Buying Health Insurance For The First Time
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Whether you choose a major medical plan, an HMO or a PPP, your plan will probably have some "cost-sharing" features. This means that you share the cost of care by paying part of the charge for each service and the insurance company pays the rest. Pick a plan that works best with the type of health insurance you think you will use. Different cost sharing features are listed below:
A deductible is the amount you pay before the plan starts to pay for most covered services. You usually must pay your deductible first, and then your other cost sharing begins, such as copays and coinsurance.
In Massachusetts over 70% of all employers offer health insurance as a benefit to their employees. Most of these employers pay part of the premium and also offer a choice of several health plans. You can choose the health plan that is best for you from the choices offered.
Massachusetts residents can buy health plans directly from an insurance company. And the company can't turn you down if you have a health condition. Sometimes the company will direct you to purchase their health plan through an intermediary. An intermediary is a company that takes care of the enrollment and premiums.
You may be eligible for subsidies to help you pay the premiums, depending on your income. Any Massachusetts resident can enroll in a health plan during the annual open enrollment period. Otherwise, you may be able to enroll at other times during the year if you have special circumstances (qualifying events). For example, recently moving to Massachusetts or recently losing your health insurance.
When choosing a health plan, it is important to consider the differences between your options. Some plans provide more generous coverage, while others could leave you responsible for high medical bills. Shopping for health insurance can be overwhelming, but remember, if the plan sounds too good to be true, it probably is.
Do not buy a discount plan as an alternative to health plan coverage. Discount plans charge a monthly fee in exchange for access to health care services at a reduced fee. These plans are not insurance and do not make any payments when you need health care services. Instead, they allow you to get a discount off of some of your medical charges. Discount plans may look like a cheap health plan, but they are not health insurance and they do not meet your Massachusetts "individual mandate" requirement for health coverage. You should check with your doctor or local pharmacist to ask whether you will receive any real savings before you give your money or your personal information to anyone offering health care discounts.
These plans allow groups of people with a religious affiliation to share in the costs of certain specified health care costs. HCSMs are not insurance and not supervised by state insurance departments. Members typically pay a monthly fee that allows them to submit qualifying medical expenses for sharing with other HCSM members. There are not specific consumer protections that apply to these plans. They may not guarantee any payments, and they do not necessarily pay expenses for the same kinds of services that health insurance covers.
Do not be fooled by bogus health plans selling on the internet or through unsolicited faxes or phone calls. You should always be careful when surfing the web. Review any website carefully and look for disclaimers such as "this is not insurance" or "not available in Massachusetts."
When you do find a health plan that looks like it meets your needs, check the Division of Insurance website or call to find out if the company is licensed to sell that type of insurance in Massachusetts before you commit to buying the product. Be careful not to give out personal information or make a payment in response to an unsolicited fax or without checking it out first.
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