Guide to Affordable Health Insurance in Massachusetts

If you are looking for affordable health insurance in Massachusetts, you are a few steps ahead of the game compared to other states. However, this does not mean that you shouldn’t take some time and make an effort to find further savings and get the best plan available for the lowest price possible.

Affordable Health Insurance in Massachusetts: Health Stats

Massachusetts is one of the healthiest states in the nation. For 2010, they ranked 3rdamong all states for overall health and finished first in several key indicators. This is good news for residents as it helps to control medical insurance rates. Massachusetts health care reform has increased the amount of residents with health care insurance to 97 percent of all residents. The reforms require most residents of Massachusetts 18 and older to obtain health insurance. If you do not purchase Massachusetts health insurance, and do not qualify for exemption, you may face tax penalties for the time in which you are uninsured.

Affordable Health Insurance in Massachusetts: Employee-Sponsored Coverage

Employers are required to make health insurance accessible to employees as long as they have 11 or more employees. Those employers with fewer than 11 employees are exempt from mandated accessibility, but still face some requirements. Employee-sponsored health care insurance is generally cheaper as employers are required to make a contribution to premiums for comprehensive coverage. However, you are not required to participate in your employers coverage offerings, you may seek health care coverage on your own or attempt to qualify for coverage through one of the public plans. If you refuse the employer-sponsored plan, and choose a private option, your employer is required to make a “fair and reasonable contribution” to your premiums.

Affordable Health Insurance in Massachusetts: Public Plans

The most notable public plans offered by the state include Commonwealth Care and Commonwealth Choice. Commonwealth Care is in place to offer comprehensive coverage for those meeting income and other eligibility requirements. Plans are available that offer partial to complete subsidization depending upon income as long as all other qualifications are met. Commonwealth Choice is a collection of approved plans that have survived a bidding war to offer affordable health insurance in Massachusetts to families, employers and individuals. To learn the specifics of these two programs, you should contact the Massachusetts Health Connector or visit their website.

Affordable Health Insurance in Massachusetts: Private Plans

The old-fashioned way of getting medical insurance on your own through a private medical insurance company is still alive and well in Massachusetts. If you wish to get coverage on your own, you are still among the majority. When seeking out private plans, you should still compare the reputations of prospective companies, quality of plans and overall cost. The best way to do this is to visit the websites of prospective companies and to learn about their philosophy and plans. You can then begin gathering rate quotes to find out which option is the most affordable for you.

Affordable Health Insurance in Massachusetts: Companies

Most residents of Massachusetts still get their health care coverage from private health plans, so first look for coverage through your employer and then look for private insurance on your own. When doing so, you will want to know which companies are out there. You will want to research each company you are considering to find a provider you are comfortable with. Some of the most prominent include:

Blue Cross Blue Shield of Massachusetts
CeltiCare
Fallon Community
Harvard Pilgrim
Health New England
Neighborhood Health Plan
Tufts

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Affordable Health Insurance in Massachusetts

Massachusetts is a unique state when it comes to health care coverage. Massachusetts has become the model for health care reform for the nation. Of all states, affordable health insurance in Massachusetts is the most possible. There are cost-efficient public options subsidized by the state as well as many private and employer-sponsored plans from which to choose.

Affordable Health Insurance in Massachusetts: Statistics

The average annual premium for an employee-sponsored health plan in Massachusetts after employee contribution was $1,110 in 2009. The average cost of one day in a Massachusetts hospital that would come out of your pocket if you do not have health insurance is over $2,100 per day. Massachusetts is in the top 3 in the U.S. when it comes to physicians, obesity, immunization, infant mortality and occupational fatalities, which makes the Massachusetts one of the healthiest states in the U.S.

Affordable Health Insurance in Massachusetts: The Health Connector

Massachusetts is the most insured state in the nation. Over 97 percent of residents have some form of health care coverage. Enacted into law in April of 2006, Massachusetts health reform has pursued the goal of near-universal health care in the state and has achieved it for the most part. The law requires adults who can obtain affordable health insurance in Massachusetts to do so. The Health Connector is a state agency of Massachusetts that aides residents of the state find affordable health care insurance and avoid tax penalties. Because health care coverage is mandatory, with some exceptions, tax penalties may be enforced if you fail to gain coverage. The Health Connector provides information concerning the public plans available, the cost of those plans, and qualification information for subsidized plans and the health care insurance exemption.

Affordable Health Insurance in Massachusetts: Commonwealth Choice

Commonwealth Choice is a collection of six unsubsidized Massachusetts health insurance plans arrived at through a competitive bidding process. They are available to individuals, families and employers and have been approved by the Health Connector. The plans available range in coverage options and overall cost and are provided by the following Massachusetts medical insurance companies.

Blue Cross Blue Shield of Massachusetts
Fallon Community Health Plan
CeltiCare
Health New England
Neighborhood Health Plan
Tufts Health Plan
Harvard Pilgrim Health Plan

Affordable Health Insurance in Massachusetts: Commonwealth Care

Commonwealth Care is a public plan that calls for complete subsidization of comprehensive Massachusetts health insurance for adults who earn up to 150 percent of the federal poverty level. The children of parents earning up to 300 percent of the federal poverty level also get completely subsidized coverage. If earning between 150 and 300 percent of the federal poverty level, partial subsidies are available for qualifying adults. Additional qualifications require you to be a Massachusetts resident and not be eligible for employee-sponsored medical insurance or any other public option.

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The Massachusetts Health Connector and IRS Section 125 POP Plan

With all the focus on Federal Health Care Reform it’s easy to lose focus on the solutions some states are creating to take control of the issue in their respective state. Since 2006, Massachusetts has required its citizens to have health care. This landmark legislation has been praised throughout the country for being proactive and for addressing the needs of Massachusetts citizens. The embodiment of this initiative is the Massachusetts Health Connector, a service that links Massachusetts residents with the health care they need.

Massachusetts employers who have more than 11 eligible employees must create a Section 125 Plan to make health care available to their employees. If you have 11 or more employees and don’t offer a Section 125 Plan, you could be subject to a Free Rider Surcharge if your employees receive state-funded health care services. While this may seem like a burden, setting up a Section 125 plan is really a great deal for both you and your employees.

Why a Section 125 Plan is a Win-Win?

A Section 125 POP Plan is often called a Premium Only Plan or cafeteria plan, and is governed by Section 125 of the Internal Revenue Code. When benefits are offered through a Section 125 Plan, the premiums that employees pay are deducted from their pay on a pre-tax basis. That means each employee’s taxable income is lower, as is their FICA and Medicare tax contribution. For the employer, you benefit from your portion of matching contribution too. Employers also save on Federal Unemployment Tax and depending on the state or county there could also be additional tax savings.

Even if you have fewer than 11 eligible employees and aren’t required to set up a Section 125 plan, the tax-savings alone could make it worth your while!

How Do I Set Up a Section 125 Plan?

For Massachusetts Employers, the Connector has a sample document that you could review or have your attorney create a document and keep in compliance. Or you could hire a professional document administration company that will create and maintain your Section 125 Plan with ease. They can provide signature-ready plan documents customized for you and your needs, and in full compliance with IRS rules, in as little as fifteen minutes.

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