A Beginner’s Guide to Health Insurance in Massachusetts

Choosing a health insurance plan can be intimidating. Between enrollment periods, the cost of plans, and determining which plan is the best fit, you may not even know where to begin. People may opt to go uninsured due to reasons like financial stress and confusion with the application process. However, Massachusetts law requires residents to have health insurance coverage, subject to a tax penalty.

If the law isn’t enough to influence you to get insured, hospital bills for uninsured patients can be extremely high. Emergencies can happen to even the healthiest people. Health insurance is important for everyone. Here’s a beginner’s guide to getting health insurance in Massachusetts.

Enrollment Periods

The Affordable Care Act (also known as Obamacare) makes insurance accessible to those with different financial situations by providing government assistance. In order to get an Affordable Care Act plan, health insurance applicants must sign up during the Open Enrollment Period.

Open Enrollment typically happens from November 1st to January 23rd. However, some special circumstances may qualify those who missed Open Enrollment to sign up for insurance during Special Enrollment. These circumstances include changes in income, loss of coverage, marriage, divorce, disability, and family changes.

Determining Eligibility

Massachusetts has many options for health insurance. Plenty of people are able to get health insurance through their employer or through their status as a student. If you meet certain financial requirements, are over a certain age, or have a disability, you may be eligible for Medicare or Medicaid.

Unlike most other states in the U.S., Massachusetts has its own official health insurance Marketplace. This is a great option for those who choose to purchase their health insurance. There are plenty of options available depending on factors such as medical needs, location, and age.

The health insurance Marketplace has four main categories of plans with varying degrees of coverage: Bronze, Silver, Gold, and Platinum. The higher the premium, the lower the out-of-pocket costs like copays and prescriptions. Those who visit the doctor more frequently may consider a plan with a higher premium, like Platinum plans.

Through the Marketplace, individuals can get information on various plans available under the Affordable Care Act and determine the best fit. From there, you can compare plans, get quotes, and apply online for a plan that fits your needs.

Becoming Insured

Once your application is approved and all the necessary fees are paid, you will receive a health insurance card in the mail with information about your plan, including your policy number, group number, copays, effective date, pharmacy network, and primary care provider. This card will help with visits to the doctor, filling prescriptions, and other healthcare needs.

Visits to the doctor may or may not be fully covered by your health insurance. You will typically be charged a copay before or after each appointment. The amount will vary depending on your type of plan. Some health services may be billed to you via the mail days, weeks, or even months after your appointment.

While signing up for health insurance may feel stressful, being insured is a necessary part of life. Once you’re insured, all you have to worry about is paying your monthly fees.