WIND EAST MEETING:

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Finding Health Insurance and Lower-Cost Services
at the Federal level and in Massachusetts
David Pomeranz
copyright © 2010
COBRA: employer required to provide continuity in group coverage, usually for 18 months
but there are exceptions such as in case of a divorce or an adopted child:
www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTML or 866-444-3272
Federal COBRA subsidy: for those who lost / will lose their jobs between Sept. 1, 2008 and
Feb. 10, 2010; 65% subsidy for 15 months; income maximums: $125,000 for individual;
$250,000 for couple. www.dol.gov/ebsa/newsroom/fsCOBRApremiumreduction.html
State’s COBRA subsidy -- Medical Security Program (MSP): Only Massachusetts
residents receiving Massachusetts unemployment benefits are eligible. Income eligibility:
gross household incomes less than or equal to 400% of the “federal poverty levels” (FPLs).
FPL website is at the end of this document. Income is based on six months prior and six
months projected excluding unemployment benefits. MSP applies no matter how you lost
your employer-based health coverage. www.mass.gov/dua/msp or 800-908-8801
Massachusetts “guaranteed issue” law: insurance companies have to waive all “preexisting conditions”
2006 Massachusetts Health Reform Law: created Massachusetts Health Connector:
www.mahealthconnector.org or 877-623-6765.
 “Individual mandate:” Massachusetts requires individuals to have health insurance or
pay a penalty -- in 2009 – of up to about $1,000. There is an “Affordability Exemption.”
 “Minimum credible coverage:” for 2009, included prescription drugs, and maximum
deductibles and out-of-pocket spending for individuals and families.
 Division of Insurance’s list of licensed health plans: http://tinyurl.com/mm2qmc
 Health Plans created by the 2006 Massachusetts Health Reform Law
o Commonwealth Care: state-contracted, discounted managed health plans for gross
household incomes less than or equal to 300% of FPLs; need to complete Medical
Benefit Request (MBR): see the end of this document for information about the MBR;
call your doctor(s) to see if they participate in Commonwealth Care
o Commonwealth Choice: market rate, commercial managed health plans for gross
household incomes greater than 300% of the FPLs
MassHealth Essential: unemployed for more than one year
 Incomes less than or equal to 100% of the FPLs; must be a Massachusetts resident;
complete a Medical Benefit Request (MBR) – see end of document on obtaining MBR
 http://tinyurl.com/ycvzcrd or 888-665-9993
www.massresources.org/pages.cfm?contentID=35&pageID=13&subpages=yes&SecondL
eveldynamicID=678&DynamicID=563
Health Safety Net / Free Care: not insurance; two types:
1. Protection for those without access to health insurance: e.g., “affordability exemption”
2. People of any income if they have medical bills for which they cannot pay: “Medical
Hardship.” This option requires a special application.
 for eligibility: 888-665-9993; for Help Desk: 877-910-2100
 www.massresources.org/pages.cfm?contentID=50&pageID=13&Subpages=yes
 Special applications and services only at community health centers and hospitals
o Community Health Centers: www.massleague.org/CHC/FindHealthCenter.php
o Hospitals: www.mhalink.org/AM/Template.cfm?Section=Hospital_Directory
Insurance Partnership
 Not insurance: premium subsidies for self-employed/businesses with up to 50 employees
 Household incomes less than or equal to 300% of the FPLs
 www.4IP.org or 508-698-2070
Sources of Lower-Cost Health Care Services
 Community Health Centers: medical; some offer mental health and / or dental
 Dental:
o Tufts Dental School 617) 636-6828
o Middlesex Community College [for dental hygienist care]
www.middlesex.mass.edu/DHClinic
 New England Eye Institute: www.ne-eyeinstitute.org or (617) 262-2020
 Medications
o NeedyMeds: resource for low-cost drug programs; they also offer a free drug
discount card: www.needymeds.org or [email protected]
o Mass. College of Pharmacy and Health Sciences’ MassMedline:
www.massmedline.com or 866-633-1617
OTHER RESOURCES:
 Health Care For All: Consumer Health HelpLine: 800-272-4232
 Mayor’s Health Line: provides information about all federal and state programs, and has
a “physician finder” service; 617-534-5050 or www.bphc.org/mayorshealthline
 Medicare beneficiaries: www.medicareinteractive.org
OTHER IMPORTANT BACKGROUND INFORMATION TO KNOW
 Federal Poverty Levels (FPLs): [will change on March 1, 2010]
www.mass.gov/Eeohhs2/docs/masshealth/deskguides/fpl_deskguide.pdf
 “Medical Benefit Request” (MBR): this form required for many state programs; for
example, Commonwealth Care; MassHealth Essential; Free Care / Health Safety Net;
888-665-9993 or www.mass.gov/Eeohhs2/docs/masshealth/appforms/mbr.pdf
This is not a comprehensive review of all federal and state programs. Information has been
“vetted” to the best of my ability. Feel free to copy and distribute this document; please give
me “attribution.”
David’s blog is http://blogginghealthcare.wordpress.com He can be reached at
www.linkedin.com/in/dpomer99
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