This week marks the implementation of the biggest health care expansion in the United States since Medicare and Medicaid became law in 1965. Known colloquially as Obamacare, the Affordable Care Act (ACA) will eventually help more than 32 million Americans gain access to affordable health insurance. Individuals can start applying for the new health coverage programs today, and enrollments become effective on Jan. 1.
While the strident national political dialogue rages on, it will be helpful to understand how to make national health reform successful in Berkshire County. With this in mind, here is a summary of the new programs in Massachusetts that will help individuals gain access to health insurance under national health reform:
Qualified Health Plans are health plans that will offer all required benefits specified under national health reform. They will be provided by private insurance companies and sold through the Massachusetts Health Connector. Individuals with incomes up to $45,960 a year, or $94,200 for a family of four (2013 guidelines) may be eligible for advanced premium tax credits, which is money that the federal government will pay directly to insurance companies every month so that individuals will have lower monthly premiums, significantly reducing the cost of health insurance.
ConnectorCare plans are Qualified Health Plans for individuals and families with incomes up to $34,476, or $70,656 of a family of four. In addition to premium tax credits, individuals and families will also receive help paying out-of-pocket costs, such as co-pays and deductibles.
Qualification for the above subsidized programs is contingent on individuals not qualifying for health insurance that is considered minimal essential coverage such as coverage through an employer sponsored plan. If they qualify for coverage through an employer, they may still qualify for a qualified health plan, if the health insurance offered by an employer does not meet affordability guidelines, or does not meet certain minimum value requirements.
MassHealth CarePlus is a new MassHealth coverage type for adult citizens and qualifying noncitizens under age 65 with incomes no greater than $15,856 a year.
Small Business Employee Premium Assistance; individuals who meet certain eligibility guidelines and who work for employers with 50 or fewer employees may be eligible for premium assistance for health insurance they receive through their employer. If eligible, this will be available to individuals with incomes up to $34,476 a year, or $70,656 of a family of four. To qualify for Small Business Premium Assistance individuals must be currently uninsured or, if insured, was a member of the Insurance Partnership program in Nov. 13, 2013.
Changes for individuals ages 19 and 20: Individuals ages 19 and 20 with incomes up to 150 percent of the federal poverty level ($17,235 in 2013) 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: Massachusetts residents who attend college in Massachusetts may now qualify for a Qualified Health Plan with premium tax credits, as long as the insurance plan offered by the college is not self-funded. Massachusetts will also begin offering stand-alone dental plans for children and adults through the state's Health Connector.
Plans that will be discontinued: Commonwealth Care, MassHealth Basic, MassHealth Essential, the Medical Security Plan, and the Insurance Partnership will be discontinued. All of the individuals currently in these programs will qualify for one of the new programs under national health reform with similar or richer benefits as compared with the benefits they currently receive.
It is important to know that individuals who are currently enrolled in Commonwealth Care who will qualify for MassHealth CarePlus will be automatically transferred. Those who will not be eligible for MassHealth will have to re-apply for coverage. Current Commonwealth Care members will be contacted in the coming weeks and will be provided information on the re-application process.
Open Enrollment Periods: While individuals will be able to enroll in MassHealth throughout the year, there are certain open enrollment periods for ConnectorCare and the Qualified Health Plans. The current planned open enrollment periods for these programs are October 1, 2013 to March 31, 2014 and October 15 to December 7, 2014. While there will be exceptions and qualifying events that will allow individuals to enroll out side of the open enrollment periods, final regulations in regard to open enrollment periods have yet to be determined.
It is important to know that individuals can also apply on-line at the Massachusetts Health Connector web-site: MAhealthconnector.org, or by telephone at 1-877-MA ENROLL (1-877-623-6765).
It has been said the only the harder than passing health reform is actually implementing health reform. In Berkshire County though, we have the resources and support to make national health reform successful. We will learn a lot in the coming years and no doubt there will be adjustments and changes along the way, but now we need to roll up our sleeves and get to work -- let the implementation begin!
Charles Joffe-Halpern is the executive director of Ecu-Health Care in North Adams.