User:Admin/healthcare

Healthcare is so broken in the US. I'm trying to fix it.

A couple points made in this article with regard to your personal health care data:

• The state and federal governments knows more about you than you do.
• Your hospital and doctors know more about you than you do.

In Massachusetts, health insurance is mandatory - or you will be fined when you file taxes. Of course everyone wants healthcare, 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 (self-employed, small employer, laid off), then you must obtain health insurance on your own. It is rather insane to tie health benefits to employment when employment changes routinely - whereas healthcare is something that you want to be continuous, permanent, and stable over time.

MassHealth

Overview of MassHealth

To obtain your own healthcare 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!) , MassHealth initiates 'information matches'. They look you up electronically to match you in (emphasis added)

1. the Federal Data Hub, which matches with the Social Security Administration, the Department of Homeland Security, and the Internal Revenue Service; and
2. 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? One of the many things you need to do is also renew and replace all you health insurance and physician relationships in 45 days or less.

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 Healthcare

Under the bi-partisan 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 .

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%