Massachusetts: You still have until WEDNESDAY NIGHT to #GetCovered!

Tue, 01/22/2019 - 9:38am

I've noted several times before that the Massachusetts Health Connector (MA's ACA exchange) is one of only a handful of states which has managed to break their Open Enrollment record for five straight years:

2014: 31,695 (major technical problems)

2015: 140,540 (complete platform overhaul)

2016: 213,883

2017: 266,664

2018: 267,260

2019: 284,969 and counting...

What's most remarkable about the current total is that the 2019 Open Enrollment Period hasn't ended yet in Massachusetts. Residents still have until midnight Wednesday, January 23rd to enroll.

Oh, yeah...and don't forget: Unlike most states, Massachusetts still has a healthcare coverage mandate law which imposes a financial penalty on MA residents who don't have adequate healthcare coverage (unless they qualify for a hardship or other special exemption):

Massachusetts has an “individual health insurance mandate” which requires most adults to carry health insurance if it is affordable to them and that meets certain coverage standards (referred to as “Minimum Creditable Coverage” or MCC). The Massachusetts Health Connector sets the coverage and affordability standards, and the Massachusetts Department of Revenue (DOR) administers the requirement via the state tax filing process. Please note that the standards described here are specific to the Massachusetts health reform law (not the Affordable Care Act, the federal health reform law).

Background of the Individual Mandate

Since the passage and implementation of the state’s 2006 health reform law, Massachusetts has achieved and maintained the highest levels of insurance in the nation. The individual mandate is one aspect of the shared responsibility among government, employers, and individuals that drove this success. The individual mandate requires adults to carry health insurance if it is affordable to them and meets the Commonwealth’s coverage standards.

Minimum Creditable Coverage (MCC)

Minimum Creditable Coverage (MCC) refers to the minimum level of benefits that adult tax filers need to carry in order to be considered insured and avoid tax penalties in Massachusetts.

For most plans, MCC standards include:

Coverage for a comprehensive set of services (e.g. doctors’ visits, hospital admissions, day surgery, emergency services, mental health and substance abuse, and prescription drug coverage)

Doctor visits for preventive care, without a deductible

A cap on annual deductibles of $2,000 for an individual and $4,000 for a family

For plans with up-front deductibles or co-insurance on core services, an annual maximum on out-of-pocket spending of no more than the annual limit set by the IRS for high deductible health plans. In 2016, out-of-pocket costs are limited to $6,850 for an individual plan and $13,700 for a family plan

No caps on total benefits for a particular illness or for a single year

No policy that covers only a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges