The Basics on Massachusetts Health Care Reform for Individual Artists and Arts Businesses

(updated 4/9/09) *indicates updates

In April 2006, a piece of sweeping bipartisan supported Health Care Reform Legislation (known as Chapter 58 of the Acts of 2006) became law. This law has changed health care in Massachusetts and beyond. The key goal of this law was to move closer to universal coverage in this state by reducing the overall number of the uninsured in Massachusetts (which is estimated at 10 percent of the population). The responsibility for paying for the implementation of this new law has been spread to many sectors- individuals, employers, and the state government.

The uninsured, the insured, and the majority of employers all have new responsibilities under this law. This law is a work in progress. Requirements and programs are still being developed and have yet to be unveiled or implemented.

The law created a new independent State agency called the Commonwealth Health Insurance Connector Authority (the Connector). This organization is charged with implementation of the law and for creating the policies, programs, and regulations to make this law a reality. The Connector is also charged to set the standards that define what "creditable and affordable" health insurance coverage is for the State. This is also referred to as Minimum Creditable Coverage or MCC (in other words health insurance products purchased by individuals who are state residents will have to meet the MCC standards set by the Connector).

The Connector's mission, as stated on their web site is: "Promoting health care coverage across the Commonwealth ...The Connector serves as a bridge between eligible individuals, small employers, and health plans to promote affordable private health insurance to uninsured residents of Massachusetts. The Connector is overseen by a board of ten directors. Six directors represent diverse types of expertise and interests from the private sector, three of whom are appointed by the Governor and three by the Attorney General. It is managed by an Executive Director who reports to the Board of Directors. There are two major components to the work the Connector has undertaken: Commonwealth Care and Commonwealth Choice."

One key component of this law is the "individual mandate." Beginning on July 1, 2007, Massachusetts residents age 18 and older are required to have health insurance that is deemed affordable to them at their income level or they risk being fiscally penalized on their personal state income taxes. Those not in compliance with the mandate lost their personal exemption for their 2007 State Income taxes (estimated at around $200 for an individual). For the 2008 tax year and beyond, those not in compliance with the individual mandate may be assessed a fine each month they are without insurance (half the cost of the lowest-cost of the monthly premium of the health care plan deemed affordable to them). Please note that there is a waiver/appeals process from the mandate, which was recently finalized. The Department of Revenue (DOR) will be policing this part of the law, but the Connector will be granting the waivers from the fines and mandate. Even those who are insured will have to prove that they have insurance. Some people may be exempt from the Individual Mandate if there is no health insurance deemed affordable to them at their income level. We encourage you to print out our fact page on the "individual mandate". That section has links to online tools to see if you are exempt from the Mandate based on your income level. The 2009 fines were released by DOR in spring 2009 and they are posted on our individual mandate page.

It is important to be aware that starting on January 1, 2009, individuals, who are NOT exempt from the Individual Mandate, will have to have health insurance that is deemed affordable to them at their income level AND meets "Minimal Creditable Coverage" (MCC) standards set by the Connector. It is very important to note that the Minimal Creditable Coverage requirement is being phased in. So for 2007 and 2008, one will only have to prove they have insurance and the insurance does not have to meet MCC standards for those years. There are also exceptions for the MCC requirement- i.e. some people may be exempt from having to have insurance that meets MCC standards in 2009 and beyond. These are detailed in our Guide for Artists.

Those of you are currently uninsured and are reading this are probably quite puzzled and possibly rather upset with the "individual mandate" mainly because the reason why you do not have insurance is because you simply cannot afford it. The Connector is charged to create affordable and creditable health coverage options for the Citizen's of the Commonwealth. The Connector has created a State subsidized health care program called Commonwealth Care for eligible individuals and families whose gross income is at or is below 300 percent of the Federal Poverty Level (FPL). It is a sliding scale program that is based on one's level of income (payments/premiums are based on how much you earn before taxes). Those who are eligible for this program purchase these plans directly from the Connector. There are, however, eligibility requirements for this program and those are discussed in our Guide for Artists on this site. Enrollment for Commonwealth Care began on January 1, 2007 (note enrollment for those under 100 percent of the FPL began in Fall 06).

*300 percent of the FPL for an individual is approximately $32,508 (NOTE every April 1- the FPL amount will increase/be adjusted) and to find what 300 percent FPL for a family is, add an additional $11,232 for each additional dependent to amount for an individual (see the Insurance Partnership's web site for a better understanding of the FPL which is also referred to as income ceilings).

However, annual gross income for those who are self-employed, seasonal workers, don't have regular pay stubs, and/or have combination income sources (W-2 income, 1099 income, etc.), is determined differently from those with just W-2 income wages with regular pay stubs. Those whose income is not solely from W-2 income sources with regular pay stubs, should contact an enrollment specialist in person to determine what their income is. (Contact Health Care for All's Help line or an enrollment specialist at a community health center, hospital, or at a health care advocacy organization).

The Connector has also created a program called Commonwealth Choice that is not a state subsidized program, but rather it is a menu of lower cost health insurance plans provided by private market. This program is for those individuals who are not eligible for Commonwealth Care and/or can not afford the available private insurance on the private market. Employers with fewer than 50 employees may also participate in Commonwealth Choice. Commonwealth Choice plans were unveiled on May 1, 2007. As individual, you can buy the Commonwealth Choice Plans directly through the Connector OR you can purchase them directly from the insurance carrier/company, through an insurance broker, and/or through a membership based association/organization.

Also the Connector unveiled Young Adult Plans (YAP) for those who are 18-26 years of age. The YAP plans can only be purchased through the Connector. Please make sure you read our buyer beware information on the YAP Plans in our Health Care Options Available section of our Guide for Artists.*

*We have a specific section for arts businesses and arts employers to help them navigate the law as there are many new requirements for employers to follow and to be aware of.

IMPORTANT INFORMATION

Important news about enrolling in health care plans to avoid the tax penalty:

We recommend that you first find out if you are exempt from the mandate. To find out if you are exempt from having to purchase health insurance, see our individual mandate*section. Also see our FAQ's section as well. 

We strongly recommend that artists who have hard to determine income DO NOT enroll or sign up for any program/health insurance plan via the Connector's website or phone lines. Only use the Connector as a way to research your options. This is very important. It is best if you talk to a seasoned enrollment specialist from Health Care for All's FREE Helpline (1-800-272-4232) or enroll through an health care advocate at a health center, health agency or hospital to see if you are first eligible for a subsidized health plan and if you find out that you are not eligible THEN use the Connector to enroll in a non subsidized health plan (i.e. Commonwealth Choice plans). It is important to be able to have an enrollment specialist to be able to advocate on your behalf or with you if something does not go smoothly with your enrollment.

*Note you can buy Commonwealth Choice Plans directly from the insurance carriers and not through the Connector, so if you miss the DEC 24th deadline for buying a Commonwealth Choice Plan (mentioned in the below press release) you can buy that plan directly from the Insurance Carrier. However, you can only buy the Young Adult Plans (Yap) through the Connector (make sure you review our health care options section before you buy a YAP). Remember that the Penalties for 2008 and beyond are higher than the 2007 penalty.   See Community Partner's list to find an advocate near you: http://www.communitywalk.com/map/list/104183?order=0

There is a waiver /hardship process from the individual mandate*and one also for Commonwealth Care premiums (The AF will post the Commonwealth Care waiver/hardship process on our website after our team goes over them).

To contact the Connector- Information and enrollment material is available online at www.MAhealthconnector.org or by calling the Health Connector's customer service center weekdays at 1-877-MA-ENROLL.  

 

 

 

The information on this site is intended only for educational purposes and is not meant to be legal and/or tax advice. All information on this site may be reproduced for educational purposes with permission from Healthcare for Artists. No permission is needed for it to be downloaded/printed out for individual use. If you have questions after reviewing the information provided on this site, it is best to call an enrollment specialist or a staff person at a designated state agency or advocacy organization. Please help to spread the word about this site to other Massachusetts artists!