“Helping Job Hunters Navigate Health Insurance and Find Lower-Cost Health Services” David Pomeranz Copyright © 2010

2 The purposes of this presentation … Overview of health insurance programs resulting from state and federal laws Overview of health insurance programs resulting from state and federal laws Provide websites and telephone numbers Provide websites and telephone numbers

3 “The Golden Rule:” IF YOU REMEMBER ONLY ONE THING FROM THIS PRESENTATION ….

5 To the extent possible: ALWAYS,ALWAYS,ALWAYS,

6 ALWAYS HAVE: HEALTH INSURANCE COVERAGE !!!

7 If you lose coverage, first check -- Does your spouse have a health insurance plan? If so, perhaps it makes sense for you to be on your spouse’s plan!

8 Other health insurance options for job hunters … COBRA and its subsidy programs COBRA and its subsidy programs 2006 Mass. Reform Law’s programs 2006 Mass. Reform Law’s programs MassHealth Essential MassHealth Essential Health Safety Net / Free Care Health Safety Net / Free Care Insurance Partnership Insurance Partnership Resources and Background Information Resources and Background Information

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10 COBRA: what is it? Federal law requires employers to provide continuity in health insurance coverage Federal law requires employers to provide continuity in health insurance coverage Typically lasts for 18 months but it can last for 36 months if, for example, you are a divorced spouse or an adopted child Typically lasts for 18 months but it can last for 36 months if, for example, you are a divorced spouse or an adopted child Employers with 20+ employees; many states have “mini” COBRA laws for smaller employers Employers with 20+ employees; many states have “mini” COBRA laws for smaller employers

11 COBRA: when does it apply? Loss of job except for “gross misconduct” Loss of job except for “gross misconduct”OR Employer eliminates your coverage because of a reduction in hours: for example, from full to part-time Employer eliminates your coverage because of a reduction in hours: for example, from full to part-timeOR When a company is [Chapter 7] bankrupt while it is reorganizing itself When a company is [Chapter 7] bankrupt while it is reorganizing itself

12 COBRA: when does it not apply? Employer stops offering health insurance to all employees Employer stops offering health insurance to all employees Company goes out of business Company goes out of business

13 If COBRA is in effect … Individual has to pay the entire health insurance premium plus up to a 2% administrative fee Individual has to pay the entire health insurance premium plus up to a 2% administrative fee BUT an employer’s group coverage is usually a better value than any non-group coverage BUT an employer’s group coverage is usually a better value than any non-group coverage

14 How Much Time Do You Have to Elect COBRA? Employers must notify their plan administrators within 30 days Employers must notify their plan administrators within 30 days Plan administrator must notice individuals within 14 days Plan administrator must notice individuals within 14 days Individuals must elect coverage within 60 days after notice is sent or the day health care coverage ceased, whichever is later Individuals must elect coverage within 60 days after notice is sent or the day health care coverage ceased, whichever is later

15 COBRA subsidy programs Federal: Feb. 17, 2009; Federal: Feb. 17, 2009; amended Dec. 19, 2009 Massachusetts’ Medical Security Program Massachusetts’ Medical Security Program

16 Original Federal stimulus law of Feb. 17, 2009 Job loss: 9/1/2008 to 12/ Job loss: 9/1/2008 to 12/ Subsidy: 65% of insurance premium for nine (9) months Subsidy: 65% of insurance premium for nine (9) months

17 Amended Federal stimulus law of Dec. 19, 2009 Job loss: 9/1/2008 to 2/28/2010 Job loss: 9/1/2008 to 2/28/2010 Subsidy: 65% of insurance premium for 15 months Subsidy: 65% of insurance premium for 15 months

18 Federal stimulus law: case study of extension Original eligibility: 3/1/2009 through 11/30/ months in total Original eligibility: 3/1/2009 through 11/30/ months in total Eligibility extension from 9 to 15 months; e.g., from 12/1/2009 to 5/31/2010 Eligibility extension from 9 to 15 months; e.g., from 12/1/2009 to 5/31/2010 If you paid your full COBRA premium for December 2009: contact COBRA administrator to your 65% subsidy back If you paid your full COBRA premium for December 2009: contact COBRA administrator to your 65% subsidy back

19 Massachusetts’ Medical Security Program Eligibility: Do not have to be COBRA eligible Do not have to be COBRA eligible Receiving Massachusetts unemployment Receiving Massachusetts unemployment Household income < 400% of the federal poverty levels (FPLs) Household income < 400% of the federal poverty levels (FPLs) Income for this Program excludes unemployment benefits Income for this Program excludes unemployment benefits or or

20 What are “Federal Poverty Levels” (FPLs)? Income standards used to determine eligibility for public programs Income standards used to determine eligibility for public programs Based on Based on –gross (pre-tax) household income –family size

FPLs for Medical Security Program Family Annual Household Gross Income Size400% 1$43,320 2$58,280 3$73,240 4$88,200

22 Medical Security Program: Two Options Medical Security Program: Two Options “Premium Assistance” for COBRA “Premium Assistance” for COBRA “Direct Coverage” for when your loss of coverage has nothing to do with COBRA “Direct Coverage” for when your loss of coverage has nothing to do with COBRA

23 Medical Security Program “Premium Assistance” Up to 80% of premium Up to 80% of premium Can receive both federal and state COBRA premium subsidies if meet both eligibility requirements Can receive both federal and state COBRA premium subsidies if meet both eligibility requirements

24 Guaranteed Issue in Massachusetts Insurers have to waive all pre-existing conditions Insurers have to waive all pre-existing conditions

25 Topics to be covered about the 2006 Mass. Reform Law Health Connector Health Connector Individual Mandate Individual Mandate Minimum Credible Coverage Minimum Credible Coverage Commonwealth Care and Commonwealth Choice health plans Commonwealth Care and Commonwealth Choice health plans

26 Health Connector as an Insurance Clearinghouse Employers with less than 50 employees Employers with less than 50 employees Individuals Individuals –Unemployed –Self-employed, part-time worker, and / or worker for multiple employers –Ineligible for large employer plan

27 Individual Mandate Adults required have health insurance that meets minimum credible coverage, OR Adults required have health insurance that meets minimum credible coverage, OR Penalty of up to about $1,000 in 2009 Penalty of up to about $1,000 in 2009 BUT there is an “Affordability Exemption” BUT there is an “Affordability Exemption”

28 Minimum credible coverage In 2009, health plans requirements: –Cover prescription drugs –Maximum deductibles are $2,000 per individual; $4,000 per family –Maximum out-of-pocket spending are $5,000 per individual; $10,000 per family

29 Health Connector’s Health Plans Programs for uninsured individuals: Programs for uninsured individuals: –Commonwealth CARE: income < 300% of the Federal Poverty Guidelines –Commonwealth CHOICE: income > 300% of the Federal Poverty Guidelines Customer Service: (877) Customer Service: (877)

FPLs for Commonwealth Care Family Annual Household Gross Income Size300% 1$32,490 2$43,710 3$54,930 4$66,150

31 Commonwealth Care State-subsidized program for health insurance State-subsidized program for health insurance At -- look for the link at the bottom left-hand corner of the web page At -- look for the link at the bottom left-hand corner of the web page Need to submit a “Medical Benefit Request” (MBR) Need to submit a “Medical Benefit Request” (MBR)

32 What is an “MBR?” MBR (Medical Benefit Request) is a form required by the State for many State-subsidized programs: MBR (Medical Benefit Request) is a form required by the State for many State-subsidized programs: –Commonwealth Care –MassHealth Essential –Free Care / Health Safety Net To request one: To request one: Can download one as well Can download one as well

33 Commonwealth Care Not all plans are available across the state: the plans that could be available: Not all plans are available across the state: the plans that could be available: –Boston Medical Center / Health Net Plan –CeltiCare –Fallon Community Health Plan –Neighborhood Health Plan –Network Health Not all doctors participate: call their offices Not all doctors participate: call their offices

34 Commonwealth Choice Choice of six health plans: not all plans offered throughout the state Blue Cross Blue Shield of Massachusetts Blue Cross Blue Shield of Massachusetts Fallon Community Health Plan Fallon Community Health Plan Harvard Pilgrim Health Plan Harvard Pilgrim Health Plan Health New England Health New England Neighborhood Health Plan Neighborhood Health Plan Tufts Health Plan Tufts Health Plan

35 Commonwealth Choice Three premium “levels” Three premium “levels” –Bronze: lowest premiums; most have deductibles, co-payments, and co- insurance; some have limited provider networks –Silver: medium premiums; moderate co- payments; some have no deductibles –Gold: highest premiums; low co- payments; no deductibles

36 MassHealth Essential One of a number of MassHealth programs One of a number of MassHealth programs For those who are unemployed for more than one (1) year For those who are unemployed for more than one (1) year Income is < 100% of the FPLs Income is < 100% of the FPLs

FPLs for MassHealth Essential Family Annual Household Gross Income Size100% 1$10,830 2$14,570 3$18,310 4$22,050

38 Health Safety Net / Free Care Not insurance: two options – 1. Protection for those without access to affordable health coverage 2. People of any income can apply if they have medical bills for which they cannot pay: “Medical Hardship”

39 Health Safety Net / Free Care To apply: For most people, complete an MBR For most people, complete an MBR For “Medical Hardship,” need to complete a special application For “Medical Hardship,” need to complete a special application Eligibility: call MassHealth at Help Desk:

40 Self-employed / Small businesses “Insurance Partnership” “Insurance Partnership” Not insurance: state premium subsidy Not insurance: state premium subsidy Eligibility: 300% of the FPLs Eligibility: 300% of the FPLs Contact information: Contact information: – – –

FPLs for Insurance Partnership Family Annual Household Gross Income Size300% 1$32,490 2$43,710 3$54,930 4$66,150

42 Examples of Lower-Cost Health Care Service Providers Community Health Centers Community Health Centers Tufts Dental School and Middlesex Community College Dental Hygiene Clinic Tufts Dental School and Middlesex Community College Dental Hygiene Clinic New England Eye Institute New England Eye Institute NeedyMeds: information about medications NeedyMeds: information about medications

43 Remember the “Golden Rule” To the extent possible: Always, always, always have health insurance coverage!

44 David’s Qualifiers Not a comprehensive review of all Not a comprehensive review of all federal and all state programs. federal and all state programs. I have “vetted” the programs to the best of my ability I have “vetted” the programs to the best of my ability You have my permission to distribute this information. Please give me “attribution.” You have my permission to distribute this information. Please give me “attribution.”

45 About David …

46 Thank you very much! Questions anyone?