Health Insurance in Massachusetts

How Do I Compare Health Insurance in Massachusetts?

Massachusetts is a unique health insurance market, because of the passage of a broad-based, statewide health care reform law in 2006 under Governor Mitt Romney. This plan greatly expanded health insurance coverage requirements within the state, and provides for free insurance to those earning less than 150 percent of the federal poverty level. The law also requires Massachusetts residents to obtain coverage or face fines. The basics of comparing insurance plans, however, are the same across the United States. 

Deductibles

• The first item to compare with competing plans is the deductible. This is the amount of money you must pay for medical care out of your own pocket before insurance benefits become payable. The higher the deductible, the more risk you have to your own pocketbook. Family plans typically combine all expenses for the family into a single deductible. But high deductibles also help keep premiums low. If you or a spouse is not covered by a plan at work, you may be able to qualify for a heath savings account/high-deductible health plan combination.
  

Coinsurance

• Coinsurance is the percentage of medical costs you must pay after you have already met the deductible for the year for yourself and your family. For example, in an 80/20 plan, the insurance company is responsible for 80 percent of costs over and above the deductible for the year; you must pay 20 percent. Your coinsurance is 20 percent. Coinsurance amounts range from zero to as high as 50 percent. The higher the coinsurance percentage, the lower your insurance premium, all other things being equal.
  

Co-Pays

• The next item to compare is the co-pay amount. This is the amount you must pay out of your pocket for each visit to a health care practitioner or for a prescription. This amount is generally between zero and $50. Some plans include a number of office visits with no co-pays, but charge co-pays once the customer has gone through the maximum number of no co-pays per year.
  

Exclusions

• Massachusetts has a comparatively generous list of required coverages. However, plans do vary. Check to see what maternity benefits your plan may offer, as well as coverage for prescription drugs and for alternate health care treatments such as chiropractor treatments.