Medical Insurance options for all

By Anne Springer







If you're a Massachusetts resident and are not enrolled in Medicare or MassHealth, you can still purchase non-group health insurance from private health carriers.



While a pre-existing condition limitation or waiting period may be imposed, consumers who qualify cannot be denied coverage.



There are several types of coverage, including managed care plans, preferred provider plans and traditional insurance that does not restrict which hospital, doctor or other provider the consumer chooses. Of course, the premiums for the latter are bound to be higher.



General questions about these plans can be addressed to the Division of Insurance, Consumer Section, in Boston, at (617) 521-7777, and consumers can get the list of available plans at the Web site: www.state.ma.us/doi .



For persons who are unable to afford coverage by one of these plans, there are other choices. To obtain information on eligibility for MassHealth coverage, call 1-800-841-2900. Elders, who need help filing the application, can call SeniorCare at (978) 281-1750 to get assistance from a SHINE (Serving the Health Insurance Needs of Elders) counselor.



There is also a Medical Security Plan for those persons who are receiving unemployment benefits. For information on that plan, call 1-800-914-4455.



If you opt to purchase a non-group health plan, it is wise to compare both price and service. You will need to know how to choose a doctor, what happens to the coverage if you are outside the plan's service area, who must file the claims, if the plan covers prescriptions, what the deductibles and co-payments are, how the premiums are paid, and grievances or complaints are filed.



Some of the carriers who provide such plans are New England Life, Tufts, Neighborhood Health Plan, Guardian Life Insurance Company of America, Blue Cross/Blue Shield of Massachusetts, Aetna Health and Aetna Life Insurance Co. Some companies provide one type of plan and not others, or serve a limited area.



Most of the companies have filed rates that vary according to a subscriber's age and location, so the onus is on the consumer to check each company's rates carefully before purchasing a plan.



Anyone who has questions about managed care plans can get help at the Bureau of Managed Care at (617) 521-7372 or the Office of Patient Protection at 800-436-7757.



Unfortunately, the downside of non-group plans is that they are significantly more expensive than group coverage generally, and the cost increases as the age of the insured increases. For example, one company's standard HMO plan costs approximately $400 per month for a 25-year-old, but the cost rises to several thousand dollars for a 63-year-old individual.



While such coverage isn't a possibility for many older people, due to the high cost, it is, nevertheless, an option for some.