Microsoft PowerPoint - MTF_SHINE_FINAL_7_21

MassachusettsHealthConnector

ServingtheHealthInsuranceNeedsofEveryone(SHINE)

7/24/2017 1

The Health Connector

The Role of the Health Connector

 Health insurance exchange facilitating access

to private health insurance coverage

 Outreach and public education about health

insurance, how to access it and why to have it

 Policymaking and appeals related to the

Massachusetts individual mandate

 State partnerships

Who Uses the

Health Connector*

Connector Care 182,915

Tax Credit-Only 9,753

Unsubsidized 52,086

Total Health 244,756

Dental 72,238

Individuals

Health 5,967/1,435

(Members/Groups)

Dental 1,064/202

(Members/Groups)

* As of April. 2017. Up to date enrollment

data can be found on Mahealthconnector.org.

Small Businesses

Yes, you may qualify if you:

 Shop through the Massachusetts Health Connector

 Live in Massachusetts

 Are a U.S. citizen, national or are otherwise lawfully present in the U.S.

 Have income that is 400% of the Federal Poverty Level (FPL) or lower

You won’t qualify if you:

 Get coverage through Medicare, MassHealth (Medicaid) or other public health insurance

programs

 Are in jail at this time

 Are offered affordable, comprehensive health insurance from an employer

Note: If the cost of your employer’s health insurance plan for individuals is more than

9.66% of your income, that coverage is not considered affordable

Can you get help paying for Connector

health insurance?

Medicare Eligibility and the Health

Connector

Medicare eligibility is checked at time of application

 Remember, applicants won’t be able to qualify if they get coverage through Medicare,

MassHealth (Medicaid) or other public health insurance programs

The Health Connector also checks Medicare eligibility during it’s annual

Redeterminations and Renewals process, late summer

Whenever a member makes updates to his or her application

 They would get an Eligibility Approval notice, stating that we believe the member(s) are

eligible for Health Connector coverage, but no longer qualify for help paying for coverage (if

they were receiving subsidies)

Sample Ad-hoc Mailing

Can you keep a Health Connector

Plan Once Medicare Begins?

Yes,butinmostcasesit’stoyouradvantagetosignupfor

Medicarewhenyou’refirst eligible.

 EligibilitywillendforConnectorfinancialassistanceprograms,the

AdvancedPremiumTaxCredits(APTCs)orCostSharingReductions(CSRs)

− Exception:IndividualswhowouldpayPartApremiumsmayqualifytoretain

them

 IfyouwaittoenrollinMedicare

− MaypaylateenrollmentpenaltyforMedicareBorD

− MayexperienceagapincoveragewhenenrollingPartB

 NocoordinationbetweenMedicareandHealthConnectorPlans

 Reminder:MedicareAdvantagePlans,Medigap Plans,andfinancial

assistanceprogramsavailabletoMedicarebeneficiaries

Can you keep a Health Connector plan

once Medicare begins?

Ifyouare:

Canyoukeepa

MarketplacePlan

afterenrollingin

Medicare?

Areyoueligibletocontinue

receivingtaxcreditsandreduced

cost‐sharing?

Currentlyenro lled ina

HealthConnector plan

andbecomeentitled

toPremium‐freePartA

Yes

No.Anytaxcreditstheindividual

isreceivingintheplanwillbe

discontinuedoncePartAcoverage

begins.

Currentlyenro lled ina

HealthConnector plan

andbecomeeligible

tobuyPremium PartA

&PartB

Yes

Yes,ifyouonly enrollinPartB

(Bdoesn’tconstitute Minimum

EssentialCoverage).

No,ifyouenrollinPremiumPart

Health Connector

Drug & Dental Coverage

PrescriptionDrugCoverage

 PrescriptiondrugcoverageinHealthConnectorplansisNOT

requiredtobecreditable

− NeedtoverifycreditabilitywithplanorpossiblyfaceaPartDpenalty

uponenrollment

DentalCoverage

 InMassachusettseveryonecanpurchasea dentalplanthrough

theHealthConnector

− DentalCoverageisnotSubsidized

− Exception:IndividualswhowouldpayPartApremiumsmay

qualifytoretainAPTCsandCSRs

Enrollment into Medicare A & B

EnrollmentintoMedicareisautomaticforthosereceivingSocial

SecurityBenefits

 EarlyRetirement

 SocialSecurityDisability

OtherwiseindividualsmustenrollbycontactingSocialSecurity

duringtheirInitialEnrollmentPeriod

 7MonthSpecialEnrollmentPeriodaroundyour65

birthday

DelayedEnrollmentintoMedicare

 GeneralEnrollmentPeriodJanuary1–March31,effectivedateofJuly1

 10%premiumpenaltyforevery12monthsyoudelay(lifetime)

 Limitedavailability:EquitableRelief(discussed later)

Canceling a Health Connector plan

IfyouenrollinMedicare,youshouldcancelyourcurrentHealthConnector

healthinsuranceplan.

 Youcandothisthroughyouronlineaccountat MAhealthconnector.org,orbycalling

HealthConnectorCustomerService

 IfyouarethePrimarySubscriberforyourhealthplanandyoudecidetocancel,any

dependents(suchasaspouse)willneedtoenrollinanewplaniftheystillneed

cover age

 Ifyoudonotcancelyourplanandyouarereceivingan

AdvancePremiumTax

Credit,youmayhavetopaybackanytaxcreditthatyoureceivedinthemonths

afteryoubecameeligibleforMedicare

 Ifyou’reenrolledinaHealthConnectordentalplan,youcanstayenrolledinyour

dentalplanwithoutworryingasitisnotaffectedbybeing

eligibleforMedicare

Note thatHealthConnectormembersmustcanceltheirplansprospectively.Forexample,ifthe

membercancelsbeforethe23rdofthemonth,coveragewillendattheendofthatmonth.Ifthey

cancelafterthe23

,coveragewillcontinuetotheendofthefollowingmonth.

Understanding Your Medicare

Coverage Options

SHINECounselors

• FreehelpwithunderstandingMedicareisavailablethroughtheSHINE

Program.

• Tomakeanappointmentwitha counselorcall:1‐800‐AGE‐INFO(1‐800‐243‐

4636)andpress3orgotothelocalCouncilonAging

AdditionalcoverageoptionsmaybefoundonMedicare.gov

• MedicareAdva ntagePlans

(MedicarePartC)

• MedicareSupplementalPlans/Medigap Policies

• MedicarePrescriptionDrugPlans(MedicarePartD)

YoumayqualifyforprogramstoloweryourMedicarepremiums,deductibles,

copaysandprescriptioncosts.See SHINEforhelpwith:

 MassHealth,MedicareSavingsPrograms,ExtraHelpandPrescription

Advantage

Forindividualswhowereduallyenrolledinthe

HealthConnectorandMedicare

EquitableRelief

 Itwasrecogniz edbythefederalgovernmentthatConnector

andMarketplacesystemsarenotyetabletoprovideeasy

accesstoMedicareeligibilityinformationsomembersarenot

alertedinatimelyfashionthattheyneedtoapply

 TherearealsodisincentivestoapplyforMedicare‐ lossof

assistancetopay,potentialpenalties,socostswouldincrease

 Consequently,anadministrativeprocesswascreatedthat

allowspeoplewithMedicaretorequestrelieffromtheSocial

SecurityAdministration(SSA)

• ImmediateorretroactiveenrollmentintoMedicarePartB

and/or

• EliminationorreductioninaMedicarePartBlate

enrollmentpenalty

EquitableReliefEligibility

 Currentlyorwereenrolledincoveragethroughthe

Marketplace

• FederalorStateMarketplace(Connector)

• SHOPEnrolleesexcluded

 EntitledorenrolledinPremium‐Free Medica rePartA

• BecameeligibleforMedicareonJuly1,2013orlater

• Notcurrentlyin7monthInitialEnrollmentPeriod

MustapplywithSocialSecuritypriorto

September30,2017

EquitableReliefProcess

 ContactSocialSecuritytorequestEquitableRelief

• 1‐800‐772‐1213ormakeappointmentatlocal Social

Securityoffice

 CompleteaMedicarePartBenrollmentform

 ProvidedocumentationreflectingMarketplace

enrollment

• Periodicdatamatchnotice

• Marketplaceeligibilitydeterminationnotice

• IRSForm1095‐A

• Marketplacepremiuminvoicesandproofofpayment

NextSteps

 SocialSecuritywillinformindividualofMedicarePartB

enrollmentandeff ectivedate

• MedicarePartBcanbeginmonthofapplicationorif

requested,uptotwomonthsbeforeapplication

 Premiumsmust bepaidforallmonthsofMedicarePartB

coverage,ev enifretroactive

• Notification oftheMedicarePartBenrollmentwilloccurafter

theMedicarePartBcoveragestarts

• ConsiderremaininginHealthConnectorcover ageuntil

MedicarePartBenrollmentconfirma tion

 Ensuresnogapoutpatient/prescriptioncover age

 ResponsibleforfullHealthConnectorpremium

NextSteps:

EnrollmentinAdditionalMedicareCoverage

 MedicareAdvantage

• Musthave MedicarePartA&MedicarePartBtoenroll

• SpecialEnrollmentPeriod(SEP)beginsmonthofPartBenrollment

notificationandends2monthslater

• Mayretroactivetothefirstdayofthemonth

 MedicarePartD

• 2monthsspecialenrollmentperiodfromendofHealthConnectorplan

• Coveragewillbeginfirstdayofthefollowingmonth

 Medigap/MedicareSupplementPlans

• Musthave MedicareA&MedicarePartBtoenroll

• Continuousenrollmentperiod

 ContactSHINEor1‐800‐MedicareforEnrollmentAssistance

KeyMessages

 IfyouhaveMedicarealready,theHealthConnectorisnotfor

you.

 Inmostcases,ifyouhaveHealthConnectorcover age,it’sto

youradvantagetosignupforMedicarewhenyou’ refirst

eligible.

 EligibilitywillendforAdvancedPremiumTaxCredit(APTC)

orCost SharingReductions (CSR)

 DelayedenrollmentintoMedicarePartBmayincrease

yourMedicarePartBpremium

 It’simportanttoendyourHealthConnectorplaninatimely

fashionsothattherearenogapsincoverage.

 Thereareresourcesinyourcommunitytohelp.

Wherecanyougethelp?

SHINECounselors

 FreehelpwithunderstandingMedicareisavailablethroughtheSHINEProgram

(ServingtheHealthInsuranceNeedsofEveryone).Tomakean appointmentwitha

counselorcall:1‐800‐AGE‐INFO(1‐800‐243‐4636)andpress3

Assisters:

 Thesetrainedandcertifiedindividualscanhelpfromapplicationthrough 

enrollment

intonewhealthinsuranceplansandanswerquestionsabouteligibility,

application,payments,plandetails,andhealthcarereformrulesand requirements

 TofindanAssister,visithttps://www.mahealthconnector.org/help‐center

HealthConnectorCustomerService:

 TheHealthConnectorhasacustomerservicelineand walk‐incentersaroundthe

CommonwealthlocatedinBoston,WorcesterandSpringfield

 ForinformationonhowtocontacttheHealthConnector,visit

https://www.mahealthconnector.org/about/contact

7/24/2017

Resources

 SHINE(Ser vingtheHealthInsuranceNeedsofEveryone)counselors:

http://www.mass.gov/elders/healthcare/shine/serving‐the‐health‐

information‐needs‐of‐elders.html

 Enrollmentassistersearch:

https://betterhealthconnector.com/enrollment ‐assisters

 HealthConnectorhomepage:www.mahealthconnector.org

 Resourcedownloadpage(ShoppingGuides,GuidetoSubsidies,

ConnectorCare Overview,StandardizedQHPs):

www.mahealthconnector.org/help‐center/resource‐download‐center

 Customerserviceinformation(callandwalk‐incenters):

https://betterhealthconnector.com/about/contact

Questions