. They generally require you to pay more  out-of-pocket costs.

Costs: You can find details about benefits, deductibles, and out-of-pocket costs of various insurance plans offered at the Massachusetts Health Connector. To learn about the premiums for each specific plan, you must call each carrier or submit information online, also at the Health Connector.

Who Will Sell Insurance in the Massachusetts Marketplace? Companies that have been approved to sell insurance plans, known as Commonwealth Choice plans, include Blue Cross Blue Shield of Massachusetts; BMC HealthNet; CeltiCare;  Fallon Community Health Plan; Harvard Pilgrim Health Care; Health New England; Neighborhood Health Plan; Network Health; and Tufts Health Plan New England. Consumers may review details of the plans at the Health Connector.

Benefits

What's covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In Massachusetts, the benefits include:

  1. Outpatient services, such as doctor visits or tests done outside a hospital. This includes fertility treatments.
  2. Emergency services
  3. Hospital stays, including weight loss surgery
  4. Pregnancy and baby care
  5. Mental health and substance abuse services, including behavioral health treatment
  6. Prescription drugs, including generic and certain brand-name drugs
  7. Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues. In Massachusetts, this includes physical and occupational therapy for people diagnosed with autism spectrum disorder, those who have home health care, and those with speech/hearing disorders.
  8. Lab tests
  9. Preventive and wellness services, along with those that help people manage chronic conditions. This includes contraceptives, hormone replacement therapy, and wigs for people who are balding.
  10. Services for children, including dental and eye care (but not eyeglasses)

Some services not included: long-term care and cosmetic surgery.

Health Insurance Advisor: Check out Web MD’s Health Insurance Advisor to compare different kinds of plans based on your needs.

Financial Aid and Medicaid

You may be eligible for financial aid to help pay for insurance or for government sponsored insurance. Here’s what’s available:

Premium Subsidies (also known as Tax Credits): You may qualify for a subsidy -- money to help pay your health insurance premium each month. The subsidy may be sent directly to your health insurance company and is available only if you buy your insurance in the Marketplace.  In general, you'll be eligible if you're single and make about $45,960 or less a year, or if you have a family of four and make about $94,200 or less a year. Subsidies are based on your estimated household income for 2014.

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