Contact Us | Directions |
Home About MassAHU Business Owners Individuals Healthcare Blog
 Individual's Responsibilities Under the Massachusetts Health Reform Act
Q 1.
What is the individual mandate?

The “individual mandate” refers to the responsibility of Massachusetts residents age 18 or older to carry health insurance that meets minimum standards set forth by the state.

Q 2.
What type of Health Insurance Plan Do I Need?

Any health insurance plan that is offered by an employer or can be legally sold in Massachusetts will meet the “individual mandate” or standards set forth by the state until January 1, 2009.

Q 3.
What changes will occur after January 1, 2009?

On January 1, 2009, the “individual mandate” will require you to carry a health insurance plan that meets the following criteria:

  • Covers prescription drugs
  • Covers regular doctor visits and check ups before any deductible
  • Caps the annual deductible at $2,000 for an individual and $4,000 for a family
  • Caps annual out-of-pocket spending for health services at $5,000 for an individual and $10,000 for a family if you have a deductible or co-insurance.
  • Does not cap annual total benefits for sickness.
  • Does not cap spending for time spent in the hospital.
  • Any high-deductible health insurance plan that allows you to have a federal Health Savings Account will quality.
Q 4.
Are there any exceptions to the law?

You can file a sworn statement with your Massachusetts income tax return that states that you either cannot afford health insurance or your religion does not allow you to have health insurance. Waiver forms [PDF]

Q 5.
What if I do not follow the law?

If you do not have health insurance by December 31, 2007 – paperwork must be completed by November 1, 2007 in order to be eligible – you will lose your personal income tax exemption. Therefore, you will receive approximately $219 less when you receive your state taxes back.However, in 2008 the penalty will rise to half of the lowest-priced Health Connector-certified plan for each month that you don’t have coverage.

Q 6.
What options are available to me for health care?
  • Commonwealth Care, provided by the Health Connector, is an insurance program for people with incomes who fall within certain guidelines and for those who do not meet other qualifications. Additionally, if you retire before you are eligible for Medicare you can enroll in Commonwealth Care if you meet the qualifications.
  • Commonwealth Choice, provided by the Health Connector is an insurance plan that is offered to residents, families, and small businesses that are not eligible for Commonwealth Care plans. They also offer a specific young adult plan that is available for 19 to 26 year olds. Additionally, if you retire before you are eligible for Medicare you can purchase plans through Commonwealth Choice.
  • Participation in your employer’s sponsored health insurance program – in 2009 you will have to make sure that the insurance benefits qualify under the new “individual mandate.”
Q 7.
Can I pick my own doctor with Commonwealth Care?

Yes, you can pick your own doctor and you will receive the following benefits: regular check ups, hospital treatment when you’re sick or injured, prescriptions at your local pharmacy, vision care, mental health or substance abuse treatment, and dental care for some members.

Q 8.
Who offers Commonwealth Care Plans?

Commonwealth Care Plans are offered through

  • Boston Medical Center (BMC) Health Net Plan,
  • Fallon Community Health Plan,
  • Neighborhood Health Plan, and
  • Network Health.
Q 9.
Who offers Commonwealth Choice plans?

Commonwealth Choice plans are offered through

  • Blue Cross Blue Shield of Massachusetts,
  • Fallon Community Health Plan,
  • Harvard Pilgrim Health Care,
  • Health New England,
  • Neighborhood Health Plan, and
  • Tufts Health Plan.

Massachusetts Association of Health Underwriters
. . . one of the most effective voices in the health insurance industry