Commonwealth Choice
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What is Commonwealth Choice?
Commonwealth Choice is a health insurance program for uninsured adult Massachusetts residents. The program offers "good value" unsubsidized health insurance to people who are not eligible for MassHealth or Commonwealth Care.
The Commonwealth Health Insurance Connector Authority is in charge of the program. The Connector reviews health plans offered by private insurance companies and approves plans that meet service and cost standards. The Connector also helps residents and employers choose the plan that best meets their needs.
If you have questions about the program, you may call Commonwealth Choice toll-free at 1-866-636-4654 or call the Connector at 1-877-MA-ENROLL (1-877-623-6765).
Am I eligible?
Commonwealth Choice health plans are for Massachusetts residents who are 18 or older and do not qualify for government subsidized health insurance such as Commonwealth Care because their family income is greater than 300% of the Federal Poverty Guidelines.
There are no income or asset limits for the program.
Note: College students living in Massachusetts temporarily are not eligible for the program. People who move out of state cannot keep their Commonwealth Care plan.
For more eligibility information, see Commonwealth Choice Policies and Procedures on the Health Connector web site.
What benefits will I get?
All Commonwealth Choice health plans must provide at least the minimum benefits outlined in the Minimum Creditable Coverage (MCC) rules set by the Health Connector. See Minimum Creditable Coverage for details on coverage requirements.
All Commonwealth Choice health plans in 2010 must include:
- medical and surgical care, including preventive and primary care
- emergency care
- hospitalization
- ambulatory patient care (outpatient, day surgery)
- mental health and substance abuse services
- prescription drug coverage
- maternity and newborn care
- x-rays and other diagnostic imaging and screening procedures
- radiation therapy and chemotherapy
Minimum Creditable Coverage (MCC) rules for 2010 have these specific requirements:
- Health plans must allow doctor visits for preventive care without a deductible
- Plans with a deductible must limit the deductible to no more than $2000 per year for an individual or $4000 per year for a family
- If there is a separate prescription drug deductible, it cannot be more than $250 for an individual or $500 for a family
- Out-of-pocket costs for health services must be limited to $5000 for an individual or $10,000 for a family per year
- There can be no cap on benefits per sickness
- There can be no annual cap on benefits
- Coverage of hospital stays cannot be limited to a fixed dollar amount per day or per stay
- Beginning January 1, 2011, there can be no annual cap on prescription drug benefits
Limits apply to in-network services
Some plans also offer extra benefits, like fitness rebates, eyewear discounts, car seats for new parents, or safety helmets. Some plans limit your choice of doctors and hospitals. Young Adult Plans do not have to offer the same benefits (for example, they can have annual maximum benefit caps), but they must provide reasonable coverage.
For more details about plan benefits:
Do Commonwealth Choice plans cover preexisting conditions?
Commonwealth Choice health plans must provide coverage for preexisting conditions. There are no waiting periods. Your coverage begins as soon as you sign up for a plan and pay your monthly premium.
What plans can I choose from?
You can compare plans that are available to you on the Commonwealth Connector web site Commonwealth Connector: Find Insurance.
Descriptions of plan benefits and service areas are also available online at Commonwealth Choice Overview; or you can use the Commonwealth Choice Gold, Silver, Bronze, and Young Adult Brochures to help you compare plans.
These companies offer Commonwealth Choice plans:
Each company offers these types of plans:
- Gold plans: higher monthly premiums, but low out-of-pocket costs.
- Silver plans: moderate monthly premiums and moderate out-of-pocket costs.
- Bronze plans: lower monthly premiums, but higher out-of-pocket costs.
- Young Adult Plans: for adults between the ages of 19 and 26. Young adult plans have low monthly premiums and higher out-of-pocket costs. Most have an annual limit on benefits.
All plans include prescription drug coverage.
How much does it cost?
Commonwealth Choice health plans vary greatly in price. The price depends on your age, where you live, and the type of plan you choose. You can get rates for Commonwealth Choice plans:
All plans have monthly premiums. Other costs you may have to pay are:
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Deductible: a dollar amount that you must pay toward your medical costs each year before your health plan starts paying benefits (for example, a $1000 annual deductible) Note: All plans with deductibles cover some office visits and preventive care before you have to start paying your deductible. Plans with prescription drug coverage offer some drugs "pre-deductible" or have a separate lower deductible for prescription drugs.
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Co-payments: a fixed dollar amount that you must pay for each medical service (for example, a $20 copayment for each doctor's visit, or a $10 copayment for each prescription). The health plan pays the rest of the cost.
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Co-insurance: a percentage of the cost that you must pay for each medical service (for example, 35% of hospital bills). The health plan pays the rest.
The total of your deductibles, copayments, and coinsurance is your "out-of-pocket cost." The maximum out-of-pocket cost for any Commonwealth Choice plan is $5000 per individual or $10,000 per family per year. If you reach the maximum, you do not have to pay any fees other than the monthly premiums for the rest of the year unless you have a Young Adult Plan. Young Adult Plans have an annual benefit maximum (usually $50,000).
How do I apply?
To apply, call Commonwealth Choice toll-free at 1-866-636-4654 or the Connector at 1-877-MA-ENROLL (1-877-623-6765), Monday through Friday, 8 AM to 5 PM; or visit the Commonwealth Connector web site Connect to Good Health!. Commonwealth Choice enrollment began on May 1, 2007 and plans went into effect starting July 1, 2007.
If you have questions about plan benefits or need help choosing a plan, you can also contact the plans directly. See What plans can I choose from? for contact information.
Do I have to buy health insurance?
Massachusetts passed a Health Care Reform Law in 2006 that requires all adult residents age 18 and older to have health insurance. For information about Massachusetts Health Care Reform and health insurance requirements, see:
Useful links
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Connect to Good Health, Massachusetts!
Official Connector web site where you can check rates, compare benefits, and enroll in Commonwealth Choice health care plans. Includes Frequently Asked Questions. From the Commonwealth Connector Authority.
Commonwealth Choice section last updated on 8/04/10
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