What to expect and how to prepare for when you call or go in person to see what your health care insurance options are. We recommend you print this page out. (This page was updated on 12/17/10)
If you are currently uninsured and you want to find out what is available to you in the way of health insurance options, you will first need to do some very basic things. (If you are insured you may also want to do some of the basic things listed below as well).
1) Start a file to keep all the paper work generated from your research and the paper work from the insurance you will eventually have to have under the individual mandate. You are encourage to make print outs from this web site and keep them in this folder.
2) If you are doing on-line research, start a file on your computer to store all of your files (back up those files!).
3) Get a notebook that is only for health care information, so when you are on the phone with an enrollment specialist and/or if you go in person to meet with an enrollment specialist you can take notes. Make sure you keep a record of the name of the person you speak and the date you spoke with them. If you are speaking to the person on the phone also make sure to record the date and time of your call. If you meet with an enrollment specialist in person, ask for their business card and staple it into your file or notebook for safe keeping. Also use this notebook to make notes at any health care seminars you attend.
4) Get your documentation in order: a) Find your pay stubs and make copies of them- if you don't have pay stubs, start to make copies of all the checks you are paid with and put them in your file. b) Find your last two years federal income tax returns and make copies of those (never bring your original income tax returns or give them to an enrollment specialist) c) Find the needed information to prove you are a US citizen (passport, Social Security card and/or your birth certificate- if you don't have a passport we recommend you get one- you never know when you might want to apply for an international residency) and the information to prove you are a Massachusetts resident (a mass license or ID, copies of utility bills/phone bills, bank statements, car insurance policy and/ or a lease in your name). You may also be asked to show a photo ID.
SOME TIPS FROM HEALTH CARE FOR ALL'S HELPLINE TEAM:
Things to provide to prove income:
For self-employed: - Copy of your most recent 1040 (long form) and Scheduled C's- If you do not have a recent 1040 then a Quarterly Profits and Loss statement on an accountant's letterhead (for most recent quarter) -
For combination income: - Include one of the above to prove self-employed income as well as a month's worth of pay stubs for any W-2 jobs you are currently working at (most recent pay stubs) -
For seasonal income - Make sure you indicate on the MBR that your current job is a seasonal job- Send in a month's worth of your current pay stubs (you will have to update when the season you are working ends) There is a discrepancy between the regs and what is practiced with seasonal employment, although it should be that one can send in their taxes as proof most of the time the MECs(state agency that processes applications) will only accept pay stubs as proof since it is W-2
5) Get a box of thank you notes to thank those who are nice and help you. These folks rarely get thanked for all of their hard work.
6) We also recommend that on your first checkup with your new doctor or visit the doctor you already have, make sure you tell your primary care doctor you are an artist and what discipline you work in. Be sure to tell them if you work with any materials that could be hazardous to your health and/or if do any kind of repetitive motion physical work/do heavy lifting etc., as a result of your art making. This is important for them to know in case you get sick or hurt so they can best help you.
What to do next....
We recommend if you don't have insurance or even if you do, to research what health care providers are geographically near you (a community health center or hospital). These providers usually have advocates on site to enroll and council people on their health care options. Even if you don't think you are eligible for any of the state subsidized plans/programs (MassHealth, Commonwealth Care, or the Insurance Partnership program) or already have insurance, these sites might be a good place to establish a relationship with for your medical care. The community health centers and many of the hospitals will continue to care for you whether you have insurance from a state subsidized plan, from a private insurer, or if you lose your private insurance.
SPECIAL NOTE for those researching Commonwealth Choice Plans and Young Adult Plans (the plans that are not subsidized)-or the Insurance Partnership, you can sign up on line for these plans BUT we urge you to speak to someone BEFORE you sign up for them to make sure you are not eligible for the subsidized plans (Commonwealth Care or a MassHealth Program). Again, Health Care for All's Helpline can help with this or an enrollment specialist at a community health center or hospital.
We strongly recommend that artists who have hard to determine income and/or if they are self-employed do not enroll or sign up for any health care program/health insurance plains via the Connector's websites or phone centers. Only use them 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 Helpline or an enrollment councilor from a community health center, hospital or a health care advocacy organization. Until the issues we have identified with the Connector's enrollment processes are corrected, it is best to follow this path. When the process are corrected we will post it on this site and will send out an email to this site's listserve.
For the Commonwealth Choice plans and Young Adult Plans you do not have to disclose/show what your income is. You will NOT need to prove you are a Massachusetts resident and meet citizen requirements to purchase these plans. You need to also understand what exactly the Commonwealth Choice plans cover and what they don't cover- the fine print matters! Note there is some new regulations impacting who and when one can buy private insurance plans in MA- more to come on this.
It is very important when you do interact with any of the enrollment specialists at the community health centers or hospitals, or with Health Care for All's Help line that you self-identify as an artist. Many are training their staffs to become familiar with artists' needs and are also keeping track of the number of artists who calls/interact with them. Some agencies and organizations have even designated a staff person to work specifically with artists (also if they are nice and you build a nice relationship with them you may want to ask them if they want to be on your mailing list for your art event/shows!). If you meet in person with an enrollment specialist, remember to ask for their business card to staple into your file or note book for safe keeping. Remember if you speak over the phone with some one- to write down their name and the date and time you spoke with them.
IN General if you are contacting an enrollment specialist at any of the above mentioned places for the subsidized plans/programs (MassHealth, Commonwealth Care or the Insurance Partnership Program), they are going to first ask you what your income is. They will ask to see your last two pay stubs and if you don't have them your last year's tax returns. Again remember the three categories we created for you to best describe your income to these specialists: W-2 Only Income, Combination Income, or Non W-2 Income/Self Employment Income. Make sure you tell them if your W-2 Income is temporary (ie you are adjunct professor etc.). They need to determine what your income is to see if you qualify for any of the subsidized health care plans. They will ask you to fill out a Medical Benefit Request (MBR). The Insurance Partnership also uses this form. You will also need to prove you are a Massachusetts resident and meet citizen requirements.
If you have any type of disability (even if it is mild) or chronic health condition, (remember your talking to the person is suppose to be confidential and you may want to ask them if that is indeed the case), you may want to see if there are any programs for available for you. Also if you have children it is important to disclose this as well. There are subsidized health programs specifically for children (even if you are not eligible for subsided care, your children might be).
If you do not qualify for any of the subsided plans due to your income level or if you can't qualify for Commonwealth Care due to its eligibility requirements, you have seven options: 1) you may want to see if you can qualify as a self-employed worker with the Insurance Partnership (IP) 2) you can see if you can afford the Commonwealth Choice Plans that were unveiled on May 1, 2007 or if you are age eligible purchase a Young Adult Plan (for ages 19-26) 3) you can see if your employer(s) is (are) going to offer you insurance due to the new law 4) you can join an association or group to buy group insurance BUT make sure their plans offered meet MCC requirements or else you will be fined by the state as if you have no insurance (the Insurance Partnership can help you find these associations/groups) 5) you can try to buy insurance as an individual from an insurance company 6) you can stay uninsured and be fined. 7) you can see if you are exempt from the mandate or attempted to get an appeal/waiver from the mandate.
You may be eligible for the Insurance Partnership if you have any type of self-employment income and/or if you pay out a significant amount of money to make your art work. The Insurance Partnership's enrollment for the self employed is slightly different than the enrollment for the subsidized health care plans. The IP is going to be looking for your gross income after your business expenses as one of the measures (Line 22 of your tax form). The IP enrollment specialist may also ask you for a profit and loss statement and/or a list of your monthly business expenses: what you pay per month for your studio, how much you spend on materials per month, your phone bill, your Internet bill, etc. Remember, if you enroll into the IP, you are not eligible for Commonwealt Care- so make sure you find out first if you are eligible for Commonwealth Care before you enroll in the IP.
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OTHER IMPORTANT TIPS FOR WHEN YOU DO GET HEALTH INSURANCE/HEALTH CARE- We recommend that you keep track of all the paper work generated from your doctor's visits in your health care folder. Make sure if you have a co-pay, that each time you pay your CO-pay you get a receipt for your payment. This is very important in case you get doubled billed by accident! Also make sure you tell your primary care doctor you are an artist and what discipline you work in. Be sure to tell them if you work with any materials that could be hazardous to your health and/or if do any kind of repetitive motion physical work/do heavy lifting etc., as a result of your art making. This is important for them to know in case you get sick or hurt so they can best help you.
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HOW TO FIND AN ADVOCATE TO HELP YOU FIND OUT IF YOU ARE ELIGIBLE FOR SUBSIDIZED HEALTH INSURANCE PLANS:
•Health Care for All's Free Helpline: 1-800-272-4232 (this help line is for individuals only)
Helpline link-and email form• The Massachusetts League of Community Health Centers (Directory)
• The Massachusetts Hospital Association (Directory)
Also see Community Partner's list to find an advocate near you: http://www.communitywalk.com/map/list/104183?order=0