Navigating Health Insurance and Finding Health Care Services Presenter: David Pomeranz Major Topics COBRA: employer required to provide continuity in group coverage, usually for 18 months; there are exceptions and other cases; www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTML Federal COBRA subsidy: for those who lost / will lose their jobs between Sept. 1, 2008 and Dec. 31, 2009; 65% subsidy for 9 months; began February 17, 2009; “look back” on COBRA election but not on premiums; income maximums: $125,000 individual / $250,000 couple filing jointly. www.dol.gov/ebsa/faqs/faq-cobra-premiumreductionEE.html State’s COBRA subsidy (Medical Security Program or MSP): Only Massachusetts residents receiving Massachusetts unemployment benefits are eligible. Income eligibility: gross household income less than or equal to (<) 400% of the “federal poverty guidelines” (FPGs). FPG website is at the bottom of this document. For the MSP, income is based on six months previous and six months projected income. www.mass.gov/dua/msp or 800-908-8801 2006 Massachusetts Health Reform Law: created Massachusetts Health Connector: www.mahealthconnector.org or 877-623-6765. • “Individual mandate:” Massachusetts requires individuals to have health insurance or pay

a penalty -- in 2009 – of up to about $1,000. But there is an “Affordability Exemption” based on a household’s ‘Adjusted Gross Income.’ “Affordability Calculator:” https://wfb.dor.state.ma.us/dorcommon/tools/hcaffordability/Year2008/Index.aspx

• “Guaranteed issue” -- insurance companies have to waive “pre-existing conditions” unless there is a break of 63 or more days in health insurance coverage

• “Minimum credible coverage:” for 2009 includes prescription drugs, and caps on deductibles and out-of-pocket spending. Division of Insurance’s has a list of licensed health plans: both those which meet the state’s “minimum credible coverage” requirements, and those that do not (e.g., for those who have “affordability exemptions”) www.mass.gov/?pageID=ocaterminal&L=5&L0=Home&L1=Consumer&L2=Insurance&L3=Health+Insurance&L4=Health+Care+Access+Bureau&sid=Eoca&b=terminalcontent&f=doi_Consumer_css_health_smlindgroup&csid=Eoca

• Health Plans created by the 2006 Massachusetts Health Reform Law o Commonwealth Care: state-subsidized health plans for household incomes < 300%

of FPGs; need to complete Medical Benefit Request (MBR): see the end of this document for information about the MBR; call your doctor(s) to see if they participate

o Commonwealth Choice: commercial health plans for those whose household incomes are > 300% of the FPGs

MassHealth Essential: unemployed for more than one year • Household incomes are < to 100% of the FPGs; must be a Massachusetts resident • need to complete a Medical Benefit Request (MBR) • www.massresources.org/pages.cfm?contentID=35&pageID=13&subpages=yes&SecondL

eveldynamicID=678&DynamicID=563 • 888-665-9993

Health Safety Net / Free Care: not insurance; two types: 1. Protection for those without access to health insurance: e.g., “affordability exemption” 2. People of any income if they have medical bills for which they cannot pay: “Medical

Hardship.” Requires a special application. • www.massresources.org/pages.cfm?contentID=50&pageID=13&Subpages=yes • 877-910-2100 • Applications and services only at community health centers and hospitals

o Community Health Centers: www.massleague.org/HealthCenters.htm o Hospitals: www.mhalink.org/public/mahospitals

“Insurance Partnership” (IP)

• Not insurance: state premium subsidies for self-employed / small businesses • Household incomes < to 300% of the FPGs • www.4IP.org or 508-698-2070 Dental and Eye Care o Tufts Dental School: http://dental.tufts.edu/1202810465883/TUSDM-Page-

dental2w_1245834004492.html or (617) 636-6828 o New England Eye Institute: www.ne-eyeinstitute.org or (617) 262-2020

Dental “Insurance” (example only):-- Delta Dental: www.deltamass.com or 800-451-1249 OTHER RESOURCES: o HealthNet’s document on “Health Insurance Options For The Unemployed”:

www.compartners.org/news/new-information-resource-unemployed o Health Care For All

� Consumer Health HelpLine: 800-272-4232 or • www.hcfa.org/index.cfm?fuseaction=Page.viewPage&pageId=523&grandparentID=

496&parentID=767 o Mayor’s Health Line: provides information about all federal and state programs, and

has a “physician finder” service • 617-534-5050 / 800-847-0710

• www.bphc.org/programs/cib/civicengagement/mhl/accessinghealthinsurance/healthinsurance/Pages/Home.aspx; click on “Health Insurance” hyperlink

OTHER IMPORTANT BACKGROUND INFORMATION TO KNOW • Federal Poverty Guidelines (FPGs): also known as Federal Poverty Levels

www.mass.gov/Eeohhs2/docs/masshealth/deskguides/fpl_deskguide.pdf • “Medical Benefit Request” (MBR): this form required for many state programs; for

example, Commonwealth Care; MassHealth Essential; Free Care / Health Safety Net; www.mass.gov/Eeohhs2/docs/masshealth/appforms/mbr.pdf or 888-665-9993

This is not a comprehensive review of all federal and state programs. I have “vetted” the information to the best of my ability. Feel free to distribute this document as you see fit. David can be reached at 617-650-0639 or dpomer99@aol.com. I welcome you to become one of my connections at www.linkedIin.com/in/dpomer99