Introduction

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We all know that good health is important.  We also know that seeing a doctor even for routine preventive care can be costly.  Medical care for a major illness or injury can cost more than most of us can afford on our own.  Fortunately, you can get health care coverage to help manage these costs.  In fact, Massachusetts law now says that if you live in Massachusetts and you are age 18 or over you must have a health plan.

You now have access to many types of health plans and many ways to buy a health plan.  You also have certain protections and rights from the state and the federal government when you buy and use your health plan.  This guide will tell you about the plans that you can get, the ways you can get them and your rights under the law.

This guide will tell you about health plans that cover hospital and medical expenses.  These health plans do not pay for the cost of long-term care that is meant to help you to live independently.  If you would like information about long-term care plans, please see the “Long-Term Care Guide” at " Your Options for Financing the Cost of Long-Term Care "   or call 1-617-521-7794 to get a copy.

Many of the requirements discussed in this guide do not apply if your employer "self-funds" its health benefits plan. This “Self-fund” means that the employer pays your health claims from its own funds and does not pay premiums to an insurance company.  The employer decides the plan coverage, including employee eligibility, covered benefits and exclusions, employee cost-sharing and policy limits.  Federal law exempts these self-funded plans from state insurance laws, so these plans do not need to include state mandated benefits. You can ask your employer if your health plan is self-funded.

There are many special terms that are unique to health care and health insurance. There is You will find a glossary of terms at the end of this guide that explains many of the terms that are used.

Section I: Health Care Services

Part 1: What Are Health Care Services?
Part 2: Who Provides Health Care Services?
Part 3: How Much Does Health Care Cost?

Section II: Health Plans

Part 1: Do I Have To Have Health Insurance?
Part 2: How Do I Get Coverage In A Health Plan?
Part 3: What Are The Types Of Health Plans?
Part 4: What Is Covered In A Health Plan?
Part 5: How Do I Use A Health Plan?
Part 6: What Are The Costs Of Health Plans?

Appendix I: Finding Health Care Providers

Appendix II: Glossary Of Health Care Terms