Massachusetts is nicknamed as “The Bay State” and is known for its rich history, baked beans, which is inhabited by its die-hard sports fan bases. It is among the best states when it comes to health, as it is ranked as the third healthiest state in the country by the United Health Foundation. Residents of this state are quite healthy, as they have great health advantages in terms of affordable, accessible and efficient health care. With more public health funding in the state, Massachusetts could improve even more in healthcare, though the state authorities are doing a tremendous work. If the authorities continue working on critical issues in the manner in which they are doing in the last couple of years then the public health will improve even better in the near future. This state has best health insurance coverage percentage in the country but could still improve on its health plans to maintain the accessibility of these plans among the people. Health insurance is mandatory in Massachusetts even though the federal individual mandate disappeared in 2019, as this state has created its own versions of the mandate.
Massachusetts Health Insurance Marketplace Highlights and Update
- Open enrollment in Massachusetts for 2020 health plans will run from November 1 to January 23, 2020.
- This state has lowest uninsured rate and lowest average subsidized premiums in the country.
- According to 2020 rate filings, the average proposed health rate increase is of about 4.5%.
- In 2019, average health premiums increased by 4.7%.
- Enrollment in health plans in Massachusetts has increased since 2014.
- No insurers offer short-term plans in the state, as Massachusetts laws are inhospitable to short-term plans.
- In Massachusetts more than 1.3 million residents are enrolled in Medicare.
- Nine insurers are offering coverage in the Massachusetts individual market.
- Residents who enroll till Dec. 23 will have a Jan. 1 effective date and enrollments done between Dec. 24 and Jan. 23 will have a Feb. 1. effective date.
- Employers are penalized by the state if employees receive state-subsidized coverage.
- A state-based health insurance exchange called Massachusetts Health Connector is operational in the state, which determines the plans that are offered for sale.
- Massachusetts has a very robust exchange, with more participating carriers compared to other states.
- Massachusetts has its own state-based health insurance exchange, Massachusetts Health Connector, which has been in operation since 2006.
Individual and Family Health Insurance Plans in Massachusetts
Undoubtedly good health is vital but obtaining health care exactly as per one need can be expensive so health insurance plans are designed to help people manage the healthcare costs. Thus, individuals and families who are unable to obtain health insurance through an employer can opt for individual and family health insurance plans. Especially with the continually rising cost of medical care, it has become significant for every individual to obtain health insurance for themselves and their family. There are several individual and family health insurance plans in Massachusetts that can be obtained by individual from the state’s exchange, private marketplace and through public programs such as Medicaid and CHIP. Some of the individual and family health insurance plans are discussed below:
Health Maintenance Organization
Health Maintenance Organization plans provides coverage for hospital, medical and preventive care, if the insured receive health care from HMO’s network of healthcare providers. These plans are offered at best price, as the healthcare are limited to the doctors, clinics and hospitals within the HMO’s network. However, in this plan, individuals have to pay a co payment for each covered service. In HMO’s plans individuals are required to choose a primary care physician who manage their health and provide them referrals for getting treatment from other network providers or specialists. If the insured of the HMOs plan go outside the network for the healthcare service then they won’t be covered except treatment for medical emergency.
Preferred Provider Organization Plans
Individuals insured under PPO plans are offered with network of doctors, hospitals and clinics that are deemed as preferred providers. If the insured visit them for treatment then they can avail treatment at the lower rates, which is negotiated by the insurance company. Though PPO plans come with more flexibility than HMOs plans simply because they allow insured to avail treatment outside the network, however insured will require to pay more in terms of deductibles and co-pays. In these plans individuals don;t require a referral to visit a specialist and they also don;t require prior approval for some expensive healthcare services.
Point of Service Plans
These plans provide maximum flexibility to the insured as they have the option to either reduce their out-of-pocket costs by selecting healthcare provider from the network or they can seek services outside the network and pay more. However, most of the POS plans are similar to HMO plans, as insured are require to choose a primary care physician to obtain referrals for visiting a specialist. If the primary care physician of the insured refer them to an out-of-network specialist then the higher cost are also covered by some of the POS plans.
Exclusive Provider Organizations Plans
These are managed care plans in which healthcare services are covered for the insured only in case if they visit doctors, specialists or hospitals that are included in the plan’s network except in an emergency.
Short-Term Health Insurance in Massachusetts
In Massachusetts it is illegal under law for any company to offer any of the short-term health insurance product, so these plans are not available in this state. Since, the state has strict guaranteed-issue and rating requirements for every health insurance product so short-term health insurance is not available for purchase. Short-term health plans are medically underwritten and so these plans do not meet the guaranteed-issue standard.
Massachusetts Dental Insurance Plans
Dental insurance plans available in Massachusetts are often categorized as either indemnity or managed-care plans. In Indemnity dental plans Massachusetts residents have wider choice of dental care providers compared to managed-care plans. The dental insurance carrier of the indemnity plans pay for the covered dental services only after receiving a bill. It means that the insured first need to pay up front and then file for reimbursement from their insurance carrier.
In managed-care dental plans in Massachusetts, dental care service providers network is maintained in which participating dentist agree to perform dental care at per-negotiated rates and then submit the claim to the insurance company on the behalf of the insured. In managed-care plans insured have less paper work and power out-of-pocket costs while have broader choice of dentists with an Indemnity plan.