Even with Massachusetts leading National healthcare reform in 2007, plus the major advancements of the Affordable Care Act in 2010, healthcare is (still) so broken in the US. (I'm on a mission to fix it.) We spend more than anybody else on the planet, yet have higher mortality rates, and lack universal health care.
A couple points made in this article with regard to your personal health care data:
- The state and federal governments know more about you than you do.
- Your hospital and doctors know more about you than you do.
Perhaps improving patient access to patient medical data would improve health care outcomes!
In the United States, individual health insurance is mandatory - or you will be fined when you file taxes. Of course everyone wants health care, so on the surface it's not too onerous to say that it's "mandatory". But, if you're not covered by an employer plan (because you were just laid off[1], self-employed, or work for a small employer with < 50 employees), then you must obtain health insurance on your own. It is rather insane to tie health benefits to employment when employment changes routinely - whereas health care is something that you want to be continuous, permanent, and stable over time.
MassHealth
To obtain your own health care insurance, you can get it through Medicaid and/or the Children's Health Insurance Program (CHIP) if you qualify. Both of those federal programs are known at the state level as MassHealth. Although these are Federal programs, they are run and administered at the state level and so costs are different in each state.
One of the nuttiest things about MassHealth is that you can get some services through MassHealth (e.g. long term services and supports; behavioral health like psychological study) that are not available through commercial insurance. So, you can find yourself trying to qualify for Medicaid or CHIP just to get services you desperately need - but get denied or find the process so lengthy and complicated that it doesn't serve the need. Getting these services at all can be extremely difficult, very expensive and definitely complicated and delayed. This is why so many kids have "meds" - it is super expensive (thousands of dollars out of pocket if you can find the service) to figure out what might be going on in your adolescent child's developing brain, but super easy to get a prescription and "see what happens".
Health Connector
Whether or not you qualify for health insurance under Medicaid and/or CHIP, you may also need to obtain health insurance through a health insurance Marketplace. In Massachusetts, that marketplace is called Health Connector. Note: small employers with less than 50 employees can offer health and dental plans through 'Health Connector for Business'.
All these programs are combined in Massachusetts under one 'application' (if you're under age 65) https://mahealthconnector.org
In order to determine eligibility (You must renew every year! Like doing taxes!) [2], MassHealth initiates 'information matches'. They look you up electronically to match you in (emphasis added)
- the Federal Data Hub, which matches with the Social Security Administration, the Department of Homeland Security, and the Internal Revenue Service; and
- other federal and state agencies and other informational services.
What are these other (data) services? And what information do they have on me at say the Department of Homeland Security that would determine my health insurance eligibility? Since they try to automatically renew every year, and the recipient doesn't have to do anything if that match is successful, how does the recipient of benefits know that possibly the information is incorrect?
What if you move from one state to another? Perhaps you live in a border town where the 'next state' is next door. One of the many things you need to do is also renew and replace all your health insurance and physician relationships in 45 days or less. It's just one of many examples why Universal health care is the system in place in all other industrialized nations on earth (and even developing countries).
Renewal
https://www.mahix.org/individual/ I assume this is the domain for the 'Massachusetts Healthcare Information Exchange'
https://www.mahealthconnector.org/wp-content/uploads/MassHealthHealthConnector-Webinar-041024.pdf
Assistance
- You can call (and wait on hold, and not get the info you need)
- You can visit an enrollement center (There are only 7 statewide. The nearest to me is over 30 miles away; approximately a 50 minute drive - during normal business hours so take an afternoon off work to get assistance.)
- best option Make an appointment with a Certified Asistance Counselor (CAC), also called a 'navigator'. There are two agencies locally that are certified: Anna Jaques Hospital (Newburyport), and the social services agency Pettingill House (Amesbury) which has a food bank location in Salisbury.
Affordable Health care
Under the Affordable Care Act (ACA), your employer's plan is considered "affordable" in 2024 if the lowest-cost plan (meeting the minimum value standard) costs less than 8.39% of your household's income. So, if the crappiest plan meeting minimum standards offered costs slightly less than 10% of your 'modified adjusted gross income', then it's affordable [3].
For perspective, let's say you're single and look at a couple scenarios where your AGI last year was either 48,255 or 130K. The numbers are summarized in the table below.
| Adjusted Gross Income | 48,255 | 130,000 |
|---|---|---|
| 8.39% affordability threshold | 4,049 | 10,907 |
| Monthly threshold | 337 | 909 |
So, if your employer offers a health plan with a monthly premium of $337, you're not going to get any marketplace credits.
An interesting note: 1/12 is 8.33% So, basically you are expected to pay one month of your income towards health insurance. And 2024 is the first year in a decade where the rate was below 9%
New in 2024 and 2025
Individual income limit is $72,900 (was $43,470 last year) for the 'ConnectorCare' insurance plans. All insurance companies participating in the Mass Health Connector must offer ConnectorCare plans. ConnectorCare plans offer low- or no-cost premiums, lower co-pays and no deductible.
Tools
Get an estimate https://betterhealthconnector.com/get-an-estimate
Plan comparison https://ma.checkbookhealth.org/hie/ma/2024/
healthcare plans are offered in "metallic" tiers like you're somehow winning medals in the Olympics instead of paying the world's highest costs for health care. The system is just another level of indirection. Personally, I think the lowest level of payout ('bronze') should start out at 80%, with additional tiers of 85, 90, and 95 - or even 100%. I mean why is it called 'platinum', better than 'gold', and only pays out 90%? Sounds like these plans are "platinum colored" rather than genuine platinum.
| Tier | Plan pays |
|---|---|
| Bronze | 60% |
| Silver | 70% |
| Gold | 80% |
| Platinum | 90% |
Changes
Someone must apply, enroll, and pay your first premium by the 23rd of the month before your coverage can start the following month.
For example, enroll and pay by April 23rd for coverage to start on May 1
Health Information Exchanges
You've probably heard of the "New York Stock Exchange" (NYSE) - where stocks are traded. Did you know that there is such a thing as "health information exchanges" (HIE)? Hint, they don't trade healthcare stocks!
The Mass HIway is the Massachusetts Health Information Exchange (HIE).
References
- ↑ If you get laid off, check the Mass Health Connector for plans BEFORE signing up for COBRA - because the connector plans can be more affordable; and you're not eligible for connector plans if you're 'covered' by insurance (through COBRA).
- ↑ https://www.mass.gov/doc/130-cmr-502-health-care-reform-masshealth-eligibility-process/download Also, "CaseText" - a division of Thomson Reuters, has the 130 Mass. Reg. 502.007 (and all Massachusetts Legal Code) in a more readable format.
- ↑ ESI Affordability Calculator
