Sunday, December 13, 2015

Masshealth is discontinuing the premium assistance program. Act now if you want free private insurance.

If you don't already know about the Masshealth premium assistance program, it's a program where Masshealth will buy children a private insurance plan. There is a brochure here that gives the basics.

Apparently they are discontinuing the program as of Dec 31 this year, which is unfortunate. They will continue to pay for plans indefinitely for people who are already participating or who enroll before Dec 31. It's convenient that right now is open enrollment for Blue Cross Blue Shield. (I don't know about other private insurance plans; Google is your friend). So, if you have Masshealth and you want private insurance for your child, here's what to do:

1. Call 1-800-422-3545, the Blue Cross Blue Shield of MA sales department. You can't buy a child-only policy online. Tell them you would like quotes for a child-only policy. If you have multiple children, explain that you need individual child-only policies, because Masshealth is paying. They will tell you you need a family plan. Insist on separate child-only quotes. Tell them you need a plan under $349 per month.* You will need to tell them your child's name, date of birth, and address. If you want to be able to use providers who are "out of network" (like, if you want to get reimbursed for therapies from therapists who don't bill insurance directly), ask for quotes for PPO plans. Otherwise, ask for the HMO and PPO plans and look them over and see what you prefer.

2. They will e-mail you a quote within a matter of minutes. Send that quote, along with your child's Masshealth number, to and state that you would like to see if your child is eligible for premium assistance. She generally does not call back or e-mail back, though if there is a problem or you do need to speak to her about something, she is very nice and very knowledgeable.

3. You will receive a letter from Masshealth within a few days saying you are eligible. The Commonwealth of Massachusetts will either mail you a check for the premium each month, or will direct deposit it if you have a direct deposit account on file because you receive other payments from them.

4. Enroll your child in the BCBS plan right away by sending all the necessary paperwork to the address on the forms that were included with the quote.

5. Note: Every December you will receive an odd form letter addressed to you (whoever enrolled the child and is receiving the payments), asking you to verify that your employee, [your own name], is still receiving health insurance benefits. They're actually asking you to verify that you are still paying for the BCBS plan for your child, and you'll need to send them your current contract with BCBS, or a bill, or whatever you have. I called them and was confused the first time I received this, and they said it's the same letter they use when Masshealth is reimbursing someone for insurance through their job. Right.

*If your child is certified by Masshealth as having a disability, which I believe means they receive SSI, the benefit amount will be higher, which means you could get a more expensive plan. In this case you should call 1-800-862-4840 and ask them to check and see what your child's eligibility is. If you haven't applied for SSI because your income is too much or child gets different disability benefits, you can do what we do and just go with the $349; I believe there is a process for getting your child certified as having a disability, but I'm sure you couldn't get it done by December 31.

No comments:

Post a Comment