How will Massachusetts health insurance reform affect you?
Are you looking for health insurance?
| |
What is the individual mandate and will it affect me?
Effective 7/1/2007, the health care reform legislation will require that all Massachusetts residents age 18 and older have health insurance coverage.
- Individuals who are above the income threshold but don't purchase insurance by Decemeber 31 that provides minimum creditable coverage will be penalized on their state income taxes. Minimum creditable coverage is the least amount of coverage an individual must have to be exempt from the individual mandate. In 2007, minimum creditable coverage consists of having a state-licensed or ERISA-exempt health benefit plan.
- In 2007, the penalty will consist of the forfeit of the personal tax exemption (approximately $219).
- In 2008 and after, individuals will be assessed a penalty of up to 50% of the minimum insurance premium that the individual would have qualified for.
- If you're an employee of a Massachusetts employer with 11 or more employees, you must complete an Employee Health Insurance Responsibility Disclosure (HIRD) form if:
- You declined to enroll in an employer-sponsored health plan that is offered,
AND/OR
- You declined to participate in the employer’s Section 125 plan.
- FCHP's Massachusetts subscribers who have coverage on December 31 will receive a 1099-HC form which shows they had creditable coverage in 2007. Individuals will use this form to fill out the Schedule HC attachment to the Massachusetts state income tax filing.
View Tax Year 2007 FAQ for more information
What is the Commonwealth Health Insurance Connector?
The Commonwealth Health Insurance Connector is a state agency which, through a subconnector (Small Business Service Bureau), will enroll small businesses (less than 50 employees) and individuals into health care plans provided by private health insurance companies. FCHP is one of the companies providing these plans. For more information, visit the Commonwealth Health Insurance Connector's Web site.
I don’t have health insurance. How do I get coverage?
- MassHealth
If you think you may be eligible for MassHealth, you may want to contact the Massachusetts Office of Medicaid at www.state.ma.us/dma or by phone at 800-841-2900 as they can assist you in determining your eligibility and enrolling you in a health plan.
- Individuals with incomes at or below 150% of federal poverty level
- Individuals with incomes between 150.1% and up to 300% of federal poverty level
- Other uninsured individuals
- If you’re not eligible for MassHealth or financial assistance as described above, you can enroll in a plan through FCHP or the Commonwealth Health Insurance Connector.
- The Commonwealth Health Insurance Connector also offers health plans designed especially for 18-26 year-olds.
- If you're looking for health insurance coverage, please visit our Looking for insurance? section of the Web site or call 1-888-PWR-FCHP (TDD/TTY: 1-877-608-7677).
I currently have coverage with FCHP through my employer. How will these changes affect me?
Small employers (less than 50 employees) will be able to choose health insurance plans through the Commonwealth Health Insurance Connector. So if you work for a small employer, it's possible that your health plan options will change. You may want to talk to your company's benefits administrator about how this might affect your coverage.
I currently have coverage through FCHP Independent Care. How will these changes affect me?
As a result of the legislation, FCHP will no longer be able to accept new members into our Independent Care plans.
- Current members in the Independent Care plans may have the choice to remain in them or enroll in one of FCHP's new plan offerings.
- If you're looking for health insurance coverage, please visit our Looking for insurance? section of the Web site or call 1-888-PWR-FCHP (TDD/TTY: 1-877-608-7677).
I currently have coverage with FCHP through MassHealth. How will these changes affect me?
Assuming that your eligibility for MassHealth doesn't change, then this new legislation shouldn't affect you. As of 7/1/2006, the legislation restored certain dental, vision, chiropractic and prosthetic benefits that were cut from MassHealth in 2002.
What are the expanded dependent age guidelines?
In April 2006, the age of FCHP member dependents was increased to under age 26 or for two years following the loss of dependent status (based on IRS guidelines), whichever comes first. The expanded guidelines do not apply to self-insured accounts or the Federal Employees Health Benefits Program.
Download FCHP's verification of dependent status form (pdf, 65K)
In order for a dependent to be covered on an FCHP plan, the dependent
must be:
- Under 26 years old
- A Massachusetts resident. There are two exceptions:
- Dependents on PPO plans are covered
- Full-time students who are attending school outside of Massachusetts but maintain their legal residency in Massachusetts can remain on the plan, but are only covered for selected services (including emergency services) while outside the plan service area
- Considered a qualified dependent or has been considered a qualified dependent within the past two years—with both scenarios based on FCHP and IRS guidelines
How will penalties be assessed for individuals that do not obtain health insurance?
Individuals who are above the income threshold but don't purchase insurance by 7/1/2007, with the exception of a lapse in coverage of 63 days or less, will incur a penalty for each month that they don't have insurance.
- In the 2007 tax filing, individuals will lose the personal tax exemption.
- After 2007, individuals who don't have coverage will be assessed a penalty of up to 50% of the minimum insurance premium that the individual would have qualified for.
Who can I contact if I have more questions?
Contact FCHP's Customer Service Department:
- By phone at 1-800-868-5200 (TTDD/TTY: 1-877-608-7677), Monday through Friday, from 8 a.m. to 6 p.m.
- By secure email. You must be a registered My FCHP user with an activated PIN to access secure email. If you have questions about using secure email, please call the customer service number above.
If you have questions about finding the right health insurance plan, please visit our Looking for insurance? section of the Web site or call 1-888-PWR-FCHP (TDD/TTY: 1-877-608-7677).
Updated 12/6/2007