Mass Health Connector Plans

The Massachusetts Health Connector is a state-based health insurance marketplace that offers a range of plans to individuals, families, and small businesses. The Health Connector was established in 2006 as part of the state’s healthcare reform efforts, with the goal of increasing access to affordable health insurance for Massachusetts residents.

The Health Connector offers a variety of plans from several insurance companies, including Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, and Tufts Health Plan. These plans are categorized into different metal tiers, including Bronze, Silver, Gold, and Platinum, which vary in terms of their premium costs and out-of-pocket expenses. For example, in 2022, the average monthly premium for a Bronze plan was 428, while the average monthly premium for a Platinum plan was 741.

Types of Plans Offered

The Health Connector offers several types of plans, including:

• Individual and Family Plans: These plans are designed for individuals and families who are not eligible for employer-sponsored coverage or other forms of insurance.
• Small Business Plans: These plans are designed for small businesses with 1-50 employees.
• Dental Plans: These plans provide coverage for dental care, including routine cleanings, fillings, and other procedures.
• Catastrophic Plans: These plans are designed for young adults and others who are exempt from the individual mandate penalty. They offer limited coverage at a lower premium cost.

According to a report by the Massachusetts Health Connector, in 2022, over 90% of enrollees received financial assistance to help lower their premium costs. The report also noted that the average premium cost for Health Connector plans decreased by 2.5% from 2021 to 2022.

Plan Benefits and Features

All Health Connector plans are required to cover certain essential health benefits, including:

• Ambulatory patient services: Outpatient care, including doctor visits and other medical services.
• Emergency services: Emergency room visits and other emergency care.
• Hospitalization: Inpatient care, including hospital stays and surgical procedures.
• Maternity and newborn care: Prenatal care, childbirth, and postpartum care.
• Mental health and substance use disorder services: Counseling, therapy, and other services for mental health and substance use disorders.
• Prescription drugs: Coverage for prescription medications, including copays and coinsurance.
• Rehabilitative and habilitative services: Physical, occupational, and speech therapy, as well as other services to help restore or improve functional abilities.
• Laboratory services: Blood tests, urinalyses, and other laboratory tests.
• Preventive and wellness services: Routine check-ups, screenings, and other services to promote health and prevent illness.

Eligibility and Enrollment

To be eligible for Health Connector plans, individuals and families must meet certain requirements, including:

• Residency: They must be residents of Massachusetts.
• Income: They must have a certain income level, which varies depending on the type of plan and the number of people in the household.
• Immigration status: They must be U.S. citizens, nationals, or lawfully present immigrants.

According to a report by the Kaiser Family Foundation, in 2022, over 300,000 individuals and families enrolled in Health Connector plans. The report also noted that the majority of enrollees (over 70%) received financial assistance to help lower their premium costs.

Enrollment Periods

The Health Connector has several enrollment periods throughout the year, including:

• Open Enrollment: This is the annual period when anyone can enroll in a Health Connector plan, usually from November to January.
• Special Enrollment: This is a special enrollment period that allows individuals and families to enroll in a plan outside of the open enrollment period, usually due to a qualifying life event, such as a change in income, marriage, or the birth of a child.
• Medicaid Enrollment: This is an ongoing enrollment period for individuals and families who are eligible for Medicaid.