Individuals & Families – Massachusetts Health Connector

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 [...]

Some Schools are considering whether SHIP enrollment can be extended beyond the term of its expiration for Students who have just graduated. Are these extensions of SHIP coverage permissible?

The Health Connector’s regulations at 956 CMR 8.00 only describe the obligation for Schools to offer a SHIP, and for Students to either enroll in the SHIP or waive the SHIP by demonstrating they have comparable coverage. To the degree Schools have questions about who may validly be considered eligible to enroll in the SHIP, the Health Connector encourages Schools to work with their health insurance carriers, Third-Party Administrators, and the Division of Insurance (as applicable) to ensure that enrollment flexibility and extension of coverage modifications are permitted and, if so, are clearly explained in SHIP evidences of coverage, are available according to clear and consistently applied standards across all eligible newly graduated students, and remain consistent with applicable state law and federal requirements, including 45 CFR § 147.145.

Some Schools have already opened their SHIP waiver processes for the upcoming academic year. If a School decides to move to remote-only learning, or if a Student decides to access courses remotely, after Students have already enrolled in the SHIP, should Students be allowed a SHIP premium refund?

The Health Connector strongly encourages Schools to work with their health insurance carriers and Third-Party Administrators to ensure they can timely disenroll individuals from the SHIP if Students have comparable coverage as defined in Question 3. To avoid undue operational complexity associated with disenrollment requests after SHIP coverage has begun for the academic year, the Health Connector urges Schools to offer an additional opportunity for Students to waive their SHIP. Note: Student Health Insurance Program (SHIP) and COVID-19 Under 956 CMR 8.00, institutions of higher education, referred to as Schools in this Frequently Asked Question (FAQ), in Massachusetts are required to offer a Student Health Insurance Program (SHIP) to Students, and Students must either enroll in the SHIP or provide proof of comparable coverage. Due to the COVID-19 pandemic, some Schools are considering expanding remote coursework beginning in Academic Year (AY) 2020-2021, as well as arrangements to support graduating Students. This FAQ aims to help stakeholders understand options for Schools that are consistent with SHIP regulatory requirements as stakeholders consider the impact of a transition to remote learning or post-graduation arrangements on SHIP offerings and enrollment.

How to update your account to apply for subsidies

If you are a Health Connector member and did not apply for subsidies, you can update your account to see if you may qualify for a free or low-cost ConnectorCare plan, MassHealth, or a tax credit that can be used to lower your monthly premiums right away. How to update your information, step-by-step: Step 1: Sign into your account and go to your "My Eligibility" page. You will see "Year 2023" application listed. Step 2: On the "My Eligibility" page, click "Edit Application" under the Actions column. If you don't see this link, skip to Step 3. Step 3: On the next page, you will need to click the "Report a Change" link under the Actions column. Step 4: On the next page, choose "Change application type". Then, click the "Report Changes" button to make your updates. Step 4: You will be taken to the start of your application. Review your profile information and click continue until you get to the question "Do you need help paying for coverage?" Change your answer to "Yes, I want to see if I can get MassHealth or help paying for health care." When you click "Continue", you will need to go through the full application, updating your information as needed and answering questions about your household income. When you sign submit your updated application, this updates your eligibility information. Please be sure to follow instructions on your Eligibility Results page as you may need to shop for a new plan or make a [...]

Upload Documents (Proof)

You now have a new way to send your verification documents (proof) When you apply for coverage, renew, or update your information, you may be asked to send proof of some information that could not be electronically verified. Your proof can be sent to the Health Connector and MassHealth by Mail, Fax, In-person, and NEW Uploaded online through your account. Important: If you are sending proof, DO NOT send the same document in more than one way. For example, don't fax and upload the same document for proof. How to upload your documents If you need to send proof, here’s how you can upload your document(s): First, log in to your online account. (If you don't have an online account, call Customer Service to get started with setting one up.) Once you are signed into your account, go to the new My Documents section of your account. Click on the Upload Documents link in the main menu to start uploading your files. Important: Make sure you have your proof saved where you can easily find and upload your document. On the Upload Documents page, under File 1, click the Browse button to find the file you want to upload from from computer, tablet, or smartphone based on the type of information we’ve asked you for. Select that file and click Open to start the upload. Note: You can only upload certain file types: Bitmap Image File (.bmp) Graphical Interchange Format File (.gif) JPEG Image (.jpeg) JPEG Image (.jpg) Portable Document [...]

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 1-877-623-7773.

What to Know If You Get Help Paying for Health Insurance from Both the Health Connector and Your Employer

Overview A Health Reimbursement Arrangement, or HRA, is an employee health benefit from your employer that reimburses you for your health care expenses up to a certain dollar amount. There are several types of HRAs. This page focuses on two types: Individual Coverage HRAs and Qualified Small Employer HRAs (QSEHRAs). If you are offered one of these types of HRAs, you should have received a clear notice from your employer explaining the terms of the Individual Coverage HRA or the QSEHRA. The type of HRA will appear prominently on that notice. If your employer offers an Individual Coverage HRA or a QSEHRA instead of a traditional employer health insurance plan, you can use it to help pay your monthly premiums for a health plan purchased through the Health Connector. However, these types of HRAs might affect your tax credit eligibility. The Health Connector’s application collects information about employer offered HRAs from you and uses this information to determine your eligibility for tax credits through the Health Connector. Keep your application information up to date. If your income changes, you should update the information you gave us about your expected income in your application. If your employer stops offering an Individual Coverage HRA or a QSEHRA, you should update your application since that may affect your tax credit eligibility. You can read more below about Individual Coverage HRAs and QSEHRAs. Find out if the Individual Coverage HRA or QSEHRA available to you is considered affordable [...]

Hardship exemption and how to apply

If you are over age 30 and have applied for and was approved for a federal hardship exemption, you may be able to shop for a Catastrophic plan. For information about the federal hardship exemption, including how to apply, go to the hardship exemption page on HealthCare.gov → Were you already approved for a federal hardship exemption? If you have a federal hardship exemption and want to shop for a Catastrophic health insurance plan through the Health Connector, please call Health Connector customer service at 1-877-MA-ENROLL (1-877-623-6765), or TTY 1-877-623-7773 for people who are deaf, hard of hearing, or speech disabled. Health plans that meet all of the requirements applicable to other Health Connector plans but that don't cover any benefits other than 3 primary care visits per year before the plan's deductible is met. The premium amount you pay each month for health care is generally lower than for other health plans, but the out-of-pocket costs for deductibles, co-payments, and co-insurance are generally higher. To qualify for a Catastrophic plan, you must be under 30 years old OR get a "hardship exemption" because the Marketplace determined that you’re unable to afford health coverage. Catastrophic health plans: For people under 30 or with certain exemptions Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself. Who can buy a [...]

Important information about identity (ID) proofing

What is ID proofing? ID proofing is one of the first steps of the process to apply for health coverage through the Health Connector website and is required by the Affordable Care Act (ACA). ID proofing is used to verify your identity by asking you customized questions based on your personal and financial history to protect your privacy and information and prevent fraud. Id proofing is performed through external services How ID proofing works To protect your personal information, you have to take a few steps to verify your identity before you can complete an application. First you will provide information when you create your profile. This information will be used for the first step of ID proofing. Once your information is verified, the ID proofing process will ask you questions that only you would be likely to know the answers to, based on your financial accounts and personal information in your credit report. This process is meant to prevent an unauthorized person from creating an account and applying for health coverage in your name without your knowledge. The ID proofing service will show you several multiple choice questions for you to answer. These questions will be based on Credit and Non-Credit information. Sample question types include: Auto Loan Lender (Credit) Previous Street Name (Non-Credit) Last 4 digits SSN (Non-Credit) Employer Name (Credit) Year of Birth (Credit) Previous Address (Non-Credit) Previous Phone Number (Non-Credit) If your identity cannot be verified online, we need to receive proper documentation such as [...]