Help Paying for Health Insurance
through the Massachusetts Insurance Partnership
If you live and work in Massachusetts and are covered under a health insurance plan through your employer, or are self-employed and buy your own insurance,
you may be eligible for state assistance to help pay your premiums.
This is NOT a health insurance plan (you keep your own insurance), but rather a premium subsidy.As of 3/11, a single person could make over $32,500/year and qualify; a family of four could make over $67,000.
If you applied in the past but made too much money, you should check the guidelines again. A couple of hours to deal with paperwork could result in up to $1800 per year in savings for individuals, over $6,500 for families. The forms may seem a little overwhelming, but think it through; if you qualify it's like paying yourself hundreds of dollars an hour for the time you spent filling out the paperwork.Massachusetts
requires residents
to have
health insurance.
If your employer does not offer health insurance, you must 'self-insure' by purchasing your own plan (visit the Massachusetts Health Connector web site or call 1-877-MA-ENROLL (TTY: 1-877-623-7773) for information on the plans available). If you don't have proof of insurance, you may lose some or all of any state tax refund you are owed. If you are healthy and have no accidents, this is usually much less than the cost of buying your own plan, but the whole idea is that you should have health insurance so you don't go broke if something unexpected happens!
True story: In February 2011, two people I know slipped on the ice and broke bones. One was at work,covered by a worker's compensation policy. The other was unemployed with no health insurance. The hospital and physical therapy bills were over $90,000! The hospital did a great job getting her emergency assistance, but she still had to pay over $4000 out of pocket.
Note that income guidelines and eligibility requirements are updated annually. The income and premium subsidy information given below should only be used as a guide - subsidies are based on a combination of income, family size and the employee's share of the health insurance cost.
Employees
- Must be between the ages of 19 and 64 (inclusive)
- Must be a Massachusetts resident
- Receive (or be eligible to receive) comprehensive health insurance through a qualified employer
- Meet income guidelines (for a single person the limit is $32,676, as of 3/11, adjusted annually)
- You
DO NOT NEED TO HAVE CHILDREN OR BE DISABLED
to qualify - You
CAN BE SELF-EMPLOYED
(but may be better off applying for Commonwealth Care; see Issues if You’re Self-Employed below) - You must provide proof of citizenship or that you are a legal guest worker
Employers
Employ 50 or fewer full-time employees
Offer, or plan to offer, comprehensive health insurance to its employees
Contribute, or plan to contribute, at least 50% of the premium costs
Example Savings
If you meet income standards, the Insurance Partnership may pay most of your share of your health insurance costs. At the lowest income levels, your monthly cost will be:- Children: $14 per child, up to a maximum of $56 per family (including all family members)
- Adults: $28 per adult (or $56 per couple)
For Example: $1,200 Family Premium, 50% Employer Contribution
- Employee share: $600
- Insurance Partnership contribution: $544
- Employee actually pays: $56
In this example, your employee would save $544 a month or over $6,500 a year.
(Note: if your health insurance deductions are done pre-tax, you would have to pay taxes on this, so your take-home pay would NOT increase by $6500/year; it would be that amount after taxes.)How to Apply
Residents of the greater Northampton area can contact Hampshire Health Connect at (413) 582-2848
for help applying for Insurance Partnership benefits or Commonwealth Care (available if your employer doesn't offer health insurance or you are self-employed), or to find out what resources are available if you have no health insurance.If you want to do it yourself, visit the Insurance Partnership web site, or call 800.399.8285 for more information and application forms
. When you fill out the application forms, don't leave anything blank. If something doesn't apply, write 'N/A' or put a line through it so they know you didn't forget. And keep copies of anything you send; you may need them later.General Notes
If your employer doesn't participate in this program, you can NOT get the subsidy even if you qualify.
There is no requirement for an employer to participate, and the administrative fee they receive may not cover their costs (especially if they add in the increased payroll taxes they have to pay when they reduce pre-tax deductions from your wages).The Insurance Partnership is a division of MassHealth
. A lot of paperwork will come from MassHealth, NOT the Insurance Partnership and a lot of it will be computer-generated form letters that you may think were a mistake. It can be confusing, but don't ignore any letters from them.If your application is denied, call the Insurance Partnership and go over the forms with them
(you did keep copies, right?). It could be as simple as someone reversing two numbers when they entered your information. They're pretty good, but everybody makes mistakes. If a phone call doesn't take care of the problem and you're sure you qualify, fill out the paperwork that came with your denial letter to request a hearing.You need to requalify each year.
Don't drop the ball on this! If you move, make sure the Insurance Partnership knows where to send any paperwork (and make a follow-up call a week or two later to confirm the new address is in their system). If they don't get your requalification paperwork back or it's returned by the post office, they may try to reach you through your employer but it's more likely they'll simply drop you from the program. Starting over from scratch is harder than requalifying, and if you do get back on the program, they don't make retroactive payments to cover the time you were off.Your taxable income will be higher if the Insurance Partnership starts contributing to your health insurance and your deductions are done pre-tax (which they usually are).
This could put you over the income limits for other programs or change how much assistance you receive from them. Usually the amount you receive from the Insurance Partnership is more than things like fuel assistance, but you should be aware of this.If you're thinking about a second job that will put you over the income limits, compare how much you will make to the value of the subsidy or other assistance you receive
, especially if that second job will increase your commuting or child-care costs. You may end up with less in the end.If your employer doesn't offer health insurance, you may be able to purchase a Commonwealth Care plan with premiums set based on your income
(visit the Massachusetts Health Connector web site or call 1-877-MA-ENROLL (TTY: 1-877-623-7773), but be aware that the July 2009 state budget cut coverage for approximately 30,000 legal, tax paying immigrants, so if you're not a citizen, this may not be an option. Smaller businesses are not required to offer health insurance at all. Larger ones may decide they would rather pay the penalties (which are much less than the cost of health insurance). Companies that offer health insurance now may drop it, as premiums can skyrocket from year to year (I've seen plans jump over 30% in a single year just because everybody was a year older and the group was in a new age bracket).Issues if You’re Self-Employed
Although self-employed people are eligible for the Insurance Partnership, it can be very hard to qualify.
When figuring income for the self-employed, the Insurance Partnership uses the business profit from the Schedule C, NOT the amount after deducting the employer's share of social security
(which the IRS lets you deduct on the form 1040). In addition, they will NOT reduce earnings by any ‘company-paid share’ of your health insurance costs, even though under employer plans the company must pay at least half that cost (and if you're self-employed, the IRS lets you deduct the same half on the 1040).This means your income will be counted as if it were 7.53% to 30%+ higher than an employee with the same total compensation
(1/2 your self-employment social security taxes, plus 1/2 your health insurance premiums).If you are disqualified on that basis, fight it! (you can request a hearing to review your application). You probably won’t win, but if enough people who are disqualified on this basis request hearings, the guidelines may get changed.
Important!
