Obtaining Affordable Health Care in Massachusetts DECEMBER 2, 2011 BY LAURA CUNNIFF Laura Cunniff, Design and Media intern at ARTMORPHEUS, sat down with Health Care for All s Help Line Supervisor, Hannah Frigand, to capture a discussion on Health Care options in Massachusetts following the Health Care Seminar for artists of all disciplines that ARTMORPHEUS held with the Actors Fund and Health Care for All, in partnership with StageSource. This interview stems from the questions participants asked as well as FAQ. This information, though here catered towards artists, gives insight into the state of Massachusetts health care and the best available options to suit residents of every employment status. Health Care for All s handouts are posted in our Resources section. Q: So Hannah, you re a visual artist and a painter. How and why did you become involved with Health Care for All? HF: When I started off at school I was at Suffolk University at the New England School of Art and Design. I was a Fine Arts major, but I started taking my core classes and took a Public Policy class and I became really interested in that. I switched to Public Policy as my major and Fine Arts as my minor. I still paint but I really just got into How can I help people? What can I do to help people? I started volunteering at Health Care For All, and then I interned here, and now I have been working here for 5 years! Q: Do you think that HCFA is one of the best organizations that people can come to for guidance on affordable health care? HF: Health Care For All is pretty unique because we are a non-profit advocacy group that has a free helpline. Our help line is for any consumer in Massachusetts to call (1-800-272-4232). We take about 37,000 calls per year in English, Spanish, and Portuguese. We have a special set-up because we also have a huge policy division, so we can see what s working, what s not working, and actually get that put into policy. Q: Why should a person call the HCFA Hot Line and what free services do you offer? HF: All of our services are free! Regarding anything that is going to be about health coverage, you should give us a call. If we don t know the answer, we have a wide network of coalitions and organizations that we work with and can make referrals to. We do help with getting people health coverage and applying over the phone to get state programs. Health Law Advocates, our partner organization, is on the same floor as us. If you have medical debt or are denied a service we refer it to them and they do a lot of pro bono work. Health Law Advocates combine legal expertise with grassroots organizing and policy reform
to advance the statewide movement for universal health care access. They also provide free legal assistance to hundreds of Massachusetts families each year. Q: What is the Health Safety Net? Can it help people who have an insurance plan that does not cover all of their expenses? HF: The Health Safety Net used to be called the Free Care Pool but transferred names as of 2006 due to health reform in MA. It s the same program basically, and it covers people for services at community health centers and hospitals. It can be used as a back up for people if their coverage doesn t cover certain services or if they have deductibles. A lot of students call about using that as a secondary to their insurance as well as for dental coverage. Another reason people may be in the Health Safety Net would be if their immigration status doesn t meet the requirements for other benefits, they can get their care at community health centers or hospitals. If someone is over-income for other subsidized programs they may be able to get onto the Health Safety Net because it now goes to a higher income level. Q: With many students in Boston being from out of town, are they allowed to utilize the Health Safety Net as well? HF: You have to be a MA resident, which means you need an address in MA and that you plan on staying here sort of indefinitely, and most students fall under that category. Q: How does MassHealth/Commonwealth Care look at income when determining eligibility for subsidized insurance options? HF: When you re applying for MassHealth and Commonwealth Care, there s one application called the Medical Benefit Request Form. For income, they re looking for a snapshot of your current situation. You re not including your past income that s just ended, but just what you re doing right now. If you re self-employed that means looking at your most recent federal tax form. If that doesn t show your current situation, you d write a profit and loss statement, which you can do for a quarter or all of the past year, whatever is going to work for you. If you have W2 income it has to be current. If you re currently working at a place where you re getting pay stubs, include a couple pay stubs, or a contract, or a letter from your employer showing this is what I m being paid or if it s a set time period, this is the time period I m working for, so that they can calculate correctly. Q: How is household defined for this same application? HF: They do look at household a bit differently than you normally would when you re describing who lives with you. You don t include your roommates. If you re over 19 you wouldn t even include your parents, even if you re living with them. If you re married you include your spouse. If you are single but are living with the parent of your child, who is under 19, you include that person as well as the child. Always include the children that are living in your household that are under 19. They cannot be living outside of the household; you have to be the custodial parent to include them.
Q: Where can one fill out this form and other forms of proof? Can they come to HCFA? HF: We do our work over the phone at the Help Line (1-800-272-4232). You can give us a call and we can fill out the Medical Benefit Request Form over the phone, which takes us only a few minutes. We ll then send you the package to sign and a list of necessary verifications, personalized for your situation. The benefit of doing it with us is that we will follow up to let you know what the processing is and what your next steps are. We are also able to assist if you are being wrongfully denied. You can fill out an application at your local community health center or public hospital. If you need urgent care that s the best option because it will speed up the processing to a ten day period rather than a one month period. You can also find the form online or at www.ma.gov. Q: If I m uninsured will I be penalized on my taxes? How can I find out the amount I will be paying? HF: The answer is maybe. It depends on your situation. Your adjusted gross income is looked at to figure out the penalty. If you want to find out if you ll be penalized, and you ve been uninsured for over 63 days, go to www.mahealthconnector.org and use their affordability tool. Put in your household size, your adjusted gross income, and you can determine what would be considered affordable. If there is not an affordable option based on that chart, then you are waived on your taxes. Otherwise you find out what you ll be responsible for paying. You can also be penalized if you have coverage that does not meet the minimal credible coverage guidelines and have access to other affordable insurance. Q: Which type of coverage would not fall under the minimal credible coverage guidelines? HF: Minimal credible coverage guidelines were set by Health Reform Massachusetts defining health insurance. Health coverage has to have prescription benefits, it has to cover doctor s visits, and it can only have a certain amount of deductibles and out-of-pocket expenses. All of the Massachusetts programs (Commonwealth Choice, Commonwealth Care, Mass Health) meet these requirements. If you go outside of Massachusetts to find health insurance you want to make sure that it has the MCC check. Even if you re going through an employer you ll want to check that out. If it s an out-of-state employer, that s where it can sometimes get tricky and you ll really want to make sure that you are meeting all MA requirements. Q: How long is Commonwealth Care insurance good for and how often do you have to renew it? HF: With all the state programs, including the Health Safety Net, there is an annual renewal form and that s based off of when you apply. If you apply in November of this year, you ll get a renewal form in November of next year. Your
insurance should remain intact unless there s been a change in household in that time. If you move you ll need to update your address. If you get a new job, especially a W2 job, if there s a baby. All of these things you need to be sure to update. There could be a break in coverage otherwise. If you ve fallen off coverage in Commonwealth Care you ll just want to do whatever they ve asked you to do. If you didn t pay your premium it may just mean getting on a payment plan. You re not going to be barred form getting back onto coverage. Normally, you ll have insurance for the entire year and will be prompted to update that information once. Q: Why can I not go through Commonwealth Choice for care whenever I want to? Can you explain the difference between Commonwealth Care and Commonwealth Choice? HF: The connector is a semi-governmental office that was created due to health reform passing. And it oversees the two different insurance options. Q: Between Public and Private? HF: Exactly. Commonwealth Care [public] is subsidized based upon your income. Commonwealth Choice is not income-based. Commonwealth Choice is private insurance, which basically operates like a shopping mall--a shopping mall of credible insurance options where you can compare the policies side-by-side. The reason to go through Commonwealth Choice instead of just calling Blue Cross Blue Shield or Harvard Pilgrim directly would be this easy comparison. It s going to be the same plans offered when you contact them directly but there might be a slight difference in the cost just because of administrative fees. The reason why you have to sign up during a certain time period to get Commonwealth Choice is because of a law that was passed in October of 2010 called the Chapter 288 Law. Insurance companies saw that there were some people going on coverage when they were sick and off when they were healthy. We hadn t seen this as huge problem and we re advocating for some changes for the law to be more flexible. As of now, there s only one time of the year that you can purchase private insurance plans, between July 1st and August 15th. If you are losing coverage however, you have what is called a qualifying event. If you re on COBRA through your former employer, and that plans exhausting since it s been the full 18 months allowable, or if it s too expensive, you can drop it and go onto a Commonwealth Choice plan. If you re losing your coverage because you re over income, you can go onto Commonwealth Choice. Also, if you are new to the state. As long as you ve had insurance coverage for the last 18 months without a 63-day disruption, you can register outside of the normal time period. You have a 30-day period to register after this qualifying event occurred. Definitely give us a call when you are going through these situations, because it is confusing, there are a lot of regulations around it, and you don t want to miss
the time period in which you can get coverage. Q: What are some things a person should look for when choosing a private health care plan? HF: I always recommend going through the connector first when you are choosing a Commonwealth Choice plan. If you re searching on your own, you might be looking out-of-state, which won t actually cover you here, or won t meet the MCC requirements for coverage. The Commonwealth Choice plans are grouped like the Olympic medals: bronze, silver and gold. Bronze will cost you the least monthly for your premium but would have a lot of out-of-pocket expenses when using it. If you are somebody who goes to the doctor a lot, or needs to be able to use a lot of medical equipment or prescriptions that might not be the right fit for you. There will be deductibles you ll have to meet before your benefits kick in, which could end up costing as much as the next, or even two levels up. The other thing to look for is co-insurance. Co-insurance is a percentage of the cost of medical services that you would have to pay. If you re paying 50% of medical services and you go to the hospital, that s going to be a big bill. Silver will have a little bit less of the outof-pocket cost and a little bit higher of a premium. Gold is going to have the lowest out of pocket and the highest monthly premium. Another thing to look for, a new thing, is called a tiered network. A tiered network is when you have different networks costing different amounts for the same services under a private insurance plan. Usually it s based off of the cost of the hospital to the insurance company. Something important to know is that paying a higher co-pay does not mean you re getting higher quality care. You want to make sure that you are going to the doctor that s right for you while paying the amount that s right for you. Q: While shopping around for private health care are there false plans that people should look out for? HF: Yes. The website I keep mentioning, www.mahealthconnector.org actually has a mock site www.mahealthconnector.com, which offers insurance brokers that will ask you for your information and contact you, even if they are out-ofstate. Many of these plans don t meet the requirements and may not even cover you as a MA resident. We ve had issues with specific insurance companies that are not allowed to do business in MA, that have changed their names to try to get in, so you have to be really careful. Q: If a subscriber moves out of Massachusetts, mid-plan, is there a possibility of transferable coverage? Are you billed for ending coverage? HF: In Massachusetts all of our plans are based on being a Massachusetts resident. If you move out-of-state you no longer qualify and you would need to update your insurance company of this. If it s an employer-specific, national coverage, you may be able to still qualify. There is no penalty for this.
Q: How do most health care plans regard usage of Emergency Room Care? Is it more expensive? Are people discouraged from using it? HF: The emergency room should be used for emergencies only. Most insurance companies do factor that in to their cost structure. It s more costly to them, it s more costly to the hospitals, and it s more costly to the consumer as we all have to pay more when people are using the emergency room incorrectly. Oftentimes that means a higher copay, especially when you are not admitted. Usually it s waived when you are admitted. We do try to get people to go to the right avenue for their care. Q: With 98% of Massachusetts residents now covered under the new legislation is there more hope that patient-centered care becomes a reality? What are the main benefits of such? HF: This is absolutely what our focus is as of now, and it s not just HCFA alone. We have a lot of partners in this including the governor. It s moving how we pay for services in a new direction. HCFA is in this conversation making sure there is a focus on the patients. The payment structure should be centered on quality care for the patient. This movement is called the Campaign for Better Care. Q: Where do you see the patient right now in the system? HF: It s hard for the patient right now because there are a lot of different players in the healthcare system. There are hospitals. There are for-profit/not-for-profits. There are doctor s, pharmaceutical companies, insurance companies. Then there s the consumer. All of this competition puts consumers in a precarious place because you re trusting the doctors and the hospitals you go to fully. It s hard to be educated on everything in order to make the best decisions possible. Now we re trying to move towards transparency, enabling doctors to easily talk to each other so that there isn t a disconnect, and allowing the consumer to choose services more easily. Q: Do you see MA as a leader in health care and health care reform? And as a practical place for artists to get care? HF: Absolutely. Massachusetts is a unique state. I started working here before health reforms had passed, in the beginning of 2006. This was just a few months before MA health reform passed, but at that time we were only getting 100-150 calls per week and weren t really able to connect people to that many insurance options. A lot of people were using the Health Safety Net, then called Free Care or the Uncompensated Care Pool. That was costly to the system because it didn t provide individuals with coverage at private doctors, which meant more people going to clinics and emergency rooms. Less people were qualified for Masshealth, and Commonwealth Care didn t exist. Then, there was a huge change in the private insurance market. The small group and the individual market actually emerged due to MA Health Reform. These were all changes that happened in a short amount of time. Health Care For All helped get Health Care on as a ballot initiative, then getting it
passed, and then with proper implementation. We made sure people like artists with unique income sources and who go on-and-off jobs with contracts, how can they get care regularly and consistently. It was key having organizations such as HCFA having a part in the conversation of implementation here, and that s going to be key with National Health Reform. Q: Because you re taking calls from people directly and connecting these issues to policy makers HF: Exactly. Seeing that this will be a problem, and it will affect these populations, and figure out how to change that. And that s huge, and MA was the example of National Health Reform. Out executive director went to work for Ted Kennedy after he left us and helped in writing the National Health Reform directly. Q: Do you see the next step in reform directed at lowering costs, since we have the highest premiums in the country? HF: We don t actually! That s recently changed, we re now somewhere around number 9 I think, which is great. But yes it is still expensive, which is what we re now working on here, part of the payment reform. Q: Does it factor in that MA has a higher medium income? HF: It s interesting because usually the fact that MA has a higher medium income than the rest of the country isn t taken into account when looking at our costlier insurance. This wasn t looked at when the new report came out. MA does have a history of having higher premiums but that s largely because we have really expensive hospitals that are some of the best in the world. We have more doctors than most states and we are paying for the quality. Also adding to the cost is the fact that we do not discriminate based on preexisting conditions. Maybe only a handful of states have that right now, which is something that s changing with National Health Reform. We have a bad rep for the cost of insurance, but we are getting the quality we pay for. Q: What are your thoughts on the current standstill between the insurance providers Blue Cross Blue Shield versus Tufts Medical? And can you elaborate on the situation a bit? HF: Why Tufts was going to end their relationship with BCBS is because they aren t getting paid as much as the other hospitals in the area, as Boston does have a lot of great hospitals that are costly. They are now back in conversation [as of Nov. 22]. We re hoping this does get fixed, with our concerns mainly for the consumers. In regards to people purchasing a private insurance plan through BCBS, Will they get a special qualifying event to change their coverage because they are no longer able to get the care that they had been receiving? That s one question that could be raised depending on what the outcome of this discussion is. For people under employer coverage, we don t know what this will mean. We re on the lookout to see what comes up so that we will be able to provide answers.
Q: Coming from a non-profit that is fighting for artists, do you have any suggestions on how our artists and the art community can be more actively involved? HF: We have our Campaign for Better Care, which is part of our Payment Reform discussion. It s about the individual and the individual s needs, such as getting the care to be patient-centered. If you want to get involved in that, that could mean coming to rallies, writing op-eds, talking to press. It depends on what you feel comfortable with. You can also go to our website and fill in your information. Then we can get in touch with you to see what you d like to do! Q: One more closing question, Now that we re no longer the state with the highest premiums, do you still think this is our biggest issue and could lowering premiums be a reality? HF: We still agree that premiums are too expensive. That s something that we re focused on. We ve asked insurance companies for 2012 to not raise premiums, meaning an increase of 0%. The estimated increase at this time is at about 4.3%, and people react that s not bad, but if your income isn t going up 4.3% that could become a lot. In the past, we have seen it a lot higher at 12-15%, so it is great that it s lower, but we are looking for 0%. Thank you so much, Hannah. Any closing remarks on anything we may have skimmed over? HF: I would just say give our line a call (1-800-272-4232). Everyone has a unique situation, and it s helpful to just talk it out and figure out what s going to be best for you and your family. You can visit our website too. If you re in Massachusetts you re in a good place because there are options. We can help figure out which is the best one for you. Health Care for All is a Massachusetts organization dedicated to making adequate and affordable health care accessible to everyone, regardless of income, social or economic status. Frigand, an artist herself, began working with the organization after seeing a need to help educate people on health care during a tumultuous time in health care reform. ARTISTS-- also check out Health Care for Artists www.healthcareforartists.org, an artist run website for Massachusetts artists of all disciplines and artists run organizations. This site acts as an outreach/advocacy tool and is indebted to the Artists Health Care Working Group for all of its support and help. This free site is for individual artists working in all disciplines and the artist run organizations that aid them in navigating the Massachusetts Health Care Reform Law, its requirements and programs, and the existing available health care options. This site is also a resource for finding health care providers, health care resources and information, and health care advocacy organizations.