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What you should know about Massachusetts health insurance and the new law
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In April 2006, Massachusetts became the first state to implement legislation to provide nearly universal health care coverage for its citizens. As we continue to learn more about the legislation and its impact, we will share the information with you on this Web site.
We've described the important elements of the legislation below. For more information on how health care reform will affect you as a FCHP member, provider, employer, or broker, please visit the pages listed under "Related links" at right.
Key points of the legislation
Creation of Commonwealth Health Insurance Connector Authority
Coverage for small employers and individuals
- The Commonwealth Health Insurance Connector will offer health insurance plans to small businesses (less than 50 employees) and uninsured individuals (including those who are unemployed, self-employed, or who are part-time or seasonal workers).
- The Health Connector also offers health plans designed especially for 18-26 year-olds.
Expansion of MassHealth program
- Expands MassHealth eligibility for children up to 300% federal poverty level
- Restores dental and vision services, chiropractic, and prosthetics benefits, effective 7/1/2006
Financial assistance for qualified individuals
- Allows low-income uninsured adults (below 150% of the federal poverty level) who are not eligible for MassHealth to access comprehensive private insurance with no monthly premiums or deductibles through the Commonwealth Care program.
- Individuals with incomes between 150.1% and 300% of the federal poverty are eligible for financial assistance based on their income.
- Fallon Community Health Plan is one of four health plans participating in this program. FCHP is proud to offer Commonwealth Care FCHP Direct Care to members who meet the requirements to participate in the Commonwealth Care program. To find out if you are eligible, call 1-877-MA-ENROLL.
Extended dependent eligibility for health care coverage
- The age of FCHP member dependents has been increased to persons who are under age 26 or for two years following the loss of dependent status (based on IRS guidelines), whichever comes first.
Employer mandate
- Companies with 11 or more full-time equivalent employees who don't make a “fair and reasonable” premium contribution toward the cost of their employees' health insurance will be subject to a "fair share" assessment, the lower of:
- $295 per employee, or
- Fair share contribution amount determined annually, plus the per employee cost of services provided by the Uncompensated Care Pool
- Employers with 11 or more full-time equivalent employees may also be assessed a “free rider” surcharge if the employer doesn't offer to contribute towards or arrange for the purchase of health insurance on a pre-tax basis (Section 125 plan) and its employees access free care.
- Companies with 11 or more full-time equivalent employees who use more than $50,000 in free care in one year may be liable for between 10% and 100% of hospital costs.
- The free-rider surcharge is triggered when an employee or his or her dependent receives free care more than 3 times a year, or when a company has 5 or more instances of employees or their dependents receiving free care in a year.
Individual mandate
- Individuals who are above the income threshold but don't purchase insurance will lose their personal exemption on their 2007 state income taxes. After 2007, they will have to pay a penalty that could be as high as half of what an affordable health care premium would cost.
- 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
Resources for learning more
MassHealth
Phone: 800-841-2900
Online: Visit the MassHealth Web site or FCHP.org's MassHealth section
Commonwealth Health Insurance Connector
Online: Visit the Commonwealth Health Insurance Connector Web site
Commonwealth Connector - Commonwealth Choice
The Commonwealth Choice health insurance program, administered by the Commonwealth Health Insurance Connector, offers a variety of affordable, high-quality private health plans for individuals and small businesses. For more information, visit the Commonwealth Health Connector's Commonwealth Choice Web site: www.mahealthconnector.org.
Contact FCHP
Updated 12/6/2007