““Helping Job Hunters Helping Job Hunters Navigate Health Insurance Navigate Health Insurance and Find Lower-Cost and Find Lower-Cost Health Services”Health Services”

David PomeranzDavid PomeranzCopyright © 2010Copyright © 2010

22

The purposes of this The purposes of this presentation …presentation …

Overview of health insurance Overview of health insurance programs resulting from state and programs resulting from state and federal lawsfederal laws

Provide websites and telephone Provide websites and telephone numbersnumbers

33

““The Golden The Golden Rule:”Rule:”

IF YOU REMEMBER ONLY IF YOU REMEMBER ONLY

ONE THINGONE THING FROM THIS PRESENTATION FROM THIS PRESENTATION

….….

55

To the extent possible: To the extent possible:

ALWAYS, ALWAYS, ALWAYS,ALWAYS,ALWAYS,ALWAYS,

6

ALWAYS HAVE: HEALTH INSURANCE

COVERAGE !!!

77

If you lose coverage,If you lose coverage,first check --first check --

Does your spouse have a health Does your spouse have a health insurance plan?insurance plan?

If so, perhaps it makes sense for If so, perhaps it makes sense for you to be on your spouse’s plan!you to be on your spouse’s plan!

88

Other health insurance Other health insurance options for job hunters options for job hunters ……

COBRA and its subsidy programsCOBRA and its subsidy programs 2006 Mass. Reform Law’s programs 2006 Mass. Reform Law’s programs MassHealth EssentialMassHealth Essential Health Safety Net / Free CareHealth Safety Net / Free Care Insurance PartnershipInsurance Partnership Resources and Background InformationResources and Background Information

99

1010

COBRA: what is it?COBRA: what is it?

Federal law requires employers to provide Federal law requires employers to provide continuity in health insurance coveragecontinuity in health insurance coverage

Typically lasts for 18 months but it can Typically lasts for 18 months but it can last for 36 months if, for example, you are last for 36 months if, for example, you are a divorced spouse or an adopted childa divorced spouse or an adopted child

Employers with 20+ employees; many Employers with 20+ employees; many states have “mini” COBRA laws for states have “mini” COBRA laws for smaller employers smaller employers

1111

COBRA: when COBRA: when does it apply?does it apply?

Loss of job except for “gross misconduct”Loss of job except for “gross misconduct”

OROR

Employer eliminates your coverage because of a Employer eliminates your coverage because of a reduction in hours: for example, from full to part-reduction in hours: for example, from full to part-timetime

OROR

When a company is [Chapter 7] bankrupt while it When a company is [Chapter 7] bankrupt while it is reorganizing itselfis reorganizing itself

1212

COBRA: when COBRA: when does it does it notnot apply? apply?

Employer stops offering health insurance to Employer stops offering health insurance to all employeesall employees

Company goes out of businessCompany goes out of business

1313

If COBRA is in effectIf COBRA is in effect … …

Individual has to pay the Individual has to pay the entireentire health health insurance premium plus up to a 2% insurance premium plus up to a 2% administrative feeadministrative fee

BUT an employer’s BUT an employer’s groupgroup coverage is coverage is usually a better value than any usually a better value than any non-groupnon-group coveragecoverage

1414

How Much Time Do YouHow Much Time Do YouHave to Elect COBRA?Have to Elect COBRA?

Employers must notify their plan Employers must notify their plan administrators within 30 daysadministrators within 30 days

Plan administrator must notice Plan administrator must notice individuals within 14 daysindividuals within 14 days

Individuals must elect coverage within 60 Individuals must elect coverage within 60 days after notice is sent or the day health days after notice is sent or the day health care coverage ceased, whichever is latercare coverage ceased, whichever is later

1515

COBRA subsidy COBRA subsidy programsprograms

Federal: Feb. 17, 2009; Federal: Feb. 17, 2009;

amended Dec. 19, 2009amended Dec. 19, 2009

Massachusetts’ Medical Security Massachusetts’ Medical Security ProgramProgram

1616

OriginalOriginal Federal stimulus Federal stimulus law of Feb. 17, 2009law of Feb. 17, 2009

Job loss: 9/1/2008 to 12/312009Job loss: 9/1/2008 to 12/312009

Subsidy: 65% of insurance premium Subsidy: 65% of insurance premium for nine (9) monthsfor nine (9) months

1717

AmendedAmended Federal stimulus Federal stimulus law of Dec. 19, 2009law of Dec. 19, 2009

Job loss: 9/1/2008 to Job loss: 9/1/2008 to 2/28/20102/28/2010

Subsidy: 65% of insurance premium Subsidy: 65% of insurance premium for for 15 months15 months

1818

Federal stimulus law:Federal stimulus law:case study of extensioncase study of extension

Original eligibility: 3/1/2009 through Original eligibility: 3/1/2009 through 11/30/2009 -- 9 months in total11/30/2009 -- 9 months in total

Eligibility extension from 9 to 15 Eligibility extension from 9 to 15 months; e.g., from 12/1/2009 to months; e.g., from 12/1/2009 to 5/31/20105/31/2010

If you paid your full COBRA premium If you paid your full COBRA premium for December 2009: contact COBRA for December 2009: contact COBRA administrator to your 65% subsidy back administrator to your 65% subsidy back

1919

Massachusetts’ Massachusetts’ Medical Security ProgramMedical Security Program

Eligibility:Eligibility: Do Do notnot have to be COBRA eligible have to be COBRA eligible Receiving Massachusetts unemploymentReceiving Massachusetts unemployment Household income Household income << 400% of the federal 400% of the federal

poverty levels (FPLs)poverty levels (FPLs) Income for Income for thisthis Program excludes Program excludes

unemployment benefitsunemployment benefits www.mass.gov/dua/msp or 800-908-8801www.mass.gov/dua/msp or 800-908-8801

2020

What are “Federal Poverty What are “Federal Poverty Levels” (FPLs)?Levels” (FPLs)?

Income standards used to determine Income standards used to determine eligibility for public programseligibility for public programs

Based on Based on – gross (pre-tax) household incomegross (pre-tax) household income– family sizefamily size

2121

2009-2010 FPLs for 2009-2010 FPLs for Medical Security ProgramMedical Security Program

FamilyAnnual Household Gross Income

Size 400%

1 $43,320

2 $58,280

3 $73,240

4 $88,200

2222

Medical Security Program:Medical Security Program: Two Options Two Options

““Premium Assistance” for COBRAPremium Assistance” for COBRA

““Direct Coverage” for when your Direct Coverage” for when your loss of coverage has nothing to do loss of coverage has nothing to do with COBRA with COBRA

2323

Medical Security Program Medical Security Program “Premium Assistance”“Premium Assistance”

Up to 80% of premium Up to 80% of premium

Can receive both federal and Can receive both federal and state COBRA premium state COBRA premium subsidies if meet subsidies if meet bothboth eligibility requirementseligibility requirements

2424

Guaranteed Issue inGuaranteed Issue inMassachusettsMassachusetts

Insurers have to waive Insurers have to waive allall pre- pre-existing conditionsexisting conditions

2525

Topics to be covered about Topics to be covered about the 2006 Mass. Reform Lawthe 2006 Mass. Reform Law

Health ConnectorHealth Connector Individual MandateIndividual Mandate Minimum Credible CoverageMinimum Credible Coverage Commonwealth Care and Commonwealth Care and

Commonwealth Choice health Commonwealth Choice health plansplans

2626

Health Connector as an Health Connector as an InsuranceInsurance Clearinghouse Clearinghouse

Employers with less than 50 Employers with less than 50 employeesemployees

IndividualsIndividuals– UnemployedUnemployed– Self-employed, part-time worker, and / Self-employed, part-time worker, and /

or worker for multiple employersor worker for multiple employers– IneligibleIneligible for large employer plan for large employer plan

2727

Individual MandateIndividual Mandate

Adults required have health Adults required have health insurance that meets minimum insurance that meets minimum credible coverage, credible coverage, OROR

Penalty of up to about $1,000 in Penalty of up to about $1,000 in 20092009

BUTBUT there is an “Affordability there is an “Affordability Exemption”Exemption”

2828

Minimum credible coverageMinimum credible coverage

In 2009, health plans requirements:In 2009, health plans requirements:– Cover prescription drugsCover prescription drugs– Maximum deductibles are $2,000 per Maximum deductibles are $2,000 per

individual; $4,000 per familyindividual; $4,000 per family– Maximum out-of-pocket spending are Maximum out-of-pocket spending are

$5,000 per individual; $10,000 per $5,000 per individual; $10,000 per familyfamily

2929

Health Connector’s Health Connector’s Health PlansHealth Plans

Programs for uninsured individuals:Programs for uninsured individuals:– Commonwealth Commonwealth CARECARE: income : income << 300% of the 300% of the

Federal Poverty GuidelinesFederal Poverty Guidelines

– Commonwealth Commonwealth CHOICECHOICE: income > 300% of : income > 300% of the Federal Poverty Guidelinesthe Federal Poverty Guidelines

www.mahealthconnector.orgwww.mahealthconnector.org Customer Service: (877) 623-6765Customer Service: (877) 623-6765

3030

2009-2010 FPLs for 2009-2010 FPLs for Commonwealth CareCommonwealth Care

Family

Annual Household Gross Income

Size 300%

1 $32,490

2 $43,710

3 $54,930

4 $66,150

3131

Commonwealth Commonwealth CareCare

State-subsidized program for health State-subsidized program for health insuranceinsurance

At www.mahealthconnector.org -- At www.mahealthconnector.org -- look for the link at the bottom left-look for the link at the bottom left-hand corner of the web pagehand corner of the web page

Need to submit a “Medical Benefit Need to submit a “Medical Benefit Request” (MBR)Request” (MBR)

3232

What is an “MBR?”What is an “MBR?”

MBR (Medical Benefit Request) is MBR (Medical Benefit Request) is a form required by the State for a form required by the State for many State-subsidized programs:many State-subsidized programs:– Commonwealth CareCommonwealth Care– MassHealth EssentialMassHealth Essential– Free Care / Health Safety NetFree Care / Health Safety Net

To request one: 888-665-9993To request one: 888-665-9993 Can download one as wellCan download one as well

3333

Commonwealth Commonwealth CareCare

Not all plans are available across the state: Not all plans are available across the state: the plans that the plans that couldcould be available: be available: – Boston Medical Center / Health Net PlanBoston Medical Center / Health Net Plan– CeltiCareCeltiCare– Fallon Community Health PlanFallon Community Health Plan– Neighborhood Health PlanNeighborhood Health Plan– Network HealthNetwork Health

Not all doctors participate: Not all doctors participate: call their officescall their offices

3434

Commonwealth Commonwealth ChoiceChoice

Choice of six health plans: not all plans Choice of six health plans: not all plans offered throughout the stateoffered throughout the state

Blue Cross Blue Shield of Blue Cross Blue Shield of MassachusettsMassachusetts

Fallon Community Health PlanFallon Community Health Plan Harvard Pilgrim Health PlanHarvard Pilgrim Health Plan Health New EnglandHealth New England Neighborhood Health PlanNeighborhood Health Plan Tufts Health PlanTufts Health Plan

3535

CommonwealthCommonwealth ChoiceChoice

Three premium “levels”Three premium “levels”– BronzeBronze: lowest premiums; most : lowest premiums; most

have deductibles, co-payments, and have deductibles, co-payments, and co-insurance; some have limited co-insurance; some have limited provider networksprovider networks

– SilverSilver: medium premiums; : medium premiums; moderate co-payments; some have moderate co-payments; some have no deductibles no deductibles

– GoldGold: highest premiums; low co-: highest premiums; low co-payments; no deductibles payments; no deductibles

3636

MassHealth EssentialMassHealth Essential

One of a number of MassHealth One of a number of MassHealth programsprograms

For those who are unemployed for more For those who are unemployed for more than one (1) yearthan one (1) year

Income is Income is << 100% of the FPLs 100% of the FPLs

3737

2009-2010 FPLs for 2009-2010 FPLs for MassHealth EssentialMassHealth Essential

FamilyAnnual Household Gross Income

Size 100%

1 $10,830

2 $14,570

3 $18,310

4 $22,050

3838

Health Safety Net / Free CareHealth Safety Net / Free Care

NotNot insurance: two options – insurance: two options –

1.1. Protection for those without access Protection for those without access to affordable health coverageto affordable health coverage

2.2. People of People of anyany income can apply if income can apply if they have medical bills for which they have medical bills for which they cannot pay: “Medical they cannot pay: “Medical Hardship”Hardship”

3939

Health Safety Net / Free CareHealth Safety Net / Free Care

To apply:To apply: For most people, complete an MBRFor most people, complete an MBR For “Medical Hardship,” need to For “Medical Hardship,” need to

complete a special applicationcomplete a special application

Eligibility: call MassHealth at 888-665-Eligibility: call MassHealth at 888-665-99939993

Help Desk: 877-910-2100Help Desk: 877-910-2100

4040

Self-employed / Self-employed / Small businessesSmall businesses ““Insurance Partnership”Insurance Partnership” NotNot insurance: state premium insurance: state premium

subsidysubsidy Eligibility: 300% of the FPLsEligibility: 300% of the FPLs Contact information:Contact information:

– www.4IP.org– 508-698-2070508-698-2070

4141

2009-2010 FPLs for 2009-2010 FPLs for Insurance PartnershipInsurance Partnership

Family

Annual Household Gross Income

Size 300%

1 $32,490

2 $43,710

3 $54,930

4 $66,150

4242

Examples of Lower-Cost Examples of Lower-Cost Health Care Service ProvidersHealth Care Service Providers

Community Health CentersCommunity Health Centers Tufts Dental School and Middlesex Tufts Dental School and Middlesex

Community College Dental Hygiene Community College Dental Hygiene ClinicClinic

New England Eye InstituteNew England Eye Institute NeedyMeds: information about NeedyMeds: information about

medicationsmedications

4343

Remember theRemember the “Golden Rule”“Golden Rule”

To the extent possible:To the extent possible:

Always, always, always Always, always, always

have health insurance have health insurance coverage!coverage!

4444

David’s QualifiersDavid’s Qualifiers

NotNot a comprehensive review of all a comprehensive review of all federal and all state programs.federal and all state programs.

I have “vetted” the programs to the I have “vetted” the programs to the best of my abilitybest of my ability

You have my permission to distribute You have my permission to distribute this information.this information. Please give me Please give me “attribution.”“attribution.”

4545

About David …. About David ….

www.linkedin.com/in/dpomer99www.linkedin.com/in/dpomer99

http://blogginghealthcare.wordpress.com http://blogginghealthcare.wordpress.com

4646

Thank you very much!Thank you very much!

Questions anyone?Questions anyone?