How Health Connector fills gaps in coverage

In the previous columns, I’ve described how Medicare, Medicaid (called MassHealth in Massachusetts), and employer-provided insurance work. But what happens when an individual or family is unable to get health coverage from any of these programs?

For example, what if you make too much money to qualify for Medicaid? Or what if you work part-time for a company that only offers health insurance to people who work longer hours? Or if the small business you work for doesn’t provide insurance? Or what if you work in the ‘gig economy’, like driving for a rideshare company or delivering meal orders placed online, and are an independent contractor with no benefits?

The good news here is that you can probably get affordable health insurance.

Prior to the passage of the 2006 health care reform in Massachusetts and the 2010 enactment of the federal Affordable Care Act, if you fell into any of the gaps between coverage programs, such as those situations described above, you may have been forced to opt out. to health insurance coverage. This often meant that if you had a medical condition, it would get worse without regular follow-up care. People receiving treatment often had to go into debt to pay for that medical care, which could take years to pay off.

Now, thankfully, in Massachusetts, there’s coverage for most people.

The Massachusetts Health Connector was created under the state’s health care reform law to match people who were unable to obtain health insurance with an affordable plan available. All plans offer comprehensive services and meet the standards required by law. That means the plans cover things like prescriptions, doctor visits, or trips to the hospital emergency room.

The Health Connector concept was so valuable that it became part of the federal Affordable Care Act when it passed four years after the state’s health care reform and is now available in every state.

Some states refer to their agencies as a marketplace or an exchange, but here in Massachusetts we still call ours the Health Connector and approximately 220,000 Massachusetts residents get their health insurance coverage this way.

Health Connector provides Massachusetts residents with a menu of medical and dental plans, along with related cost information, so the consumer can make an informed choice about which coverage best meets their needs and fits their budget. By visiting the Health Connector’s website ( individuals can also determine the financial aid available to them.

Subsidized programs, for example, are available to individuals and families earning up to three times the federal poverty level, which is set at about $41,000 a year for a single person or just over $83,000 for a family of four. people. The price you pay for that insurance — called a premium — is much less expensive than what an insurance company might charge you directly for coverage. For example, premiums for people in this income group could range from $0 a month to around $140 a month.

People earning more than three times the federal poverty level may also receive a subsidy to help pay the premium, through a federal tax credit (i.e., a deduction from what they might otherwise owe in federal income taxes) that you gradually depletes based on their income and how much the plans available to them cost.

Even if you are not eligible for premium payment assistance, you can still get coverage through the Health Connector. Even small businesses with fewer than 50 employees, such as a small supermarket, gas station or neighborhood restaurant, can purchase their employee coverage from the Health Connector.

There are some rules, however, to getting health coverage through the Health Connector. You must live in Massachusetts and be a US citizen or legally in the country, such as through a permanent resident card or visa.

There are also only certain times you can sign up for Health Connector coverage. The Health Connector’s “open enrollment” period, which is when anyone can apply, runs from November 1st to January 23rd. You can sign up at other times when you’ve had what’s called a qualifying event, like losing your health insurance; a job loss or change; marry, divorce or have a child or adopt a child; and turn 26 and lose coverage under a parent’s plan.

Even with a resource like Health Connector, it can be difficult to understand the options and their complicated details. Fortunately, there are free services available throughout Massachusetts to help you understand your choices and choose a plan that works for you and your family. You can find a “health navigator” on the Health Connector website.

Health insurance is never easy and can be expensive, but it’s important to know that there are many resources available to make this coverage more affordable. More importantly, where large gaps in insurance coverage once existed, making it difficult to obtain coverage under certain circumstances, there are now solutions.

Audrey Shelto is president and CEO of Blue Cross Blue Shield of the Massachusetts Foundationa private non-profit organization whose mission is to ensure equitable access to healthcare for all who are economically, racially, culturally or socially marginalized in the Commonwealth.

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