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, you may be eligible for state assistance to help pay your health insurance premiums. It’s available for the self-employed, too. It is NOT a health insurance plan (you keep your own insurance), but rather a premium subsidy.
As of 3/09, a single person could make over $32,500/year and qualify; a family of four could make over $66,000. 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. (Subsidy amounts and income guidelines keep changing, so please don't assume amounts on this page are correct.). 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.
Remember, health insurance is now mandatory in Massachusetts. 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 do not 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!
Note that income guidelines and eligibility requirements have changed several times as Massachusetts revises the law on this, and are updated annually (driven in part, I’m sure, by the condition of the state budget). 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 $32,508, as of 3/09, adjusted annually)
- You DO NOT NEED TO HAVE CHILDREN OR BE DISABLED to qualify
- You CAN BE SELF-EMPLOYED
- 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, the employee would have to pay taxes on this, so their take-home pay would NOT increase by $6500/year; it would be that amount after taxes.)
How to Apply
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 something. And keep copies of anything you send; you may need them later.
General Notes
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 put your information into the system. 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 make sure 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.
If the Insurance Partnership starts contributing to your health insurance cost and your health insurance deductions were done pre-tax (which they usually are) your taxable income will be higher. This could put you over the income limits for other programs or change how much you get from them. Usually the amount you get from the Insurance Partnership is higher than things like fuel assistance, but you should be aware of this.
If you're near the income limits and thinking about taking a second part-time job, consider how much you will make compared to the value of the subsidy, 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 offers health insurance but decides not to 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 usually doesn't cover their costs (especially if they add in the increased FICA taxes, etc. they have to pay when they reduce the pre-tax health insurance premiums they deduct from your wages).
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 again, the IRS lets you deduct that on the form 1040). For an employee, the company-paid share of social security and health insurance does not show up on their W-2’s and tax returns as part of their wages, but for the self-employed, it WILL be included when the Insurance Partnership looks at your income. The end result is that 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 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 eventually get changed.