The Medical Security Program (MSP) provides subsidized health insurance to many people who receive unemployment benefits in Massachusetts. MSP Premium Assistance will partially reimburse people who continue their employer’s coverage. However, for many people, it is a hardship to pay their monthly premium up front and then wait for reimbursement.
To make coverage available to eligible people who cannot afford to wait for reimbursement, MSP offers a Hardship Waiver allowing them to apply for MSP Direct Coverage. Direct Coverage provides subsidized insurance with no monthly premium.
To apply for Direct Coverage under a Hardship Waiver:
Applicants whose current incomes are at or below 200% of the Federal Poverty Level should automatically qualify for the Hardship Waiver regardless of their expenses.
People who did not have health insurance from their employer, or were not offered COBRA, are also eligible for Direct Coverage and do not have to show financial hardship. Please see our recent HAN meeting notes for more information about MSP.
Many thanks to Karen Landry for sharing the Hardship Waiver monthly expenses form over our HAN email discussion list. The form was developed by the Gateway Health Access Program at Heywood Hospital in Gardner.
Dental?
Hi - I am completely new to MSP as I am recently seperated from my Husband, and had been covered for both Medical/Dental by him. I wasoriginally told I had to pay MSP once we split up, but now that they have seen my pitiful earnings for last year, they have offered me full premium assistance. My only question now, is how do I find out what is covered inder this Premium plan? Is there dental? Are prescriptions covered - and how much/year? I have searched online in all the Gov't websites - and this information conveniently does not exist to the public. Any links you can provide would be most helpful!! Thanks, C.
re: Dental?
If you are receiving MSP Premium Assistance, then I assume that your ex-husband is collecting unemployment benefits and that you are on his COBRA plan. Is this correct? (If not, I am unsure what kind of health benefit you are receiving.)
If you are receiving MSP Premium Assistance, then the benefits are the same as the employer's plan (since MSP is just helping to pay the cost of COBRA). If dental is not included, or if prescription costs are high, my understanding is that you may also be eligible for benefits (such as dental care) paid by the Health Safety Net -- but for this, you must go to a community health center.
To find a community health center near you, use this directory: www.massleague.org/CHC/FindHealthCenter.php
If you are unsure exactly what benefits you are eligible for, I recommend calling Health Care For All's helpline at: 800-272-4232. They can help you figure it out. Hope this helps! I'll email you as well.
MSP and dental
I was told from Customer service @ MSP that I am quilified for Direct covergae I was layed off again in May. I needed dental for my 2 kids so I kept the dental portion of my COBRA from a previous employer and dropped the medical portion. I could not keep paying the up front costs. I then would only pay for dental and then submit the claim to MSP. They mailed me a letter stating they would not pay the dental portion only had to be both or nothing. Can they do this? I have to have dental due to a cleft pallete child. I can not find anything in there info. that states this. Any advice??
re: MSP and dental
My understanding from working on our FAQ about MSP is that MSP's policy is to pay for dental benefits only if they are included as part of a whole COBRA package (medical/dental).
There may be other ways to get dental care for your family, though -- especially considering that your child has a cleft palette -- so my recommendation would be to call Health Law Advocates at 617-338-5241 and explain the situation. They may have advice for your case. I'll also email you to see if there's another reference I should give.
Laura
How new COBRA premium assistance program changes MSP hardship
Outreach workers should be aware of some changes affecting MSP (including hardship) based on the new COBRA premium assistance program. The unemployment agency has a helpful fact sheet about this posted on their website with links to more detailed information. From www.mass.gov/dua follow the links to "help with health insurance" and "new federal subsidy for Cobra premiums."
The federal stimulus law created a new (temporary) program that reduces the costs of COBRA coverage for workers who lost their jobs after 9/1/2008 up to the end of 2009. Laid-off workers who are eligible for both the new COBRA Premium Assistance program and MSP will now only have to pay 35% of the cost of COBRA up front and will be reimbursed by MSP for 80%, bringing the net cost to the individual down to 7% of the full cost of continuation coverage. For example, this means if full COBRA cost $500, the worker must initially pay $175 (35%) & is reimbursed by MSP for $140 leaving a net cost of $35 per month.
While the MSP hardship rules haven't changed, the reduced cost of COBRA will mean more laid off workers will be able to afford COBRA. Continutity of coverage with COBRA is one important advantage of MSP premium assistance over MSP direct, and COBRA, unlike MSP, may continue after unemployment assistance ends.
Of course $35 per month may be too much for individuals with income under 200% fpl who are deemed eligible for a hardship if they ask for it. That's why it's so important to have MSP direct available too. But even people with income under 200% fpl may want to think hard about whether to take advantage of COBRA PA and MSP or ask for a hardship. With both subsidies the net cost of a $1000 COBRA family plan is just $70 per month. For some people COBRA PA may make more sense than MSP direct, for example those who anticipate being called back to work, or who have a group plan with broader coverage than MSP direct, or whose unemployment assistance is likely to end before the COBRA PA ends.
Re: How new COBRA premium assistance program changes MSP hardshi
Vicky,
Thank you so much for explaining that important factor (which I had left out)! I added a brief update to our original post, based on what you added.
Laura
Confused.. Commonweath Care medical ins. vs MSP
I applied for MA Health and was told I qualified for Common Wealth Care. I was on this for less than 2 months and received a letter stating I was not longer qualified (now receiving unemployment) and now have to re-apply for The Medical Security Program. The form is the same as when I first applied.
I cannot afford the Cobra option (over $600.00 per month). What are my options?
Thanks,
Confused!
re: Confused.. Commonweath Care medical ins. vs MSP
It is true that people on unemployment are not eligible for Commonwealth Care (though sometimes it can take the system some time to catch up, so you may not have known this at first). This is the form you should use to apply for the Medical Security Program: http://www.mass.gov/Elwd/docs/dua/2161_app_508.pdf It is a completely different application than the one you used to enroll in Commonwealth Care, and it will be reviewed by a different agency entirely!
In terms of your options: You may be eligible for both the new federal COBRA subsidy AND Premium Assistance from the Medical Security Program. If this is true, then you will only end up paying 7% of your monthly COBRA premium. So, if your COBRA is $600, then you would have to pay $42 a month. The way this actually works is that your employer would pay $390 a month of the total, before you are even billed for COBRA (they get a tax break for this), and then you would pay $210 BUT you would also get a reimbursement check for $168 a month from the Medical Security Program. If paying $210 a month up front and then waiting for reimbursement isn't going to be affordable for you, then you can apply for a hardship waiver from the Medical Security Program.
I'm sorry this is so confusing! I'm laughing at myself as I type this, because I'm trying to make it sound simple, and... it's not working. It is hard to explain this without using hand gestures, drawing diagrams, etc.
The other problem is that it is taking the Medical Security Program several weeks to process applications these days. If you have specific, urgent medical needs that make it difficult to go without insurance during that gap of time between your Commonwealth Care coverage ending and the Medical Security Program starting up, an outreach worker may be able to help you. You can find an outreach worker near you by using our map of outreach sites, or you could talk to one at the Health Care For All helpline (1-800-272-4232). Either way, though, during that gap in coverage you should still have access to some services at hospitals and community health centers through the Health Safety Net.
For more information about the federal COBRA subsidy and the Medical Security Program, you can use our Frequently Asked Questions about the Medical Security Program. If you need help with your application, you can call the Medical Security Program at 1-800-908-8801, call the Health Care For All helpline at 1-800-272-4232, or use the outreach map mentioned above to find an outreach worker near you.
Hope this helps! I'll email you also.
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