Health Insurance
In this section:
1619b
Section 1619(b) of the Social Security Act allows eligible individuals who are enrolled in SSI to continue Medicaid coverage when they earnings surpass the SSI requirements. Although Section 1619(b) is essentially a continuation of Medicaid coverage, it is an SSI benefit.
Eligibility
To qualify for continuing Medicaid coverage, a person must:
- have been eligible for an SSI cash payment for at least one month
- still meet the disability requirement
- still meet all other non-disability SSI requirements
- need Medicaid benefits to continue to work
- receive gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services
If an SSI beneficiary’s earnings exceed the requirements for an SSI cash payment, he or she may be eligible for Medicaid if the above requirements are met. SSA uses a threshold amount to measure whether earnings exceed the allotted SSI and Medicaid benefits.
This threshold is based on:
- the amount of earnings that would cause a person to become ineligible for SSI cash payments in Massachusetts
- the average Medicaid expenses in Massachusetts
If gross earnings are higher than the threshold amount for Massachusetts ($37,757 in 2009), SSA can figure an individual threshold for the individual if he or she has:
- impairment-related work expenses; or
- blind work expenses or
- a plan to achieve self-support (PASS); or
- a personal attendant whose fees are publicly funded; or
- medical expenses above the average State amount.
In 2009, the 1619(b) income threshold amount for SSI beneficiaries with disabilities in Massachusetts was $37,757.
For more information on 1619(b), click here
Commonwealth Care
Commonwealth Care is a Massachusetts health insurance program for low- and moderate-income residents who otherwise don’t have health insurance.
Commonwealth Care members receive free or low-cost health services through managed care plans by private insurance companies. Several health plans are available; each plan has different premium structures.
Commonwealth Care is the result of comprehensive health reform legislation passed in Massachusetts in 2006. As a result, 97 percent of Massachusetts residents are now covered by health insurance, according to a study by the Urban Institute.
Eligibility
A person may be eligible for Commonwealth Care if:
- the family’s income before taxes meets the income guidelines for the program
- the person is uninsured
- he or she is a U.S. citizen/national, or legal alien
- the person is age 19 or older (*persons under age 19 may be eligible for MassHealth benefits.)
Benefits
The benefits of Commonwealth Care include regular check-ups, emergency treatment, prescriptions, vision care, and mental health or substance abuse treatment. Some members may also be covered for dental care.
Commonwealth Care is as simple as selecting a health plan and a doctor. Plans are offered by Boston Medical Center (BMC) HealthNet Plan, CelitCare Health Plan, Fallon Community Health Plan, Neighborhood Health Plan and Network Health.
To search plans, click here
MassHealth and CommonHealth
MassHealth, the Massachusetts Medicaid program, offers comprehensive benefit plans for people with disabilities. The plans may be used alone or combined with other health insurance programs such as Medicare or health insurance offered by an employer.
With MassHealth, your benefits are determined by these factors:
- household earned income – wages
- unearned income – cash benefits from sources other than wages
- employment status
- whether the applicant has a disability
In certain circumstances, MassHealth will cover items that private health insurance will not cover such as personal care attendants, specialized wheelchairs and other necessary medical supplies. MassHealth may also cover the cost of private health insurance co-payments and/or private insurance premiums for individuals with disabilities.
Three MassHealth benefit plans for adults with disabilities are outlined below.
| Eligibility Criteria | MassHealth Standard | CommonHealth Working | CommonHealth Non-Working |
| Age | 19-64 | 19 or older | 19-64 |
| Household Income | At or below 133% federal poverty level | Above 133% federal poverty level | Above 133% federal poverty level |
| Work Status | Could be working | Working 40 hours or more each month or 240 hours in the previous 6 months | Not working or working less than 40 hours each month |
| Disability | Determined by Social Security (SSA) or MassHealth | Determined by SSA or MassHealth | Determined by SSA or MassHealth |
| Needs Test | None | None | One time send down will apply |
| Premium | None | Based on family size & monthly household income | Based on family size & monthly household income |
| Asset Test | None | None | None |
| Redetermination | Annually | Annually | Annually |
For more information about plans, click here
To apply for MassHealth, call MassHealth Customer Service at 1-800-841-2900 or click here
When an application is submitted along with the necessary documentation, MassHealth renders a decision of approval with determination of benefit plan, denial or a request for additional information within 10 business days. All MassHealth decisions are in writing and come with the right to appeal.
Applicants with questions about their submitted application may call:
MassHealth Enrollment Center at1-888-665-9993
(TTY: 1-888-665-9997 for people with partial or total hearing loss)
Those with more general questions, applicants and members, should call:
MassHealth Customer Service at 1-800-841-2900
(TTY: 1-800-497-4648 for people with partial or total hearing loss)
Medicaid and Medicare
Medicare is a federally sponsored medical plan for individuals age 65 or older who have a qualifying disability or who have end-stage renal disease, or permanent kidney failure.
Medicare benefits are provided in four parts – A, B, C and D.
Part A helps pay for inpatient hospital care, some skilled nursing facilities, hospice care, and some home health care. Part A is premium-free for most people. Most beneficiaries pay a monthly premium to be covered by Medicare.
Part B helps pay for doctors, outpatient hospital care, and other care that Part A does not cover, such as physical and occupational therapy. There is a premium cost for Part B.
Part C allows various HMOs, PPOs and similar health care organizations to offer health insurance plans to Medicare beneficiaries. At a minimum, they must provide the same benefits that the Original Medicare Plan provides under Parts A and B. These organizations are also permitted to offer additional benefits such as dental and vision care. To control costs, Part C plans are allowed to limit a patient’s choices of doctors and hospitals to pre-selected networks. This can be a major disadvantage if a patient’s favorite doctor or hospital is not a member of a specified network.
Part D provides prescription drug benefits through various private insurance companies. Like Part B, most patients must pay additional monthly premiums each for prescription drugs. Premiums for Part D are different for every state, and often vary by company.
For more information about Medicare, click here
