““Helping Job Hunters Helping Job Hunters Navigate Health Insurance Navigate Health Insurance Options”Options”

David PomeranzDavid PomeranzThe Career PlaceThe Career Place

October 13, 2009October 13, 2009

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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

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““The Golden The Golden Rule:”Rule:”

IF YOU REMEMBER ONLY IF YOU REMEMBER ONLY

ONE THINGONE THING FROM THIS PRESENTATION FROM THIS PRESENTATION

….….

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To the extent possible: To the extent possible:

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

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ALWAYS: HEALTH INSURANCE

COVERAGE !!!

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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!

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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

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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

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

Loss of job Loss of job

OROR

Employer eliminates your coverage; Employer eliminates your coverage; examples: examples: – you change from full-time to part-time statusyou change from full-time to part-time status– employer stops offering health benefit employer stops offering health benefit

altogetheraltogether

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

When a company goes bankrupt, usually When a company goes bankrupt, usually there is no reserve to pay for the there is no reserve to pay for the employee health insurance benefit employee health insurance benefit

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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

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COBRA subsidy COBRA subsidy programsprograms

Federal stimulus law Federal stimulus law

State Medical Security ProgramState Medical Security Program

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Federal stimulus lawFederal stimulus law

Job loss between Sept. 1, 2008 Job loss between Sept. 1, 2008 through Dec. 31, 2009through Dec. 31, 2009

Have to be COBRA eligibleHave to be COBRA eligible

Subsidy of 65% for 9 months of Subsidy of 65% for 9 months of health insurance premiumhealth insurance premium

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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 is calculated for Income is calculated for thisthis Program: six Program: six

past plus six future months of incomepast plus six future months of income www.mass.gov/dua/msp or 800-908-8801www.mass.gov/dua/msp or 800-908-8801

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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

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2009-2010 FPLs for 2009-2010 FPLs for programs to be discussedprograms to be discussed

Family Annual Household Gross Income

Size 100% 300% 400%

1 $10,830 $32,490 $43,320

2 $14,570 $43,710 $58,280

3 $18,310 $54,930 $73,240

4 $22,050 $66,150 $88,200

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

1. “Premium Assistance” for COBRA1. “Premium Assistance” for COBRA

2. “Direct Coverage” for when your 2. “Direct Coverage” for when your company goes bankruptcompany goes bankrupt

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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

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2006 Massachusetts2006 MassachusettsHealth Reform LawHealth Reform Law

““Individual mandate”Individual mandate” ““Minimum credible coverage”Minimum credible coverage” Commonwealth Care: state-Commonwealth Care: state-

subsidized health insurance planssubsidized health insurance plans Commonwealth Choice: non-Commonwealth Choice: non-

subsidized health planssubsidized health plans

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Individual MandateIndividual Mandate

Required to have health insurance Required to have health insurance that meets minimum credible that meets minimum credible coverage, 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”

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Minimum credible coverageMinimum credible coverage

In 2009, health plans are required to:In 2009, health plans are required to:– Cover prescription drugsCover prescription drugs– Cap deductibles at $2,000 per Cap deductibles at $2,000 per

individual; $4,000 per familyindividual; $4,000 per family– Cap total out-of-pocket spending at Cap total out-of-pocket spending at

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

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Types of Health PlansTypes of Health Plans

Programs for the uninsured individuals:Programs for the 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

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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)

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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

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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

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Commonwealth Commonwealth ChoiceChoice

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

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CommonwealthCommonwealth ChoiceChoice

Three premium “levels”:Three premium “levels”:– BronzeBronze: low premiums; most have : low premiums; most have

deductibles and co-payments / co-deductibles and co-payments / co-insuranceinsurance

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

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

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MassHealth EssentialMassHealth Essential

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

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

Income is Income is << 100% of the FPLs 100% of the FPLs Need to file an MBR; to request one:Need to file an MBR; to request one:

888-665-9993888-665-9993

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Health Safety Net / Free CareHealth Safety Net / Free Care

NotNot insurance: two options – insurance: two options –

1.1. Provides protection for those without Provides protection for those without access to affordable health coverage; access to affordable health coverage; for example, “Affordability for example, “Affordability Exemption”Exemption”

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

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Health Safety Net / Free CareHealth Safety Net / Free Care

To apply:To apply: In general, complete an MBRIn general, complete an MBR For “Medical Hardship,” need to For “Medical Hardship,” need to

complete a special applicationcomplete a special application

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

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Locations of Community Locations of Community Health Centers and HospitalsHealth Centers and Hospitals

Community Health Centers Community Health Centers www.massleague.org/HealthCenters-www.massleague.org/HealthCenters-

ByMap.htmByMap.htm

HospitalsHospitalswww.mhalink.org/public/mahospitalswww.mhalink.org/public/mahospitals

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Self-employed / Self-employed / Small businessesSmall businesses ““Insurance Partnership”Insurance Partnership” But it is NOT insurance: it is a state But it is NOT insurance: it is a state

premium subsidypremium subsidy Eligibility: 300% of the FPLsEligibility: 300% of the FPLs Contact information:Contact information:

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

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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!

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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 You have my permission to distribute this information.distribute this information.

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About David …. About David ….

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

dpomer99@aol.com or 617 650 0639dpomer99@aol.com or 617 650 0639

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Thank you very much!Thank you very much!

Questions anyone?Questions anyone?