Massachusetts health care how does it work

Included in its busy schedule: generating a plan of operations and a budget and hiring staff. The Connector also met its first legislative deadline, which was to develop and issue regulations and criteria by July 1, , for contracting with health plans for the Commonwealth Care Health Insurance Program, or C-CHIP. Funding for this plan will come from federal and state matching Medicaid funds made possible by a waiver currently being negotiated between Massachusetts and CMS.

Formal approval had not yet been granted by CMS as of July The legislation calls for The Connector to provide its seal of approval for plans that are offered and make determinations about continuing or withdrawing approval.

After two years, the agency will formally evaluate the program and make recommendations for changes. Massachusetts has passed healthcare care reform bills in the past: Witness the legislation under Governor Michael Dukakis that was later repealed.

Nevertheless, Dr. A lot of people have been wondering how we are going to address the issue of the 45 million uninsured in this country. This is one step toward that, but there are really a lot of ifs, ands, and buts on whether it will truly be pulled off in a year or two. Shortly after the ceremonial signing of the bill in early April, Nancy C. Recently, Turnbull said she was still optimistic about the workability of the reform.

The individual mandate deadline is July 1, , and before that date The Connector is charged with making determinations about affordability standards. People such as Steffie Woolhandler, MD, MPH, a primary care physician in the Department of Medicine, Cambridge Hospital and Harvard Medical School Boston and a co-founder of Physicians for a National Health Program, which favors a single-payer system, worry that insurers will rely on high deductibles and co-pays to make premiums affordable.

Calling the statute a hoax, Dr. Turnbull acknowledges that concerns such as those voiced by Dr. Woolhandler are well-founded because insurers and employers have traditionally resorted to increased cost-sharing to regulate premiums.

Asked what he would say to critics who do not think private insurance companies can structure products that are both affordable and of good quality, Dr.

A well-functioning market with a lot of good information, which is what this reform calls for, can improve upon the plans available to what is perhaps the least well-functioning part of the existing insurance market: the non-group and small-group insurance market. Determination of good quality, affordable benefit packages will be a difficult decision. Hospitalists, in general, are accustomed to and adept at caring for unassigned patients included in the uncompensated pool, he notes, and at UMass, caring for these patients is a major mission of the hospital.

Allison is hopeful that the legislation holds promise for bringing many previously marginalized and uninsured people into the healthcare system. Thomas H. One change Dr. Another consequence of affordable insurance products may be a narrowing of provider networks.

And a narrow network product, says Sylvia C. As of December , about 1. You can apply online at MAHealthConnector. Medicare is typically for people over the age of 65, but there are some exceptions. In Massachusetts, more than 1 million people are enrolled in Original Medicare, and approximately , are enrolled in Medicare Advantage Plans. If you are 65 or older, you may be eligible for Medicare.

If you or your spouse worked and paid Medicare taxes for at least 10 years, you can even qualify for premium-free Medicare Part A, meaning you can get health insurance without having to pay monthly premiums. Depending on your needs, you may decide to add Medicare Part B coverage to your policy, as well.

Another option is Medicare Supplement Insurance or Medigap. A Medigap policy can help pay for remaining costs, including your deductibles, copayments, and coinsurance. If you lost your job or left for a new opportunity and are waiting for your coverage to kick in , there are a few different health insurance options available to you.

However, you are responsible for paying for your entire premium, which can be very expensive. Massachusetts passed a law in that required small group health carriers to provide continuation of coverage benefits similar to those required by federal COBRA rules.

If you worked for a small employer — a business with two to 19 employees — and lost your job or left for a new one, you can extend your coverage for up to 18 months with mini-COBRA. Many people opt for short-term health insurance plans instead of private insurance. However, Massachusetts implemented regulations that made short-term plans follow nearly all of the same rules that ACA plans have. Depending on your family size, income, and age, there are several health insurance options for Massachusetts residents.

By researching the available plans, you can find coverage that works for your budget. United Health Foundation.

Kaiser Family Foundation. Massachusetts Health Connector. The Commonwealth Fund. Commonwealth of Massachusetts. Center for American Progress. Centers for Medicare and Medicaid Services. Department of Labor.

Sanger-Katz, Margot. We do not sell insurance products, but there may be forms that will connect you with partners of healthcare. You may submit your information through this form, or call to speak directly with licensed enrollers who will provide advice specific to your situation.

Read about your data and privacy. Our mission is to provide information that will help everyday people make better decisions about buying and keeping their health coverage. Our editorial staff is comprised of industry professionals and experts on the ACA, private health insurance markets, and government policy.

Learn more about our content. But it has taken a village of health care policymakers, economists, practitioners, community leaders, and legislators to create an insurance coverage system that not only works, but that also rises above partisan acrimony.

How did the state manage to be almost radically bipartisan when it comes to health care, or at least sensibly pragmatic? Another ingredient in the successful overhaul, according to John E. McDonough, professor of public health practice at the Harvard T. What does the evidence tell us? About 22 percent of adults in Massachusetts have trouble paying medical bills, according to a new report by Washington-based consultancy Altarum, with many complaining that high-deductible health plans come with steep out-of-pocket costs.

Expanding coverage was just the first step, Blumberg says. And then from there, you can talk about where we can create efficiencies in the health care delivery systems and reduce costs. Making inroads on affordability — lowering co-pays and providing value-based alternatives to traditional yet unchecked fee-for-service payment systems, while monitoring for inappropriate care — seems to be the way forward, according to experts.