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Massachusetts Health Insurance

Health insurance nowadays comes in two main categories: individual and group.
Mainly those people apply for individual insurance who are self-employed, or are working in a company that does not have provisions for a health plan, or who maintain a family and want individual insurance members of the family. When one buys an individual plan, he/she is required to pay an annual premium, and also a deductible for each insured dependent, up to a base amount. However, if one opts for a group policy, he/she must pay an annual premium, co-payments payable at each medical service, and a deductible payable before insurance starts making payments for his/her valid medical bills.

In Massachusetts, insurers are not allowed to deny you individual health insurance because of a health problem. Any HIPAA eligible person follows the same rules for buying individual insurance. Massachusetts demands standardized policies for all consumers. Insurers can impose a six-month waiting period for coverage with individual plans. They can also exclude coverage for six months on pre-existing conditions if there has been a break of over 63 days in prior insurance. Attachment of elimination riders to individual policies is not allowed. Premiums on individual policies cannot be increased based on modified community rating. Your insurance cannot be cancelled on account of your illness.

In Massachusetts, group health insurance cannot be denied to you even if you have health problems, provided you qualify. Your new employer can seek a waiting period before offering group insurance. The look back period for insurers to review pre-existing conditions is six months. The exclusion period for pre-existing conditions in group policies must not exceed six months. In Massachusetts, a waiting period is allowed for any insured before health coverage begins, even in the absence of a pre-existing condition. When you join new group insurance, if you have had continuous unbroken coverage of more than 63 days, creditable coverage protects you from exclusion or waiting periods for pre-existing conditions.

In Massachusetts, small businesses with one to 50 employees cannot be denied small group health coverage. Small employers have to pay premiums that cannot vary due to health conditions, gender, and number of claims within the group. The MassHealth Insurance Partnership helps small employers pay health premiums, depending on certain income characteristics of their groups.

Massachusetts allows self-employed people to purchase small group health insurance. You should contact the Massachusetss Division of Insurance for information about professional associations who have group health insurance available for members.

Financial help in Massachusetts is provided through MassHealth, Children’s Medical Security Plan, Medical Security Plan, and Breast and Cervical Cancer Treatment Program.

Choosing the right health insurance quotes is always difficult. You must do some homework before you make your choice. The best option is to engage professional health insurance agents and brokers who can greatly help you in this regard.

The main health insurance provider in Massachusetts is Blue Cross and Blue Shield of Massachusetts.



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Useful links and information:

Massachusetts Division of Insurance
(617) 521-7777 (Boston)
(413) 785-5526 (Springfield)
(617) 521-7490 (TTY/TTD)

U.S. Department of Labor, Boston Regional Office
(617) 565-9600

U.S. Department of Labor, Division of Technical Assistance and Inquiries, Washington, D.C.
(202) 219-8776

For Department of Labor publications:
(800) 998-7542

Office of Health and Human Services of Massachusetts
(617) 628-4141
(800) 841-2900

Massachusetts Department of Public Health
(800) 909-2677 (CMSP)
(888) 665-9993 (MassHealth Enrollment Center)

Massachusetts Division of Employment and Training
(800) 914-4455
(617) 956-3801 (TTY/TDD)

Women's Health Network
(877) 414-4447
(617) 624-5992 (TTY)

Internal Revenue Service (IRS)
(866) 628-HCTC
(Click on HCTC); or call HCTC customer service center



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