Massachusetts Discusses Minimum Creditable Coverage

Armen Hareyan's picture

It is the floor of benefits that adult tax filers need to be considered insured and avoid tax penalties in Massachusetts. Starting on January 1, 2009, specific benefits will be required under Minimum Creditable Coverage. Massachusetts-licensed health insurance companies must put an MCC-compliance notice on their plans to indicate if it does or does not meet MCC. Most do meet the MCC standards.

Check your plan to see if it meets the MCC standards for 2009. If you are uncertain, your employer's human resources department or benefits administrator can probably help you, if you get health coverage through your job.

What if your health insurance doesn't meet Minimum Creditable Coverage?

The Health Connector will offer a flexible and generous waiver and appeals process for 2009. Tax filers can also file hardship and other appeals with their 2009 taxes.

Benefits Required Under MCC

For most health insurance plans*, the 2009 "Minimum Creditable Coverage" standards include:

* Coverage for a comprehensive set of services (e.g. doctors visits, hospital admissions, day surgery, emergency services, mental health and substance abuse, and prescription drug coverage).
* Doctor visits for preventive care, without a deductible.
* A cap on annual deductibles of $2,000 for an individual and $4,000 for a family.
* For plans with up-front deductibles or co-insurance on core services, an annual maximum on out-of-pocket spending of no more than $5,000 for an individual and $10,000 for a family.
* No caps on total benefits for a particular illness or for a single year.
* No policy that covers only a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges.
* For policies that have a separate prescription drug deductible, it cannot exceed $250 for an individual or $500 for a family.


*Other ways of Meeting MCC

You meet MCC if you are enrolled in:

* Medicare Part A or B;
* Any Commonwealth Care plan;
* Any Commonwealth Choice plan (including Young Adult Plans);
* MassHealth (except MassHealth Limited);
* A federally-qualified high deductible health plan (HDHP);
* A Student Health Insurance Plan (SHIP);
* A tribal or Indian Health Service plan;
* The U.S. Veterans Administration Health System; or
* Peace Corps, VISTA or AmeriCorps or National Civilian Community Corps coverage...

Also, the Health Connector may deem collectively-bargained plans that are in force on Jan. 1 2009 compliant with MCC for up to one year after a collectively-bargained agreement has expired.

Individuals may be exempt from the tax penalty if they can validate that they have a firmly held religious belief that prevents them from enrolling in a health insurance plan.
Information for Employers, Unions, Plan Sponsors and Health Insurance Carriers on MCC Certification

There are health plans that meet the spirit, if not each and every letter, of the MCC regulations. Employers, unions, plan sponsors, and carriers that have or offer a plan like that can apply for an MCC Certification from the Health Connector.

If you do apply, you must demonstrate that the plan is comprehensive and the relative value of your plan's health benefits is comparable to the value of a Commonwealth Choice Bronze-level plan sold by the Health Connector. See the MCC Certification documents on this page (top right). Please check back within the next few business days.
Massachusetts Residents: Don't Think You Can Afford MCC-Level Coverage?

The state has standards that show what people should be able to afford. The mandate to get health insurance may not apply to you if the cost of your insurance options exceeds these standards or if you have a special exemption or hardship. Learn more or speak to your employer to find out if you might be eligible for health benefits through your job.