“ Helping Job Hunters Navigate Health Insurance Options” David Pomeranz The Career Place October 13, 2009
The purposes of this presentation … <ul><li>Overview of health insurance programs resulting from state and federal laws </...
“ The Golden Rule:” <ul><li>IF YOU REMEMBER ONLY  </li></ul><ul><li>ONE THING   </li></ul><ul><li>FROM THIS PRESENTATION …...
 
To the extent possible:  <ul><li>ALWAYS,  </li></ul><ul><li>ALWAYS, </li></ul><ul><li>ALWAYS, </li></ul>
ALWAYS :  HEALTH INSURANCE COVERAGE !!!
If you lose coverage, first check -- <ul><li>Does your spouse have a health insurance plan? </li></ul><ul><li>If so, perha...
Other health insurance options for job hunters … <ul><li>COBRA and its subsidy programs </li></ul><ul><li>2006 Mass. Refor...
 
COBRA: what is it? <ul><li>Federal law requires employers to provide continuity in health insurance coverage </li></ul><ul...
COBRA: when  does it apply? <ul><li>Loss of job  </li></ul><ul><li>OR   </li></ul><ul><li>Employer eliminates your coverag...
COBRA: when  does it  not  apply? <ul><li>When a company goes bankrupt, usually there is no reserve to pay for the employe...
If COBRA is in effect  … <ul><li>Individual has to pay the  entire  health insurance premium plus up to a 2% administrativ...
COBRA subsidy programs <ul><li>Federal stimulus law  </li></ul><ul><li>State Medical Security Program </li></ul>
Federal stimulus law <ul><li>Job loss between Sept. 1, 2008 through Dec. 31, 2009 </li></ul><ul><li>Have to be COBRA eligi...
Massachusetts’ Medical Security Program <ul><li>Eligibility: </li></ul><ul><li>Do  not  have to be COBRA eligible </li></u...
What are “Federal Poverty Levels” (FPLs)? <ul><li>Income standards used to determine eligibility for public programs </li>...
2009-2010 FPLs for  programs to be discussed $88,200 $66,150 $22,050 4 $73,240 $54,930 $18,310 3 $58,280 $43,710 $14,570 2...
Medical Security Program:   Two Options <ul><li>1. “Premium Assistance” for COBRA </li></ul><ul><li>2. “Direct Coverage” f...
Medical Security Program  “Premium Assistance” <ul><li>Up to 80% of premium  </li></ul><ul><li>Can receive both federal an...
2006 Massachusetts Health Reform Law <ul><li>“Individual mandate” </li></ul><ul><li>“Minimum credible coverage” </li></ul>...
Individual Mandate <ul><li>Required to have health insurance that meets minimum credible coverage,  OR </li></ul><ul><li>P...
Minimum credible coverage <ul><li>In 2009, health plans are required to: </li></ul><ul><ul><li>Cover prescription drugs </...
Types of Health Plans <ul><li>Programs for the uninsured individuals: </li></ul><ul><ul><li>Commonwealth  CARE : income  <...
Commonwealth  Care <ul><li>State-subsidized program for health insurance </li></ul><ul><li>At www.mahealthconnector.org --...
What is an “MBR?” <ul><li>MBR (Medical Benefit Request) is a form required by the state for many state-subsidized programs...
Commonwealth  Care   <ul><li>Not all plans are available across the state: the plans that  could  be available:  </li></ul...
Commonwealth  Choice <ul><li>Choice of six health plans: not all plans offered throughout the state: </li></ul><ul><li>Blu...
Commonwealth   Choice <ul><li>Three premium “levels”: </li></ul><ul><ul><li>Bronze : low premiums; most have deductibles a...
MassHealth Essential <ul><li>One of a number of MassHealth programs </li></ul><ul><li>For those who are unemployed for mor...
Health Safety Net / Free Care <ul><li>Not  insurance: two options –  </li></ul><ul><li>Provides protection for those witho...
Health Safety Net / Free Care <ul><li>To apply: </li></ul><ul><li>In general, complete an MBR </li></ul><ul><li>For “Medic...
Locations of Community  Health Centers and Hospitals <ul><li>Community Health Centers  </li></ul><ul><ul><li>www.massleagu...
Self-employed /  Small businesses <ul><li>“Insurance Partnership” </li></ul><ul><li>But it is NOT insurance: it is a state...
Remember the  “Golden Rule” <ul><li>To the extent possible:   </li></ul><ul><li>Always, always, always  </li></ul><ul><li>...
David’s Qualifiers <ul><li>Not  a comprehensive review of all  </li></ul><ul><li>federal and all state programs. </li></ul...
About David ….  <ul><li>www.linkedin.com/in/dpomer99 </li></ul><ul><li>dpomer99@aol.com or 617 650 0639 </li></ul>
Thank you very much! <ul><li>Questions anyone? </li></ul>
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Helping Job Hunters Navigate Their Health Insurance Options

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These PowerPoint slides are from a workshop I conducted at The Career Place in Woburn, Massachusetts on October 13, 2009: www.careerplacejobs.com/aboutUs.htm

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Helping Job Hunters Navigate Their Health Insurance Options

  1. 1. “ Helping Job Hunters Navigate Health Insurance Options” David Pomeranz The Career Place October 13, 2009
  2. 2. The purposes of this presentation … <ul><li>Overview of health insurance programs resulting from state and federal laws </li></ul><ul><li>Provide websites and telephone numbers </li></ul>
  3. 3. “ The Golden Rule:” <ul><li>IF YOU REMEMBER ONLY </li></ul><ul><li>ONE THING </li></ul><ul><li>FROM THIS PRESENTATION …. </li></ul>
  4. 5. To the extent possible: <ul><li>ALWAYS, </li></ul><ul><li>ALWAYS, </li></ul><ul><li>ALWAYS, </li></ul>
  5. 6. ALWAYS : HEALTH INSURANCE COVERAGE !!!
  6. 7. If you lose coverage, first check -- <ul><li>Does your spouse have a health insurance plan? </li></ul><ul><li>If so, perhaps it makes sense for you to be on your spouse’s plan! </li></ul>
  7. 8. Other health insurance options for job hunters … <ul><li>COBRA and its subsidy programs </li></ul><ul><li>2006 Mass. Reform Law’s programs </li></ul><ul><li>MassHealth Essential </li></ul><ul><li>Health Safety Net / Free Care </li></ul><ul><li>Insurance Partnership </li></ul><ul><li>Resources and Background Information </li></ul>
  8. 10. COBRA: what is it? <ul><li>Federal law requires employers to provide continuity in health insurance coverage </li></ul><ul><li>Typically lasts for 18 months but it can last for 36 months if, for example, you are a divorced spouse or an adopted child </li></ul>
  9. 11. COBRA: when does it apply? <ul><li>Loss of job </li></ul><ul><li>OR </li></ul><ul><li>Employer eliminates your coverage; examples: </li></ul><ul><ul><li>you change from full-time to part-time status </li></ul></ul><ul><ul><li>employer stops offering health benefit altogether </li></ul></ul>
  10. 12. COBRA: when does it not apply? <ul><li>When a company goes bankrupt, usually there is no reserve to pay for the employee health insurance benefit </li></ul>
  11. 13. If COBRA is in effect … <ul><li>Individual has to pay the entire health insurance premium plus up to a 2% administrative fee </li></ul><ul><li>BUT an employer’s group coverage is usually a better value than any non-group coverage </li></ul>
  12. 14. COBRA subsidy programs <ul><li>Federal stimulus law </li></ul><ul><li>State Medical Security Program </li></ul>
  13. 15. Federal stimulus law <ul><li>Job loss between Sept. 1, 2008 through Dec. 31, 2009 </li></ul><ul><li>Have to be COBRA eligible </li></ul><ul><li>Subsidy of 65% for 9 months of health insurance premium </li></ul>
  14. 16. Massachusetts’ Medical Security Program <ul><li>Eligibility: </li></ul><ul><li>Do not have to be COBRA eligible </li></ul><ul><li>Receiving Massachusetts unemployment </li></ul><ul><li>Household income < 400% of the federal poverty levels (FPLs) </li></ul><ul><li>Income is calculated for this Program: six past plus six future months of income </li></ul><ul><li>www.mass.gov/dua/msp or 800-908-8801 </li></ul>
  15. 17. What are “Federal Poverty Levels” (FPLs)? <ul><li>Income standards used to determine eligibility for public programs </li></ul><ul><li>Based on </li></ul><ul><ul><li>gross (pre-tax) household income </li></ul></ul><ul><ul><li>family size </li></ul></ul>
  16. 18. 2009-2010 FPLs for programs to be discussed $88,200 $66,150 $22,050 4 $73,240 $54,930 $18,310 3 $58,280 $43,710 $14,570 2 $43,320 $32,490 $10,830 1 400% 300% 100% Size Annual Household Gross Income Family
  17. 19. Medical Security Program: Two Options <ul><li>1. “Premium Assistance” for COBRA </li></ul><ul><li>2. “Direct Coverage” for when your company goes bankrupt </li></ul>
  18. 20. Medical Security Program “Premium Assistance” <ul><li>Up to 80% of premium </li></ul><ul><li>Can receive both federal and state COBRA premium subsidies if meet both eligibility requirements </li></ul>
  19. 21. 2006 Massachusetts Health Reform Law <ul><li>“Individual mandate” </li></ul><ul><li>“Minimum credible coverage” </li></ul><ul><li>Commonwealth Care: state-subsidized health insurance plans </li></ul><ul><li>Commonwealth Choice: non-subsidized health plans </li></ul>
  20. 22. Individual Mandate <ul><li>Required to have health insurance that meets minimum credible coverage, OR </li></ul><ul><li>Penalty of up to about $1,000 in 2009 </li></ul><ul><li>BUT there is an “Affordability Exemption” </li></ul>
  21. 23. Minimum credible coverage <ul><li>In 2009, health plans are required to: </li></ul><ul><ul><li>Cover prescription drugs </li></ul></ul><ul><ul><li>Cap deductibles at $2,000 per individual; $4,000 per family </li></ul></ul><ul><ul><li>Cap total out-of-pocket spending at $5,000 per individual; $10,000 per family </li></ul></ul>
  22. 24. Types of Health Plans <ul><li>Programs for the uninsured individuals: </li></ul><ul><ul><li>Commonwealth CARE : income < 300% of the Federal Poverty Guidelines </li></ul></ul><ul><ul><li>Commonwealth CHOICE : income > 300% of the Federal Poverty Guidelines </li></ul></ul><ul><li>www.mahealthconnector.org </li></ul><ul><li>Customer Service: (877) 623-6765 </li></ul>
  23. 25. Commonwealth Care <ul><li>State-subsidized program for health insurance </li></ul><ul><li>At www.mahealthconnector.org -- look for the link at the bottom left-hand corner of the web page </li></ul><ul><li>Need to submit a “Medical Benefit Request” (MBR) </li></ul>
  24. 26. What is an “MBR?” <ul><li>MBR (Medical Benefit Request) is a form required by the state for many state-subsidized programs: </li></ul><ul><ul><li>Commonwealth Care </li></ul></ul><ul><ul><li>MassHealth Essential </li></ul></ul><ul><ul><li>Free Care / Health Safety Net </li></ul></ul><ul><li>To request one: 888-665-9993 </li></ul>
  25. 27. Commonwealth Care <ul><li>Not all plans are available across the state: the plans that could be available: </li></ul><ul><ul><li>Boston Medical Center / Health Net Plan </li></ul></ul><ul><ul><li>CeltiCare </li></ul></ul><ul><ul><li>Fallon Community Health Plan </li></ul></ul><ul><ul><li>Neighborhood Health Plan </li></ul></ul><ul><ul><li>Network Health </li></ul></ul><ul><li>Not all doctors participate: call their offices </li></ul>
  26. 28. Commonwealth Choice <ul><li>Choice of six health plans: not all plans offered throughout the state: </li></ul><ul><li>Blue Cross Blue Shield of Massachusetts </li></ul><ul><li>Fallon Community Health Plan </li></ul><ul><li>Harvard Pilgrim Health Plan </li></ul><ul><li>Health New England </li></ul><ul><li>Neighborhood Health Plan </li></ul><ul><li>Tufts Health Plan </li></ul>
  27. 29. Commonwealth Choice <ul><li>Three premium “levels”: </li></ul><ul><ul><li>Bronze : low premiums; most have deductibles and co-payments / co-insurance </li></ul></ul><ul><ul><li>Silver : medium premiums; moderate co-payments; some have no deductibles; </li></ul></ul><ul><ul><li>Gold : higher premiums; low co-payments; no deductibles; </li></ul></ul>
  28. 30. MassHealth Essential <ul><li>One of a number of MassHealth programs </li></ul><ul><li>For those who are unemployed for more than one (1) year </li></ul><ul><li>Income is < 100% of the FPLs </li></ul><ul><li>Need to file an MBR; to request one: </li></ul><ul><li>888-665-9993 </li></ul>
  29. 31. Health Safety Net / Free Care <ul><li>Not insurance: two options – </li></ul><ul><li>Provides protection for those without access to affordable health coverage; for example, “Affordability Exemption” </li></ul><ul><li>People of any income can apply if they have medical bills for which they cannot pay: “Medical Hardship” </li></ul>
  30. 32. Health Safety Net / Free Care <ul><li>To apply: </li></ul><ul><li>In general, complete an MBR </li></ul><ul><li>For “Medical Hardship,” need to complete a special application </li></ul><ul><li>Help Desk: 877-910-2100 </li></ul>
  31. 33. Locations of Community Health Centers and Hospitals <ul><li>Community Health Centers </li></ul><ul><ul><li>www.massleague.org/HealthCenters-ByMap.htm </li></ul></ul><ul><li>Hospitals </li></ul><ul><ul><li>www.mhalink.org/public/mahospitals </li></ul></ul>
  32. 34. Self-employed / Small businesses <ul><li>“Insurance Partnership” </li></ul><ul><li>But it is NOT insurance: it is a state premium subsidy </li></ul><ul><li>Eligibility: 300% of the FPLs </li></ul><ul><li>Contact information: </li></ul><ul><ul><li>www.4IP.org </li></ul></ul><ul><ul><li>508-698-2070 </li></ul></ul>
  33. 35. Remember the “Golden Rule” <ul><li>To the extent possible: </li></ul><ul><li>Always, always, always </li></ul><ul><li>have health insurance coverage! </li></ul>
  34. 36. David’s Qualifiers <ul><li>Not a comprehensive review of all </li></ul><ul><li>federal and all state programs. </li></ul><ul><li>I have “vetted” the programs to the best of my ability </li></ul><ul><li>You have my permission to distribute this information. </li></ul>
  35. 37. About David …. <ul><li>www.linkedin.com/in/dpomer99 </li></ul><ul><li>dpomer99@aol.com or 617 650 0639 </li></ul>
  36. 38. Thank you very much! <ul><li>Questions anyone? </li></ul>

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