KB Category General Information

Consumer Protections Against Surprise Billing through the No Surprises Act

The No Surprises Act protects people from getting surprise medical bills when they have an emergency, get services from an out-of-network provider at an in-network facility, or get services from an out-of-network air ambulance service provider. It also establishes a process for payment disputes between plans and providers. It provides new opportunities for dispute resolution for people who are uninsured or self-pay individuals when they receive a medical bill that is much greater than the good faith estimate they get from the provider. If you have private health insurance, the new protections - which started in 2022 - will ban most types of surprise bills. If you're uninsured or decide not to use your health insurance for a service, you can get an estimate of the cost of care before your visit. If you disagree with your bill, you may be able to dispute the charges. Here are some frequently asked questions about the No Surprises Act: Am I protected against surprise medical bills? Starting in 2022, the federal No Surprises Act (NSA) established new protections that prevent surprise medical bills for individuals covered under group and individual health plans. These new protections ban the most common types of surprise bills. What types of surprise medical bills does the No Surprises Act protect against? The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive: most emergency services; non-emergency services from out-of-network providers at in-network facilities; and services [...]

Federal Poverty Level (FPL)

The Federal Poverty Level, or FPL, is a measure of income level published each year by the Department of Health and Human Services. Federal poverty levels are used to help determine your eligibility for certain programs and benefits.The 2024 Income Standards and Federal Poverty Levels are used to determine who may be currently eligible for MassHealth programs for 2024.The 2023 Federal Poverty Levels are used to determine who may be eligible for Health Connector or ConnectorCare plans during the 2024 plan year, January 1 through December 31, 2024. 2024 MassHealth Income Standards and Federal Poverty Guidelines Family Size MassHealthIncome Standards 100%Federal Poverty Level 133%Federal Poverty Level 150%Federal Poverty Level 190% Federal Poverty Level Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly 1 $522 $6,264 $1,255 $15,060 $1,670 $20,040 $1,883 $22,596 $2,385 $28,620 2 $650 $7,800 $1,704 $20,448 $2,266 $27,192 $2,555 $30,660 $3,237 $38,844 3 $775 $9,300 $2,152 $25,824 $2,862 $34,344 $3,228 $38,736 4 $891 $10,692 $2,600 $31,200 $3,458 $41,496 $3,900 $46,800 5 $1,016 $12,192 $3,049 $36,588 $4,055 $48,660 $4,573 $54,876 6 $1,141 $13,692 $3,497 $41,964 $4,651 $55,812 $5,245 $62,940 7 $1,266 $15,192 $3,945 $47,340 $5,247 $62,964 $5,918 $71,016 8 $1,383 $16,596 $4,394 $52,728 $5,844 $70,128 $6,590 $79,080 For each additional person add $133 $1,596 $449 $5,388 $597 $7,164 $673 $8,076 These figures are rounded and may not reflect the figures used in program determination. Institutional Income Standard is $72.80. Family Size 200%Federal Poverty Level 225%Federal Poverty Level 250%Federal Poverty Level [...]

What’s the difference between the Health Connector and MassHealth?

We’ve heard questions from many members over the years who are confused about the difference between MassHealth and the Health Connector. Here’s a quick overview of the differences between these two separate state agencies: Massachusetts Health ConnectorWhere people who don’t get coverage through a job can buy a health or dental plan Where people with any level of income can buy a health plan The only place where people can get access to special programs to save money on health insurance if they qualify MassHealthWhere people can get free and low-cost health coverage if they qualify based on income level, a disability, pregnancy, or chronic (long-term) illness How are the agencies connected?One application for coverageWhen people apply for coverage at MAhealthconnector.org, they fill out one application to find out if they qualify for coverage through MassHealth, the Health Connector, or both. People or families can have a mix of coverage from both agenciesFor example, a family could have parents covered by the Health Connector with children who are covered by MassHealth. Or a person may get temporary benefits from MassHealth (called Health Safety Net) that cover some services before their Health Connector enrollment starts.Who do I call for help?If you need help with MassHealth benefits, call the MassHealth contact center at 1-800-841-2900, or TTY 1-800-497-4648. This is a separate call center from the Health Connector.If you need help with Health Connector coverage, call the Health Connector at 1-877-MA-ENROLL (1-877-623-6765), or TTY 711.

Your coverage end date and renewing your coverage

When you buy health and dental insurance through the Health Connector, your coverage period ends on December 31 regardless of your coverage start date. But, don’t worry. You have the opportunity to review coverage each year during the Open Enrollment period. Before your coverage end date for the year, you will get letters in the mail that will let you know about your coverage options for the next year. Your plan renewal information will tell you if your plan will be available for the next year, or, if it is not, will give your information about the new plan you are matched to. During open enrollment you can shop for a different plan, even if the plan you have is available. By shopping during open enrollment, you may be able to find plans with lower costs. If your plan is available for the next year and you do not want to change it, then all you have to do is continue to pay your monthly premium. About plan premiums It is important to know that plan premiums change each year. Premiums are calculated based on The ages of covered household members, The number of people covered on the plan, Where you live, and Rates set by health insurers, approved by the Massachusetts Division of Insurance If you are eligible for savings that help lower your monthly premium cost, this may change, too. For example, if you are eligible for an Advance Premium Tax Credit, how much you are eligible for [...]

Where can I get more information?

You can explore this website, or call Customer Service at 1-877 MA ENROLL (1-877-623-6765) or TTY: 711.For in-person help, you can work with a Navigator or a Certified Application Counselor at a local hospital or community health center. These are people who have been trained to help you apply through the Health Connector. For a list of people in your area, go to the Find Local Help tool or call Customer Service.

When is Open Enrollment and when do Health Connector plans start?

The most recent Open Enrollment period was November 1, 2023 through January 23, 2024. the next begins November 1, 2024. In general, Open Enrollment is the only time of year when you can purchase or change insurance plans for any reason. However, you may be allowed to enroll any time of year if you experience certain life events, such as losing your current insurance. If you qualify for MassHealth, or for a ConnectorCare plan, or want to purchase a stand alone dental plan, you may enroll at any time during the year. Find out more now → When you enroll in a health or dental plan by the enrollment deadline - which is the 23rd day of each month - then the earliest plan start date is the first day of the following month. For example, if you complete enrollment by September 23, then your coverage start date will be October 1.

Can I get help paying for my health insurance if I buy a plan outside the Health Connector?

No. You can’t qualify for help paying for a health insurance plan with an Advance Premium Tax Credit if you bought it outside of the Health Connector, such as directly with a carrier.

Are there different ways to get help paying for health insurance?

Yes. When you apply, you will be able to find out which programs you can qualify for. The three main ways to get help paying for coverage are through MassHealth (Massachusetts’ Medicaid program), ConnectorCare health plans, and tax credits that lower your monthly insurance premium.All applications for help paying for coverage can be done through the online application, or by filling out a paper application that is used by both the Health Connector and MassHealth.

Do I have to buy health insurance?

Under both Massachusetts and national health reform laws, most people must have health insurance if it’s affordable to them. There can be penalties for not being insured.Find out more about the Massachusetts Individual Mandate →

Who can shop as a business, and who needs to shop as an individual or family through the Health Connector?

The rules around shopping as a small business through the Health Connector have changed. If you are the owner of a business that has no eligible employees other than your tax dependents, you will need to shop as an individual or family, instead of as a small business. However, most of the health plans available to small businesses are the same as the health plans offered to individuals through the Health Connector. And, you may be able to qualify for help paying for your coverage through programs that are available only for individuals and families.