Premium Assistance Plan
If you have the option of continuing participation in COBRA, your former employer's plan or a health insurance plan you previously purchased on your own, you may receive monthly subsidies in the form of reimbursement of your premium payments. Here's how this plan works:
- You must be responsible for 100% payment of the monthly premium.
- You may receive 80% of the actual premium paid, or up to $1,350 per month for a family plan and up to $550 per month for an individual plan.
- You must collect at least 10 days of unemployment insurance benefits for any month you are requesting reimbursement.
If eligible, you will be enrolled in the Premium Assistance plan with the same type of coverage (family or individual) you have on your existing plan. You must continue to pay your health insurance premium each month. The Medical Security Program will reimburse you upon receipt of a claim form with proof of payment.
Direct Coverage Plan
If you do not have the option of continuing a health insurance plan in which you were enrolled or if you did not previously have health insurance prior to applying for unemployment insurance benefits, you may be eligible to be enrolled in a Managed Care Organization (MCO) plan. The MCO plan covers office visits and screenings, wellness visits for infants and children, hospital care, and treatment for mental health and substance abuse, and prescription drug coverage. There are some co-payments required and you must choose a primary care physician (PCP).
You may be required to pay a weekly premium based on your family income and size. Failure to pay your premium will result in a loss of health care coverage for your and your family. Weekly premium cost will range between $0 and $27 per covered individual. Families with income less than 150% of the Federal Poverty Income Guidelines (FPIG), children 19 and under, disabled individuals, and pregnant women are exempt from premiums. You may apply for a premium waiver at any time. You may request recalculation of your premium once in any two-month period.
Overview of the Direct Coverage Program Benefits
Direct Coverage plan is administered by Network Health. Under the Direct Coverage Plan, members receive the following benefits and services:
- Doctors’ office visits and checkups
- Access to thousands of medical and behavioral health specialists
- Hospital stays
- X-rays and lab tests
- Vision services
- Emergency services
- Pregnancy and infant well-visits
- Plus great EXTRAS, and more!
More information on covered benefits and services is available at www.network-health.org/msp/
If your household includes someone who is pregnant, under age 19, or disabled, you and/or your household members may be eligible for more benefits at lower cost through MassHealth. For more information, see www.mass.gov/masshealth or call 1-800-841-2900.