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1. Am I eligible for Commonwealth
Care?
2. Will Commonwealth Care take away my Medicaid
(MassHealth) coverage?
3. How much will Commonwealth Care cost?
4. What if I don’t pay?
5. How can I enroll?
6. What services does Commonwealth Care program cover?
You are likely eligible for Commonwealth Care if:
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You have been uninsured and ineligible for health insurance through
Medicaid/Medicare, your employer, or your spouse’s employer for the last six
(6) months.
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You or your family’s income before taxes is at or below 300% of the federal
poverty level. For an individual, that amount is $29,400/year. For a family of
four, that amount is $60,000/year.
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You have lived in Massachusetts for at least six months, are a U.S.
citizen/national, qualified alien, or alien with special status.
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You are age 19 or older. (Eligible persons under age 19 may be covered by
MassHealth. Both programs are covered by BMC HealthNet Plan.)
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Those who are legal state residents for at least six (6) months.
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For more information on eligibility, please visit the Commonwealth Connector
Web site: www.mahealthconnector.org
The State of Massachusetts will determine if you are
eligible for MassHealth or Commonwealth Care health insurance through the same
application process.
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Members below the Federal Poverty Level will pay no premiums and only have
small co-payments on prescriptions.
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Members with incomes between 100% and 300% of the Federal Poverty Level, the
premium will be shared by the State and the member based upon a sliding
scale.The less you earn, the less you have to pay.
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Depending on your income, you might be charged a co-payment when you receive
medical services.
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The State of Massachusetts has designed a benefit package/plan design based on
the income levels of members:
| Plan Type |
Income
|
Premium
|
Co-pays |
| I |
0-100% FPL |
None |
Same as MassHealth |
| II |
100.1%-200% FPL |
Low |
Low |
| III |
200.1%-300% FPL |
Low |
Moderate |
Note: Spending limits also exist to protect you from
unreasonable cost burdens.
Each month, the State of Massachusetts will bill a preset
premium based on income to members between 100.1% and 300% of the Federal
Poverty Level. If you do not pay the bill, you risk losing your coverage as
determined by the Connector.You may also be denied services if you do not pay
your co-payments before receiving care or prescriptions.
You can enroll at your local provider’s office through an
application called the Virtual Gateway. The law requires that you provide the
State of Massachusetts with income information, an employment record, note of
disabilities or illnesses, a list of family members, and other details. They
will then determine if you are eligible for either MassHealth or Commonwealth
Care. You will be notified of you eligibility in writing. Additional
information on how to enroll in BMC HealthNet Plan will be supplied if you are
determined eligible.
Commonwealth Care is comprehensive health care insurance.
It pays for office visits to your primary care provider, as well as
hospitalization, mental health and substance abuse services, pharmacy, vision
and dental benefits.
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) features.