Health Insurance 101

Understanding health insurance is an important part of finding a health plan that will work for you. Each plan has different benefits and costs. In some cases, the plan available to you is dependent on eligibility factors such as income and family size. We want to help you spot the differences now so that you can research the right plan and have the best care available to you later.

Step 1: What plan do you qualify for?

  • Depending on certain eligibility factors, 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.

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

Plan Type Description  Costs 
MassHealth MCO or ACO These plans are for those who qualify for no-cost insurance. Monthly premiums are covered in full. A small prescription cost may need to be paid by some members.
ConnectorCare This is a Qualified Health Plan and will meet the minimum credible coverage standards for a member to avoid tax penalties. Members are placed in the appropriate plan level depending on their income and other factors. Members who qualify for this plan type will get help paying their monthly premiums.
Qualified Health Plan (QHP) All Qualified Health Plans meet the minimum credible coverage standards for a member to avoid tax penalties. Members may choose their plan level depending on how often they expect to use their health insurance and how they prefer to pay for it. Some members under this plan will get help paying their monthly premiums. Other members will not qualify for financial help. 
Senior Care Options This plan is available to seniors ages 65 and up who qualify for Medicaid. Monthly premiums and prescriptions are covered in full. 

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 needed. 

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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