Glossary

Federal Poverty Level (FPL)

The Federal Poverty Level, or FPL, is a measure of income level published each year by the Department of Health and Human Services. Federal poverty levels are used to help determine your eligibility for certain programs and benefits. The 2019 Federal Poverty Levels are used to determine who may be currently eligible for MassHealth programs. The 2018  Federal Poverty Levels are used to determine who may be eligible for Health Connector or ConnectorCare plans. 2019 MassHealth Income Standards and Federal Poverty Guidelines Family Size MassHealth Income Standards 100% Federal Poverty Level 5% Federal Poverty Level 120% Federal Poverty Level 133% Federal Poverty Level 135% Federal Poverty Level 1 Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly $522 $6,264 $1,041 $12,492 $53 $636 $1,249 $14,988 $1,385 $16,620 $1,406 $16,872 2 $650 $7,800 $1,410 $16,920 $71 $852 $1,691 $20,292 $1,875 $22,500 $1,903 $22,836 3 $775 $9,300 $1,778 $21,336 $89 $1,068 $2,365 $28,380 4 $891 $10,692 $2,146 $25,752 $108 $1,296 $2,854 $34,248 5 $1,016 $12,192 $2,515 $30,180 $126 $1,512 $3,344 $40,128 6 $1,141 $13,692 $2,883 $34,596 $145 $1,740 $3,834 $46,008 7 $1,266 $15,192 $3,251 $39,012 $163 $1,956 $4,324 $51,888 8 $1,383 $16,596 $3,620 $43,440 $181 $2,172 $4,814 $57,768 For each additional person add $133 $1,596 $369 $4,428 $19 $228 $490 $5,880 Family Size 150% Federal Poverty Level 200% Federal Poverty Level 250% Federal Poverty Level 300% Federal Poverty Level 400% Federal Poverty Level 1 Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly Monthly [...]

Monday, March 13th, 2017|

Metallic Tiers

The Health Connector plans are grouped in metallic tiers to make it even easier for shoppers to compare: Platinum plans have the highest premiums but the lowest co-pays and deductibles.  Learn more → Gold plans have lower premiums, but higher co-pays and deductibles than Platinum plans. Learn more → Silver plans have lower premiums, but higher co-pays and deductibles than Gold plans. Learn more → Bronze plans have the lowest premiums but the highest co-pays and deductibles. Learn more →   [youtube id="http://youtu.be/CpqbBTMxyKc" width="600" height="350" autoplay="no" api_params="" class=""]  

Tuesday, May 12th, 2015|

Premium tax credit (Advanced Premium Tax Credit – APTC)

A premium tax credit is money that the federal government pays directly to your insurance company every month so that you have lower monthly premiums. If you qualify for premium tax credits, you may be able to use some of the tax credit towards the purchase of dental insurance as well. Your tax credit is based on the income you and the people in your tax household expect to have during the year.

Tuesday, May 12th, 2015|

Open Enrollment Period

Open Enrollment is the period in the year when you can can enroll in a health insurance plan through the Health Connector Marketplace without a qualifying event. The 2017 Open Enrollment period ended January 31, 2017. Outside the Open Enrollment Period, you generally can enroll in a health insurance plan only if you qualify for a Special Enrollment Period. You qualify if you have certain life events, like getting married, having a baby, or losing other health coverage. Learn more → You can enroll any time of the year if: You qualify for MassHealth. You now qualify for a ConnectorCare plan through the Health Connector after not having qualified in the past, or after applying for the first time. You are applying for dental coverage. You are a member of a federally recognized tribe or Alaska Native shareholder. If you have have insurance from a job, job-based plans may have different Open Enrollment Periods. Check with your employer.

Tuesday, May 12th, 2015|

Out-of-Pocket Maximum

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges, or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count your co-payments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit. In Medicaid and CHIP, the limit includes premiums.

Tuesday, May 12th, 2015|

MassHealth

The Massachusetts Medicaid program. (See Medicaid, below.)

Tuesday, May 12th, 2015|

Essential Health Benefits

A set of health care service categories that must be covered by certain plans, starting in 2014. The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace, and all Medicaid state plans must cover these services by 2014.

Tuesday, May 12th, 2015|

Cost-sharing

The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and co-payments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost sharing in Medicaid and CHIP also includes premiums.

Tuesday, May 12th, 2015|

Co-insurance

A way of meeting your share of health costs under some health insurance plans. Co-insurance is based on a percentage of the cost of a service. Example: a plan may say that you pay 35% of the cost of a service. If a medical test costs $100, you would pay $35 for that test.

Tuesday, May 12th, 2015|

Annual Deductible

The amount that you or your family member(s) must pay before the health plan will pay for covered services.  Not all covered services are subject to the Annual Deductible. The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

Tuesday, May 12th, 2015|