Help Finding Health Insurance Coverage

Submitted by ananas33333 t3_10ekuov in boston

Hey guys, we'll be moving to Boston in the spring, and we're trying to figure out how to go about looking for health insurance. We won't be getting it from employment for the time being, and have to take our a policy ourselves.

In California, you can just use coveredca.com to see your options and find plans you qualify for. Is there something similar for Massachusetts? How would one go about finding policies, comparing coverage between them, etc?

As a side question: does anyone know if there is a separate process required to insure someone who is here in a fiancee visa, and is not yet a permanent resident (but will be after the status is adjusted)?

Thanks in advance, everyone

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lwsdy t1_j4rh321 wrote

Look on the state website to start

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ananas33333 OP t1_j4rilk4 wrote

not helpful.

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AlarmingMuffin77 t1_j4rjn0p wrote

Um, very helpful

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ghostlypyres t1_j4rkdqz wrote

Hey there, thanks for the reply. The site lists different options, and obviously for us it links us to health connector. The thing is, the website requires a mailing address at the very least, and we don't have one in Mass until after we move, obviously. I called them on the phone, and they were entirely unwilling to provide any information until I move and apply for something.

Moreover, they only do EPOs and not PPOs or even HMOs... That's not ideal, to say the least. Are PPOs not available in Massachusetts? That can't be the case...

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willzyx01 t1_j4rvl1k wrote

You can look at the plans and prices without giving a mailing address. Put in basic info and it will show you all the plans that are offered.

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-CalicoKitty- t1_j4ro9ho wrote

I have a PPO through my employer and used to have an HMO. Everyone I know under 60 has health insurance through their employer. If you can't get it through your employer or your spouse's, you'll need to get a plan through the state marketplace and it will be more expensive.

Sounds like you can't get it until you have a MA address, and I guess that makes sense as it's only available to MA residents. Are you eligible for COBRA to cover the gap temporarily until you establish residency?

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ghostlypyres t1_j4rpfwd wrote

Do all employers offer insurance up there? I currently work in Cali and will be going remote, and they don't offer insurance. I've got my own for the time being, but of course it's only for CA.

The state marketplace being the health connector, right?

I don't believe I'd qualify for cobra, but I believe it should be fine for the time being. As I understand it, I don't have a lot of time to source new insurance after I move, anyway, since the "qualifying event" of moving isn't indefinite

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-CalicoKitty- t1_j4rqal1 wrote

I think most employers offer it to full time employees. If you have a job lined up, you can check. Yes, the health connector. You're right, I think you have 30 or 60 days from the qualifying event to make the change. Otherwise you have to wait until open enrollment.

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lwsdy t1_j4rkn1j wrote

Obviously you didn't even look. We have our own version of Obama care and other options there. That being said I'm pretty sure that YES, it is a different process for anyone who is not a US citizen.

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ghostlypyres t1_j4rl1h0 wrote

We looked. How is Obamacare or similar useful for people above the poverty line and below the age of 65? There's health connector, but as ive been replying to everyone, they refuse to give any information until we are actually in the state, which we won't be until spring. They also told me they only do EPOs, not PPOs and HMOs. How is that possible? Does the entire state not have PPOs?

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bostonchef72296 t1_j4rmgbc wrote

For connectorcare insurance with a subsidy? Yeah, you are going to have to pick a network and get care within their network, but the networks are pretty generous if you pick a good plan. If you come to mass you can get signed up really quickly once you get here and depending on the plan they may even be able to make the coverage retroactive once you get signed up. Itā€™s to prevent people from out of state signing up for our stateā€™s health insurance marketplace paid for by our taxes and then using our hospitals when they live in a neighboring state like CT or VT.

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ghostlypyres t1_j4rnjih wrote

That makes a lot of sense, thank you for the reply. I'm glad to hear that at least the process sounds straightforward once we actually have a Mass address.

Are EPOs really the only option though? Even if the network is large or generous, it's a bit strange I think.

It's also a bit troublesome finding quotes online, most sites seem to just exist to harvest your information. That's part of why we're trying to find out in advance, in order to be able to budget. Coverage for 2 people seems to range wildly between like $400 and even $1600, and it would help vastly to Joe what to expect...

Thanks again for the reply!

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bostonchef72296 t1_j4rq4dw wrote

Of course. So, it ranges so much because there are different coverage options, and the amount of the subsidy, like in California (I presume, I havenā€™t lived there) depends on your income. You can pay as little as zero dollars (for Masshealth which is our Medi-cal) or for the tier 1 connectorcare which is not Medicaid but may as well be- it is very cheap copays and no deductible. If you make a higher income than that you get put to tier 2 which when I was on it for the cheapest option was around $88 (but there was an option that cost $300+) for one person and I have never experienced tier 3.

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ghostlypyres t1_j4rr7kg wrote

Thank you. My understanding of connectorcare is it's kind of like a subsidy based on income?

I actually remember coming across this, but it didn't sink in exactly what it meant. Do you know how they calculate your annual income? If it's hourly wage x 2080, or if they look at your paystubs and math it out from there... And is it pre- or post- tax?

I know I could probably maybe find this myself if I dug hard enough, and you've already been a great help, but I'd really appreciate it šŸ™

Edit: my understanding of the subsidy thing is due to the preview option on mahix, which says we qualify for a tax credit and says connectorcare plan type etc etc... But of course that's based off of the very rough estimate of income I put in

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bostonchef72296 t1_j4rs17q wrote

Yes it is a subsidy based on income. The application asks you what your hourly wage is, how many hours you work in an average week, but also if your hours are consistent and what you expect to make in a year, to account for seasonal work differences. If you are salary you can just put in your salary. It is pretax income.

I am more than happy to help because when I had to do it my first time I was SO CONFUSED and I would have loved for someone to have helped me

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ghostlypyres t1_j4rttrp wrote

Got it, thanks a bunch! I'd remembered that the site had that preview of what credits you qualify for, and that's where I'd seen the type whatever connectorcare. Using the info you gave me I re-calculated my current annual income (which I suppose unfortunately is a bit more than last year haha), and it shows that whole I don't qualify for connectorcare, I qualify for "Health Connector Plans with Advance Premium Tax Credit," and the subsidy it shows is only about $100 less than the connectorcare one, so that's not bad if it works the same way, I think!

If it's not too much to ask, would you mind if we possibly sent you a message in the future when it's actually time to apply, in case we need it? I totally understand if you'd rather not! You've actually done a lot to clear up my anxieties around this stuff already

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bostonchef72296 t1_j4rubkt wrote

that means that youā€™ll get some sort of subsidy. I may have worded mine not quite the same way the government does. But sure! Feel free to message me when you do apply. Iā€™ve applied loads of times and some of the questions can be confusing on your first time. My fiancĆ© just turned 26 this year so I did his application for him with his financials. He was overwhelmed. It took me 15 mins but would have taken him an hour.

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ghostlypyres t1_j4rux9s wrote

Gosh, thanks lots! I appreciate it. I just applied for health insurance for the first time in general here in CA and it took over an hour... But then looking at MA, and now with my fiancee on the plan instead of just myself, it sent my head spinning.

15 mins from an hour though, you've got it down pat haha

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bostonchef72296 t1_j4rwbdm wrote

Oh, Iā€™m an expert at this point with MA health connector. But damn, I qualified for Medicare from being disabled this year and that sent MY head spinning! Everything was so different! All of a sudden I had two insurances and then thereā€™s Medicare advantage plans, part d coverage, One care plans, etc. and I had no idea what I was doing. Not a single bill from Sept 1 2022 when I started Medicare to Dec 31 got correctly billed because Medicare had an ancient insurance on file and I had to spend tens of hours on the phone to figure out what was wrong and fix it. Some of those bills still ainā€™t right. Needless to say I wrapped my Medicare and Medicaid together into one plan (onecare) for 2023. (That may have made absolutely no sense to you and thatā€™s exactly what it felt like to me when I learned about Medicare for the first time.)

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ghostlypyres t1_j4ryjgf wrote

Oh my god. That sounds like a total nightmare tbh, I wouldn't even know where to begin with that stuff. I'm glad it sounds like you've almost got it sorted for this year though! My work entails a lot of contact with Medicare patients, but thankfully I don't need to know anything about it other than if they have it or not...

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bostonchef72296 t1_j4rmmdg wrote

Also no matter what they will cover ER care regardless of where it is at.

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twowrist t1_j4rxeeb wrote

I thought all of the marketplace web sites, regardless of state, are central starting points for all insurance except Medicare. ā€œObamacareā€ isnā€™t well defined and doesnā€™t always mean just people below the poverty line.

Anyway, the mahealthconnector.org site is a good starting point for everyone except for Medicare (remembering that Medicare means seniors or permanently disabled, not low income people).

The estimate button is a good starting point. It just needs a zip code, so take a guess as to your likely location. I donā€™t think thereā€™s much difference, if any, for the counties including and around Boston. Then youā€™ll have to drill down to the individual provider web sites.

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ghostlypyres t1_j4rywwg wrote

Thank you! I hadn't mentioned it but shortly after the post I'd made the facepalm level discovery that there are two buttons there, one prominent one to show you if you qualify for credits, and one less prominent that is exactly what you're describing. It helped to get an idea for sure. I'm also now planning to use that list to contact individual providers, as you mention. Thanks!

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twowrist t1_j4rxmk4 wrote

For your side question, you might get good answers at r/healthinsurance.

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ghostlypyres t1_j4ryldj wrote

Thanks for pointing us in the right direction! Appreciate it

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Firm_Love3598 t1_j4rz0dj wrote

I get an HMO plan through the connector. I donā€™t qualify for any discounts or subsidies. We are 49m and 39f, no kids. Monthly premium for a platinum level plan is $2388 per month, no dental coverage.

If you currently have health insurance where you live and will lose that insurance when you move you will be able to apply in Massachusetts under a qualifying event.

I find the health connector quite cumbersome and largely unhelpful when I have a problem.

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ghostlypyres t1_j4rzsfu wrote

You have an HMO through them? When I called this morning, the lady on the line insisted they only do EPOs... Good news, then;

But also that monthly premium is more than my rent will be :')

Yeah, the health connector has just... Not been helpful. Not the site and not the call center operators. That's why we asked here. Thanks for your response!

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Firm_Love3598 t1_j4s1sce wrote

There are certainly lower premiums available for HMO plans. We choose the platinum tier to avoid additional costs associated with healthcare. Our max out-of-pocket is $3,000, no deductibles, very low co-payment and prescription coverage is unmatched.

I have diabetes and a recent kidney transplant. I didnā€™t even reach my max out of pocket last year.

I imagine gold, silver, and bronze plans will be substantially less per month but if you have a medical emergency your annualized cost could be significantly higher than paying up front.

Most people here get their insurance through their employer. Iā€™m self-employed and she doesnā€™t work so this is our best option.

Good luck.

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ghostlypyres t1_j4s38xa wrote

That is a really nice plan, from the sounds of it!

Thank you, gonna need it šŸ™

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KatinkaVonHamhof t1_j4t508e wrote

An EPO is very similar to an HMO. Same sorts of network restrictions, but you typically don't need a referral, and a PCP is often not required.

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beepbopmeepmop t1_j4vchkz wrote

You can call the SHINE program (Serving the Health Insurance Needs of Everyone) to speak with a trained insurance counselor about your options. It's free to call 1-800-439-2370. It's a state funded program and they aren't affiliated with any particular insurance so won't try to sell you on anything.

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tandemtuna t1_j4tal9y wrote

Recent experience: the health care system in general, and Mass Health in particular, actively discourage advanced planning and won't meaningfully interact with you until you've had a qualifying event. We tried to arrange coverage in November/December to begin the 1st of January, and it was like talking to a brick wall.

Magically, January 3rd, the 1st business day after our previous coverage had expired and we were "qualified", all of the sudden folks were willing to talk to us. Somewhat miraculously, the customer service was actually pretty good once we were "qualified".

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ghostlypyres t1_j4tzg6e wrote

> it was like talking to a brick wall.

Same. That's the exact experience we're having, and what prompted this post. I didn't realize you also need a qualifying event during the enrollment period, though, that seems ass-backwards. What's the point of an open enrollment period if its not actually open?

>the customer service was actually pretty good once we were "qualified".

That's a relief to hear, at least. Hopefully they'll be similarly "accommodating" with our qualifying event of just... moving in to the state.

Thanks for sharing your experience, it really helps assuage the anxieties.

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