Getting a plan through the healthcare exchange

Consider getting a plan through the healthcare exchange

You can use the federal government's healthcare exchange to find insurance coverage for your family member.

To apply for coverage through Health Exchanges:

  1. Keep an eye out for important dates and deadlines. (Note: even if you have missed the deadline, there are still chances to enroll in specific programs - click the tips button below for details.)

  2. Explore the many different health plan options.

  3. When you've found a plan that meets your needs, start the application process by selecting your state from the menu on the site.

If you live in Massachusetts, click the box below to learn more about Health Connector options for children with disabilities:

 

Health Connector is the health insurance exchange for Massachusetts.

If you get your health plan through them, here are some tips to help:

  • You can get started with MA Health Connector by visiting their website

  • If you have a child with a disability, you can apply for MassHealth CommonHealth at any time, regardless of the open enrollment dates.

  • Everyone else can only get a health plan during the open enrollment period. The website will tell you when this period is. 

  • If you need coverage that starts before the next enrollment period, you may be able to get it earlier. If you have had a change that counts as a qualifying event, you may be able to get coverage during a 60-day special enrollment period.

Sources: Federation for Children with Special Needs, MA Health Connector

Read about the different types of MassHealth plans so you can decide which one is right for your family.

image of Mass Health options; Standard, Commonhealth and Kaileigh Mulligan

There are 3 options:

1. MassHealth Standard

  • This option is for you if your family income is less than 150% of the federal poverty level.

  • To find your family's income level, use this online calculator.

  • If you qualify, this can be your primary insurance plan.

  • But if you also have private health insurance, this can be a supplemental (secondary) plan.

  • Even if you have private insurance, you may be able to get this for free.

  • This will pay for deductibles, co-payments and other extra costs not covered by your private insurer. But, you must use a doctor or provider who takes MassHealth.

2. MassHealth CommonHealth

  • This option is for you if your family income is greater than 150% of the federal poverty level and you have a child with a disability.

  • To find your family's income level, use this online calculator.

  • If you qualify, this can be your primary insurance plan.

  • But if you also have private health insurance, this can be a supplemental (secondary) plan.

  • This is a great way to supplement private health insurance coverage for a child with a disability.

  • You pay a monthly fee (called a 'premium') based on your family income.

Premium Assistance:

  • This is a program that lets you pay a lower premium, or none at all.

  • You must apply to this program separately.

 

image of character, Paula, on the phone. To apply for Premium Assistance call 1-800-862-4840 extension 7

3. Kaileigh Mulligan program

This option is for you if your child:

  • has a severe disability,

  • is living at home, and

  • needs skilled nursing care or technology

There are no income or asset requirements.

Ask your child's hospital social worker or a Department of Public Health case manager how to apply.

 

Image of exclamation point with text: If your child is covered through the Kaileigh Mullign program, you can't renew your coverage online. You have to use the paper form when you renew.

Sources: Autism Consortium, Federation for Children with Special Needs, Autism Insurance Resource Center

Sources: Massachusetts Health Connector, U.S. Centers for Health and Human Services, Healthcare.gov

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