Health Insurance 101

Understanding health insurance is an important part of finding a health plan that will work for you. By following these steps you'll learn the basics about how eligibility works, the plan types available with BMC HealthNet Plan, and what to do once you choose the health plan that best fits your needs.

Step 1: How do you know what plan you are eligible for?

  • Depending on certain factors, like income and family size, you may qualify for help paying your insurance premiums.
  • The best way to learn whether you qualify for financial help is by going to MAhealthconnector.org and entering your personal information. The Health Connector will then tell you what you are eligible for based on the information that you provide. 

Step 2: Now that you know your eligibility, which plan do you qualify for?

Plan Type Description 
MassHealth MCO or ACO These plans are for those who qualify for no-cost insurance. Members receive access to preventive care services, specialty doctors, behavioral health services, prescription drug coverage, programs to manage health conditions, and extra member benefits.  Some Primary Care Providers exclusively partner with health plans (this is called an Accountable Care Organization). In this situation, you will need to join that health plan to keep seeing your doctor.
ConnectorCare Members who qualify for this plan will get help paying their monthly premiums. The amount of help you receive is based on family income and other factors. With ConnectorCare, members receive no-cost preventive care as well as access to specialists, behavioral health services, prescription drug coverage, and exclusive member extras. This plan meets health insurance coverage standards so that you can avoid tax penalties.
Qualified Health Plan (QHP) Some members who qualify for this plan will get help paying their monthly premiums. Other members will not qualify for financial help. The amount of help you receive is based on family income and other factors. You may choose your plan level (platinum, gold, silver, or bronze) depending on how often you expect to use your health insurance. With a Qualified Health Plan, members receive no-cost preventive care as well as access to specialists, behavioral health services, prescription drug coverage, and exclusive member extras. This plan meets health insurance coverage standards so that you can avoid tax penalties.
Senior Care Options This is a no-cost plan for seniors ages 65 and up who qualify for Medicaid. Seniors can get preventive care, specialty visits, and behavioral health visits covered at no cost. They also receive prescription drug coverage and extra benefits. Since no two seniors are alike, we assign a personal care manager that helps coordinate all care and services, such as scheduling medical appointments, transportation to appointments, interpreters and other services you might need.

Step 3: Choose your health plan and PCP.

  • Qualified Health Plans: Learn how to choose between Qualified Health Plans.
  • MassHealth: If you qualify for MassHealth, you should know the difference between Accountable Care Organizations (ACO) and Managed Care Organizations (MCO). The benefits for both of these plans are the same. The difference is the network of doctors that are available to you. You can visit the provider directory at any time to see which plan your doctor belongs to.
  • Choose your PCP: The doctor that you choose as your Primary Care Physician (PCP) must be in the provider network that is available under your plan type. Your PCP will provide all of your routine care and direct you to specialists when you need them. 

Step 4: Mark your renewal or open enrollment dates.

  • MassHealth members will likely need to renew their applications with MassHealth (not with BMC HealthNet Plan) every year. Mark your renewal date on your calendar! MassHealth will send you letters in the mail when it is your time to renew. Make sure that your address is ALWAYS updated with the state and with BMC HealthNet Plan.
    • There is a window each year called the Plan Selection Period when members can try out new plans. 
    • After that, there is a period called Closed Enrollment when members are unable to change their plan until the next try-out period, except in special situations. 

  • Qualified Health Plans have an Open Enrollment period in the fall of each year. This is the only time when members can switch plans unless they have a qualifying life event.

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