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Kate Bicego Senior Consumer Education and Enrollment Manager How to Apply for Public Health Insurance Benefits in Massachusetts.

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Presentation on theme: "Kate Bicego Senior Consumer Education and Enrollment Manager How to Apply for Public Health Insurance Benefits in Massachusetts."— Presentation transcript:

1 Kate Bicego Senior Consumer Education and Enrollment Manager How to Apply for Public Health Insurance Benefits in Massachusetts

2 Agenda 1.What is Health Care For All? 2.Overview of public health coverage options 3.How to apply 4.Application and enrollment tips

3 What is Health Care For All? o Non-profit, health care advocacy organization o (Spanish, Portuguese, and English) o Fill out applications for free and low cost health care coverage over the phone! o We help to answer questions and troubleshoot almost any health care coverage issue.

4 Public Health Care Coverage Options in Massachusetts o Medicaid (MassHealth) o “Help paying for health insurance” via the Health Connector (Mass. health ins. marketplace) o Health Safety Net (“free care”) o Children’s Medical Security Plan (CMSP)

5 How to Apply (<65) A person can fill out the one application for MassHealth, the Health Connector, HSN and CMSP in one of these ways: Online: Over-the-phone: 877-MA-ENROLL ( ) In-person with a Navigator or Certified Application Counselor (CAC) NOT RECOMMENDED Paper application [NOT RECOMMENDED]

6 Online Application Process Step 1: Create an account (Optum ID) Step 2: Verify Step 3: Create an account (MAhealthconnector.org) Step 4: Complete ID proofing submit application Step 5: Fill out and submit application Shop Step 6: Shop for a health plan (if ConnectorCare or QHP eligible) Pay Step 7: Pay premium (if applicable) by 23 rd of the month

7 New Application Tips! The new online application is the only way to get a real-time eligibility decision. Use updated versions of browsers including Internet Explorer, Safari, Chrome, or Mozilla (Ex. Don’t use Internet Explorer 8) Clear your internet cache People without a credit history or Social Security Number may still pass identity proofing. Always include an applicant’s name as it appears on their Social Security card or immigration document Do not include symbols in names It takes 3-5 business days for identity proofing documents to be processed. A paper application can still be submitted if an applicant fails ID proofing, but you must also submit the ID proofing documents as well Try identity proofing for all members in the household before switching to the paper application.

8 How to Apply (>65) A person over age 65, or households with at least one person over age 65 (unless child under 19), or a person seeking long-term care services must fill out: Paper Paper SACA-2 application english.pdf

9 Who to Include on an Application o Applicant and applicant’s spouse* o Applicant’s unmarried partner if they have a child(ren) living with them o Applicant’s children that live with them or are their tax dependents o Any tax dependents claimed by applicant or applicant’s spouse/partner *Instructions for applicants who are married, but filing taxes separately: If you are helping an applicant with an online application and the applicant claims s/he is married but plans to file taxes separately from a spouse for tax year 2015, the applicant will not have access to tax credits or subsidies for that year. If the applicant expects to be unmarried or legally separated under a divorce or separate maintenance decree by the last day of 2015 the applicant should select “single” on the application. This will allow for the Advanced Premium Tax Credit (APTC) and other subsidies to be applied. If, however, the person ends up not being divorced in 2015 if they selected “single” on the application, s/he could be subject to a tax liability.

10 Who to Include on an Application o Applicant and applicant’s spouse* o Applicant’s unmarried partner if they have a child(ren) living with them o Applicant’s children that live with them or are their tax dependents o Any tax dependents claimed by applicant or applicant’s spouse/partner *Instructions for applicants who are married, but filing taxes separately: If you are helping an applicant with an online application and the applicant claims s/he is married but plans to file taxes separately from a spouse for tax year 2015, the applicant will not have access to tax credits or subsidies for that year. If the applicant expects to be unmarried or legally separated under a divorce or separate maintenance decree by the last day of 2015 the applicant should select “single” on the application. This will allow for the Advanced Premium Tax Credit (APTC) and other subsidies to be applied. If, however, the person ends up not being divorced in 2015 if they selected “single” on the application, s/he could be subject to a tax liability.

11 Helpful Documents for Application* o Social Security Numbers and dates of birth o Household income information (ex. most recent 1040 tax form, current pay stubs) o Immigration documents (ex. green card, certificate of naturalization) o Health insurance information and card(s) (if applicable) *It’s important to remember that an applicant does not need any document(s) to submit an application and should not delay submission because they do not have a document(s).

12 What to Expect After Submitting an Application o Online or over-the-phone application: An applicant(s) will receive a real-time eligibility decision.  If found eligible for MassHealth, the applicant can use their coverage right away. and  If found eligible for Health Connector, the applicant must select a health plan and pay their premium by the 23 rd of the month to start coverage for the 1 st of the next month. o Paper application: An applicant(s) will receive an eligibility decision in the mail within 45 days. does not  An applicant does not have coverage until an eligibility decision is made.

13 Application and Enrollment Tips Apply online, over-the-phone or in-person o Paper applications take longer to get processed. o Benefits may be delayed o Navigators and CACs can help

14 Application and Enrollment Tips Don’t wait to apply! o 90-day “provisional coverage” - applicants can get benefits while MassHealth waits for documentation

15 Application and Enrollment Tips Check off “yes” to the question: “Are you applying for health or dental coverage?” o Check off even if the person or family member already has MassHealth or Health Connector coverage o May lose MassHealth or Health Connector coverage if you do not check “yes!”

16 Application and Enrollment Tips Do not list income on the application that is “non-countable” including: SSI Child support Worker’s compensation Veteran’s disability payments SSDI for children that do not have to file a tax return Income for dependents that do not have to file a tax return Student loans or gift income

17 Application and Enrollment Tips Always respond to notices that request more information Provisional eligibility only lasts 90 days If a person does not respond to a notice from the Health Connector or MassHealth, they may lose their coverage.

18 Additional Application and Enrollment Tips o Make sure to answer all questions on the application o Fax information whenever possible o Use the homeless, pregnancy and disability check-off boxes when applicable o Fill in preferred language, race, & ethnicity o Permission to share (PSI) & Authorized rep. designee (ARD) forms o Make sure the applicant’s name, SSN,DOB, and Medicaid ID number are on all documents submitted & make clean copies o Provide pay stubs/income verification that is current and reflects current income situation and write how often applicant is paid o Remind applicants of the need to update the Health Connector or MassHealth with any changes in their household

19 Questions???


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