Commonwealth Care sign-ups add up

By Susan Vaughn - July 12, 2007

Martha's Vineyard residents have been enrolling in the state's new, free, and subsidized Commonwealth Care health insurance plan on an average of 80 to 100 a month, or a total of 585, joining almost 38,000 residents statewide who signed up by July 1.

The figures provided by the Boston Medical Center do not include those who do not qualify for the free or subsidized plans, but who have signed up for the lower-cost Commonwealth Choice plans. More than 130,000 state residents, about one-third of those uninsured a year ago, have enrolled in one of the Choice private insurance plans.

Under the new state healthcare law, July 1 was the deadline when all state residents were required to have health insurance. The plan, approved by the Legislature in March 2006, has been phased in since October.

Most of those who have signed up on the Vineyard are poor enough to qualify for the subsidized Commonwealth Care plan, said Sarah Kuh, director of Vineyard Health Care Access Program, which has the only state contract in the county to enroll people in the program. "We're seeing people who are signing up every week," she said.

The enrollees include many young people who make less than $30,636 gross annual income under the federal poverty guidelines, according to Ms. Kuh. Some of that group can get the insurance for free if their income is under $15,000, or for as low as $100.

State officials have been worried that the 19 to 26 age group will not elect to have insurance. About 27 percent of state residents ages 19 through 26 are not insured, compared with 10 percent of the under-65 population as a whole.

The state law provides a young adult plan for those who make more than the $30,636 limit, which costs from $106 to $220 a month. That plan is available to anyone who doesn't get health insurance through work or school, isn't still on a parent's plan and isn't qualified for subsidized care.

The local agency also is getting a lot of those who fall into the latter category, Ms. Kuh said. She believes her young staff has helped bring them in.

Commonwealth Care is available only to those who make less than 300 percent of the federal poverty income guidelines.

Dyan Redick is one young person who has benefited from the Commonwealth Care plan. She moved to the Island permanently a year ago with her fiancé, a teacher who has been able to only substitute teach so far. Neither had any insurance when they first came, so they qualified for free care, and then were funneled into Commonwealth Care.

"I find it to be amazing," Ms. Redick said. "I think Massachusetts has got it right in looking at healthcare and the whole industry." She left Maryland where she worked for a county, but to continue the insurance from there would have cost her $800 a month.

Ms. Redick said the state plan provides comprehensive coverage and very good preventive care, and is comparable to the excellent insurance she had before, including vision, dental, and well care. The only glitch she has found with Commonwealth Care was that doctors seemed to know little about it. The primary care physician she was assigned to from the plan's network was sorting out the program information, she said. It also took two and a half months to get her first appointment with her primary care physician. That could be because only one of Commonwealth Care's four managed care organizations is available on the Vineyard, the Boston Medical Center HealthNet Plan.

Ms. Redick said some of the information provided to her and her fiancé individually was different and a bit confusing, but she said, "For the most part, I have not felt frustrated with trying to deal with the system."

She added that she knows many people on the Vineyard in all income brackets who don't have health insurance. "I know a lot people on the Island who have Lyme disease and aren't being treated because they can't afford to go to the doctor," she said. "It would make a lot of difference if they had health insurance."

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.

Vineyard Health Care Access and the state have been trying to get the word out about the new programs to those who don't have health insurance, Ms. Kuh said. The state has been running advertisements on television and even during Red Sox baseball games.

While the response to the subsidized program has been good, Ms. Kuh said the next challenge will be whether people who exceed the guidelines can or will get the insurance or risk being penalized on next year's tax return if they don't. The penalty will be a loss of a state tax exemption, worth about $219.

Those who exceed the poverty level can purchase health insurance through Commonwealth Choice, from a choice of six private insurers, such as Blue Cross-Blue Shield, Harvard Pilgrim and Tufts health plans, however, those plans still may not be affordable to the estimated 160,000 to 200,000 who do not qualify for the subsidies and may have no insurance. Massachusetts has one of the best health care systems in the state, but because of that it is more costly, Ms. Kuh noted.

State officials have already anticipated that 60,000 people will still not be able to afford the new insurance, so they have provided an exemption from the requirement, but that is still no solution. "It will exempt those people, but they are still stuck with no insurance," Ms. Kuh said. Commonwealth Health Insurance Connector Authority, which manages both the Commonwealth Care and Commonwealth Choice programs, has recently released an affordability table for those who do not qualify for the subsidized plan, Ms. Kuh said. For example, the "affordable rate" for a couple who make $50,000 a year would be $270 a month. That figure is the basis for an exemption if they can't afford that, she said.

"It's great to be involved when you're eligible," Ms. Kuh said, but not for those who don't qualify for the subsidized plan, she said. "Choice (plan) is the best they could do because the system is based on private insurance."

Commonwealth Connector has set up a user-friendly web site, www.mahealthconnector.org, where residents who don't qualify for the subsidized plans can access the "Affordability Tool" and determine if they can afford the Choice health insurance coverage based on age, family size and where they live in the state. The state is divided into the western, central, and eastern regions, including the Boston area, and southern region, which includes the Cape and Islands.

By looking at the chart, a person can see the least expensive policy available in the Commonwealth Choice plan.

The costs range widely. For example, a Dukes County resident up to age 26 would pay a $150 monthly premium, a couple would pay $300, and a family in that age category would pay $750. The costs increase substantially by age.

In the three 50 and over age brackets, a single person would pay $410 a month; a married couple would pay $820 and a family would pay from $890 in the 50-54 age bracket to $1,230 in the 60 and over group.

Ms. Kuh said it will be interesting to see how the program unfolds. State officials have acknowledged it has a lot of kinks to work out.

Employees at the Vineyard Health Care Access Program will help people enroll in the Commonwealth Care plan, and they will also give help and information to those who may not qualify for that plan, Ms. Kuh said. Many people who are not eligible for the subsidized plan are enrolling in the Choice plan online.

The rest of the nation also is looking at the Massachusetts plan as a model, even though it may not work everywhere. The state has a lower portion of uninsured people than other states. The state has also slowed down its efforts to enforce the new program.

In 2008, the penalty for not having insurance will be a loss of a state tax exemption, worth about $219. Later it will be up to half of a monthly insurance premium for each month a person is uninsured. While any insurance is acceptable at first, by January 2009, everyone must have drug coverage.

Commonwealth Connector also has postponed from July 1 to Nov. 15 employer filing requirements for the so-called Section 125 "cafeteria plan" for employee health insurance. Under that plan, employers with 11 or more full-time equivalent employees must offer the Health Connector "seal of approval" plans, either voluntary plans for part-time and contractual employees or contributory plans for full-time employees.

How Commonwealth Care works

Commonwealth Care has four Managed Care Organizations in the state. However, only one of them is available on Martha's Vineyard, the Boston Medical Center HealthNet Plan. The plan has its own network of hospitals, doctors, and other providers.

After you enroll, you are given information on the plan, doctors, and hospitals. An enrollee has to go to a participating provider and sign up with a primary physician.

The first income group, between $9,805 and $19,600 for a single person and $20,000 and $40,000 for a family of four will have co-pays for the various services. The second income group, $20,000 to $40,000, a single person, $40,000-$60,000, family of four, can choose between two kinds of plans, one with higher premiums and lower co-pays or the other with lower premiums and higher co-pays.

To enroll

Obtain a Medical Benefit Request (MBR) form, which also is an application for MassHealth and the Uncompensated Care Pool. When you submit the form, you will be checked for eligibility for all health programs and placed in the most comprehensive program you qualify for.

A person must have a permanent mailing address and proof of income, such as a weekly pay stub or, for self-employed people, an income tax return. For Vineyard residents whose work is seasonal, using an annual total of winter and summer pay is recommended.

Obtain the MBR forms on the Vineyard from Vineyard Health Care Access Program, 114 New York Ave., Oak Bluffs, 508-696-0020, or call Commonwealth Care Customer Service, 877-623-6765 or Boston Medical HealthNet Plan, 800-792-4355.

Vineyard Health Care Access representatives will help residents determine their eligibility and enroll in the program. The Health Connector web site is www.mahealthconnector.org.