State health insurance plan could help you

By Susan Vaughn - February 8, 2007

If you are one of the more than half a million state residents who don't have health insurance because you have recently changed jobs, you are self-employed, your employer doesn't offer it, or you simply can't afford it, the new statewide Commonwealth Care Health Insurance Program may help.

If you meet income guidelines and other eligibility requirements, as an individual you could get a comprehensive health insurance plan for as little as $18 to $106 a month. Unlike most private health care plans, the state-subsidized plan requires no physical examinations, no minimum residency and no deductibles.

The program covers overnight hospital stays, checkups and physicals with a regular doctor, medical care from a specialist, emergency room visits, vision care, prescription drugs, mental health substance-abuse services, and for some, dental coverage.

"These plans are very geared toward getting people to get preventive health care," Mary Leddy, health access specialist from Vineyard Health Care Access, said in a presentation last week at the Tisbury Senior Center. "You can get affordable health care if you can't find the right provider or can't afford most health insurance," she said.

Commonwealth Care was approved by the state Legislature last March to provide and mandate affordable health insurance for all state residents. The plan requires the participation of both individuals and employers.

The plan requires every legal state resident to purchase health insurance by July 1, 2007, and imposes financial penalties through income tax filings of up to 50 percent of the cost of a health insurance plan on those who do not comply. It also requires employers with more than 10 employees to provide health insurance coverage or pay a "fair share" contribution of up to $295 annually per employee.

"The state is really helping people a lot," Ms. Leddy said, referring to the insurance program, which is being seen as a national model. "Massachusetts is ahead of the game," she said.

The plan began phasing in in October with free coverage for residents with incomes below the federal poverty level. By the end of December, 29,000 people in that category had signed up for the insurance plan, according to the Commonwealth Care web site.

The second phase began in January for those with incomes between the poverty level and three times the poverty level, which is $29,400 for an individual, $29,600 for two, and $60,000 for a family of four. Those groups will pay different premiums depending on income and choice of plan.

A third phase, called Commonwealth Choice, is expected to begin July 1 for even higher income levels. The Connector Board, the board that is running the Commonwealth Care program, has asked the major health insurers in the state to offer a variety of plans which will come without subsidies. No one outside the insurance companies knows what these plans will contain or what they will cost, so it's impossible now to know whether they will be affordable to those making, say, $50,000 to $70,000 a year, according to a Feb. 2story in the Boston Globe.

The program is not available for everyone, however. Several people at Thursday's meeting were disappointed to learn that people on Medicare or whose employers pay at least 30 percent of health insurance premiums are not eligible for Commonwealth Care. A person also must also be a legal resident of the state with a green card or an otherwise qualified alien. She did provide extra information on extra health care programs for the elderly who meet the income limits.

"This plan is [intended] for anyone who doesn't have employer-based insurance," Ms. Leddy said. "You have to take your employer's health insurance [if it's available]."

However, she said, a self-employed person who is paying an entire insurance premium is eligible for the state program. Others who may benefit include those with a COBRA plan from a previous employer or young adults who have turned 19 and can no longer be on their parents' insurance plan. The Commonwealth Choice plan will have a special category for young people from ages 19 to 25.

"They are generally a healthier group and not as expensive to insure," Ms. Leddy said. Commonwealth Care is also available to all children who are not covered under other programs, whether their parents are legal residents or not.

When the insurance plan was first announced, Ms. Leddy said many people focused on the punitive aspects, such as the requirement that all residents must sign up for some insurance program. In addition to the penalty on a tax return, the cost of the plans will also increase in the second year, she said.

The purpose of the program is not to penalize people, however, Ms. Leddy said. It is meant to encourage people to have insurance rather than use the health system and have the rest of the taxpayers foot the bill, she explained.

"The state is encouraging people to take more responsibility for their health care," she said.

One member of the audience asked how the state is going to pay for the program.

"It is yet to be seen whether the state can really afford it," Ms. Leddy answered, but added, "They would never eliminate it completely. They might make adjustments."

Commonwealth Care is expected to cost $1.2 billion over three years and relies on redistribution of existing funding and new funding from employer contributions and General Fund revenues ($308 million over three years), according to a Kaiser Foundation fact sheet on the program. The state anticipates that no additional funding will be needed beyond three years.

Of the 500,000 to 600,000 uninsured state residents, or 10 percent of the state's population, an estimated 200,000 are expected to be eligible for the program.

Special Programs for seniors

Ms. Leddy also described briefly the senior status programs, such as Mass Health for people over 65. Mass Health is available to those with Medicare coverage whose income and asset level is low. Another Mass Health category is a buy-in plan for those with higher income and asset limits.

Mass Health will pay for Part B Medicare supplement, which is $93 a month to those who qualify. A person can also enroll in the Part D prescription program through Mass Health.

The Prescription Advantage program supplements prescription costs for those below certain income levels. Social Security also has a very low co-pay of $1 and $2 for those in the lower income levels.

The Free Care program will pay hospital bills even for seniors who have assets above the limits. Ms. Leddy suggested that elderly people who are interested in any of the senior programs could make an appointment with her office to see whether they are eligible. The hours are weekdays from 9 am to 4 pm.