Massachusetts has a long history of providing insurance to residents in the state. With the adoption of the Affordable Care Act, even greater numbers of residents gained access to basic health care services. Medical assistance throughout the state is offered via the Health Connector Insurance exchange, through private employers and through public assistance agencies such as Medicaid, Medicare and CHiP. Medical programs exist in the state to cover specific groups who are at-risk, including the disabled, low-income seniors and veterans. Massachusetts is one of many states that accepted Medicaid expansion as part of the Affordable Care Act, and allowed approximately 398,300 new enrollees into the program. Within the state, residents who need help with obtaining quality health care coverage, medical assistance or emergency aid, can do so through various programs that are state and federally funded. Each program listed below will have its own set of criteria and requirements, but nearly all are needs-based programs and are dependent on the level of income of the applicant. The most accessed health care programs in Massachusetts are outlined below.
Health Connector of Massachusetts
The Affordable Care Act required all states to provide a marketplace for residents to purchase a health care plan. Massachusetts opted to create a health care exchange called the Health Connector. Residents use this platform to access health care plans, to compare plans, to update or change information or to receive subsidized health care options. Families who fall below a certain level of income are automatically issued subsidies to defray the cost of a health care plan. Those residents who are unable to afford health care plans, even with the subsidies, are referred to other state and federal agencies.
MassHealth is a program that oversees both the adult Medicaid, and Children’s Health Insurance Programs. The children’s program is called CHiP. MassHealth for adults allows qualifying members to enjoy many medical services at low to no-cost, including doctor’s visits, short hospital stays and prescriptions. MassHealth works by paying the benefits directly to the health care organization. These payments are either in full, or in part. The difference must be covered by the subscriber. Participants who are disabled, HIV positive or have cervical or breast cancer will be offered different types of coverage. Coverage is also based on the age of the applicant.
OneCare is a program that has combined the Medicare and MassHealth health care plans into one program. Referred to as MassHealth plus Medicare, the OneCare program allows residents who would qualify for both to receive the full range of services from both programs. One plan, one card, and one health care professional will administrate the plan as opposed to two or more.
Medicare is a health insurance program that residents automatically qualify for when they reach 65 years of age. The health care plan is also issued to the disabled. The program has several parts, Part A, B, D and Medicare Advantage (Part C). Each part offers something different. Plan A is issued automatically for most residents, with Plan B as optional (though most accept it). Residents who wish to combine A and B into one expanded package often choose Part C. Part D covers prescription medications that are not already covered under the other plans. Premiums vary, but for most qualifying residents Part A is free.
Prescription Advantage Overview
The Prescription Advantage program is state offered prescription assistance for residents who are 65 years of age or older and the disabled. Income and employment criteria must be met to qualify for assistance. This is considered a supplemental insurance offered by the Commonwealth.
Children’s Medical Security Plan (CMSP)
The Children's Medical Security Plan offers health and dental services to children who are uninsured. This program covers all children, under the age of 19, who are living in Massachusetts and who do not qualify for MassHealth. Monthly payments are dependent on the family’s financial situation and size. There is often a waiting list for this program.
Health Safety Net
The Health Safety Net is a program that covers the costs of acute care centers and health service centers in Massachusetts. This is a fund that assists low-income residents in paying for health care services or co-pays. This program is also referred to as Free Care, or the Uncompensated Care Pool. There are many limitations and restrictions inherent with this program, so those who feel they may qualify should speak with a local free clinic or board of health.
Healthcare for Veterans
Because most veterans have earned health care coverage through service in the military, most of their care is already offered free or at no cost. VA health care can be obtained prior to signing up for MassHealth, Medicare or Commonwealth Care programs. For a duration of five years after discharge from active duty, veterans can have special eligibility for medical services, VA hospital care services, or nursing home care. Free mental health services are offered through various Vet Centers and VA hospitals. Gender specific veterans’ services, for example women veterans’ services, are offered in Massachusetts. These health care services are designed to address health care issues specific to women, including health screenings, sexual abuse counseling and gynecology services.