A Quick Guide To Massachusetts Health Insurance

health insurance

Having healthcare is more important than ever. Whether you have the flu or find yourself in a car accident, healthcare is essential for helping you get the treatment you need without spending your entire savings. Massachusetts has specific insurance guidelines for its residents.

You Must Carry Health Insurance

If you are 18 years old or older, you are required to carry Massachusetts health insurance under the state’s individual mandate law. The plan must include minimal creditable coverage standards.

  • Annual deductible caps at $2,000 (individuals) or $4,000 (families).
  • Caps out-of-pocket spending on co-insurance at $5,000 for individuals or $10,000 for families annually.
  • Covers check-ups or other regular doctor visits before deductibles.
  • Covers prescription drugs (although may have deductibles of up to $250/$500).
  • No caps on total benefits for sickness.
  • No spending caps per day for hospital stays.

The only exception to the health insurance mandates is for religion. If yours does not allow health insurance, you can provide a sworn statement when filing your income tax return each year.

You Have Many Insurance Options 

Depending on your situation, you can get insurance through employment-based health coverage, individual coverage, or government-provided coverage. Employment-based coverage is available for eligible full-time employees under large employer groups. Small employer groups have access to insurance as well and includes sole proprietors. 

If you choose to seek out individual coverage, you can do so directly from a carrier, through a connector, or via a qualified student health insurance plan. A direct plan is available when you call insurance carriers directly, while connector plans are available for those who don’t receive enough insurance from their employers and who have a family income that is less than 300% of the federal poverty line. A qualified student health insurance plan is available to students who attend a university or college in the state.

Finally, government-funded plans include MassHealth, Medicare, and some other plans. MassHealth is the state’s Medicaid program for qualified individuals, while Medicare is available for those with disabilities or who are at least 65 years old. Other options include Indian Health Services, HealthyStart, and the Peace Corps.

There Are Insurance Scams

Unlicensed health plans are abundant in Massachusetts. It’s important to know what to look for to avoid falling for something that is too good to be true. One commonly advertised alternative is a discount plan. These plans charge monthly fees to access healthcare for reduces prices, but they are not insurance and will not help you and do not meet the individual mandate requirements. In the end, you could see yourself with big bills. 

Always read the fine print of any plan you’re ready to sign up for to ensure you know what fees you’re paying and how much you can expect it to pay for your healthcare. Never provide money without receiving written information first. By knowing the signs of a scam and understanding which types of plans are available to you, you are more likely to choose a plan that not only fits your budget but meets your family’s needs.

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