Uninformed about healthcare

November 19, 2015 2:31 PM

I'm about to age out of my parent's healthcare system (turning 26 late December) and as a stroke of unfortunate timing I'm completely out of a job right now. I'm incredibly uninformed about how the new US healthcare system is set up other than a vague knowledge that there's potentially a fine for not having insurance, but I don't even know how much or when it'd kick in. My question is, basically: As someone unemployed and living in Massachusetts, either how much would I have to pay to buy my own insurance (and where would I go to do so) or how much is the fee for me if I can't actually buy it?
posted by anonymous to Law & Government (16 answers total)

You go to healthcare.gov, start the sign up process, and look at the plans available to you in your marketplace. Here in Illinois plans for single folks are in the $120-250 a month range depending on how robust a plan you want. Call the 1-800 number hotline and talk to a helper. They will walk you through the process and even explain to you how to go and apply for medicaid through your state if that's the best option for you.

I'm in exactly this boat, unemployed and on a plan I found through the marketplace. A few years ago I would have been totally screwed.
posted by phunniemee at 2:41 PM on November 19, 2015

You need to find a healthcare navigator in your area. The service is free and they can explain what subsidies you are eligible for (aka how much you will have to pay), the plans available to you, and they can help enroll you. This is open enrollment season right now, so navigators may be busy, but keep trying until you connect with one! Here is a link to help you find a navigator in your state. The navigator in my state was super helpful, and essential to the process of getting insurance!
posted by kimdog at 2:43 PM on November 19, 2015

If you're unemployed, you may be able to get MassHealth, which is a low- to no-cost plan. I have some friends who are or have been unemployed and have taken advantage of MassHealth at different points. Your first step is go to to the Health Connector site and apply.

If you need help with the application, there are a zillion locations for getting help with a navigator (available at kimdog's link!) but if you're in or near the city, I think their main walk-in center is the one at 133 Portland Street near Government Center/Bowdoin.
posted by Kosh at 2:47 PM on November 19, 2015

Here in Oregon, I just wandered in to my local public health clinic and basically said "sign me up" and that's what they did.
posted by aniola at 3:20 PM on November 19, 2015

Seconding if you are unemployed, you may be eligible for Medicaid. If not, you can can a tax credit for marketplace insurance. The amount you get in tax credit towards your premium depends on your income, so the amount you pay may be much less than the amount phunniemie mentions.

Also, you can qualify for an exemption for paying the cost-sharing fee if you are low-income or have other hardship factors. The fee would be taken out of your taxes if you need to pay it.

Don't worry though, you are most likely eligible for healthcare you can probably afford. Find a healthcare navigator or call the marketplace number. They will also tell you if you are eligible for Medicaid.
posted by bearette at 3:29 PM on November 19, 2015

There are many exemptions from the requirement to have insurance.
Interesting, if you do incur a penalty, the IRS can only collect it by withholding a tax refund.

"The only way for the IRS to collect the fee for not having health insurance, if you choose not to pay it, is for them to withhold the money you would get back from your Federal Income Tax Refund from the IRS after you file your income tax return."

Of course, if you ever have a refund, they're going to get it.
posted by H21 at 3:49 PM on November 19, 2015

I'm an attorney in the Commonwealth who often deals with health insurers, including MassHealth. I am, obviously, not your attorney. Kosh is absolutely spot on. Getting health insurance through the connector is pretty easy. How much you'd have to pay to buy your own insurance is a question best answered by going to the connector's website, but if you have no income, the answer is usually going to be "not much, if anything at all."
posted by mattbcoset at 4:11 PM on November 19, 2015

https://www.healthinsurance.org/obamacare/obamacare-penalty-calculator/

That link should be a helpful place to start.

Also, yes, just go to your state's online marketplace. I have not done so, but everything I have read indicates that if you qualify for Medicaid or similar, the site should notify you.
posted by Michele in California at 4:40 PM on November 19, 2015

Yep, you are in one of the top five or so states to be in your situation. Massachusetts is the model for the affordable care act, and they are doing everything they can to make it easy to enroll.
posted by rockindata at 4:55 PM on November 19, 2015

I was on the Health Connector in MA earlier this year. I was employed, but not full time, was barely making enough to support myself, and paid $40 a month for great coverage. Highly recommended. A point of interest -- I was on a Health Connector plan, not a MassHealth plan (MassHealth is Medicaid, more or less). Friends of mine who were on MassHealth reported that it was very difficult to get care for specialty conditions, and long waits for doctors -- I had no such issue with the Health Connector. If you can come up with a little bit of money each month, it might be worth it to slightly inflate your anticipated income in order to get a Connector Care plan instead of Mass Health.
posted by femmegrrr at 5:28 PM on November 19, 2015

Friends of mine who were on MassHealth reported that it was very difficult to get care for specialty conditions, and long waits for doctors

The most recent "Patient Access to Care Study" from the Mass. Medical Society found "physicians’ acceptance of Medicare and Medicaid remains high." Wait times vary more by geography and specialty than they do by insurance. FWIW, all of the major academic medical centers and their affiliated groups (Partners, Caregroup, Steward) all accept MassHealth.
posted by mattbcoset at 6:08 PM on November 19, 2015

My only experience is with WA State Medicaid, but when I was on it, they assigned you a GP, and printed it on the health insurance card. A couple of weeks later, the clinic I was 'assigned to' called to schedule a checkup.
posted by spinifex23 at 6:28 PM on November 19, 2015

I have MassHealth. The short answer is go to the mass health connector and sign up. If your income is very low you will likely be put on MassHealth, but your insurance will be underwritten by a private company which you may be able to choose. The long story is that depending on whether you still live with your parents the time it takes to get on MassHealth could be measured in months.

Hospitals in mass. often have someone whose job it is to help people navigate the morass of bureaucracy... good luck.
posted by ennui.bz at 5:39 AM on November 20, 2015

The most recent "Patient Access to Care Study" from the Mass. Medical Society found "physicians’ acceptance of Medicare and Medicaid remains high."

also, access to doctors is quite limited in western Massachusetts. "Baystate" the company that runs most of the hospitals and outpatient clinics in wmass recently had a contract dispute with one of the companies which provides insurance for MassHealth. the solution was to put all of the effected MassHealth patients onto the insurance run by Baystate. All is not rosey... I have pretty much zero choice for primary care, where I live.
posted by ennui.bz at 5:49 AM on November 20, 2015

also, (sorry) on the other hand, if you can find a doctor, the coverage for MassHealth is excellent. most procedures will be free, no deductible. in addition, of you go to a state subsidized dental clinic, you can get a lot of dental care, free. I had two root canals taken care of, free!
posted by ennui.bz at 5:55 AM on November 20, 2015

Once you get health insurance, there is an excellent (pdf) guide that helps you understand how it works from the CMS: https://marketplace.cms.gov/outreach-and-education/downloads/c2c-roadmap.pdf

I would have killed for this kind of info when I got off my mom's plan.
posted by galvanized unicorn at 6:52 AM on November 20, 2015