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Looking for health insurance for you or your family and your employer doesn’t offer it?  The Commonwealth’s Health Insurance Connector’s Open Enrollment begins this year on November 1, and continues through January 31st. Massachusetts and federal law prohibit consumers from purchasing an insurance plan outside of the Open Enrollment period unless there is a qualifying event, such as a birth or adoption of a child, marriage, divorce, loss of insurance through employer, etc.

The Division of Insurance is providihealth insurance policyng the following tips to help you make the appropriate choice for you and your family:

  • Read and understand the materials. There are many different types of health plans offered in Massachusetts, such as Preferred Provider Plans (PPP), Health Maintenance Organizations (HMO), and Indemnity plans. Each plan details which medical providers (physicians, hospitals, labs, pharmacies, etc.) are considered in-network and out-of-network.  Before making a choice, be sure to check if a plan has a provider network and whether your current physicians and area hospitals are in it. Some plans, such as HMOs, will not pay for any services outside of the provider network.
  • Some plans tier their provider network.  Review which tier your current physicians and area hospitals are in, because the amount you pay to see a provider will depend on which tier that provider is in. Also check to see if a plan with a network will also cover care you get from out-of-network providers.  Make sure you understand any difference in benefits for network providers and out-of-network providers.
  • Note your rights and responsibilities under each plan. For help understanding differences, explore the Division’s health insurance section online for basic information or ask for help from the insurance provider.
  • Compare the costs and coverages. It is important to carefully evaluate your healthcare costs when making your annual enrollment decisions. One plan might have high monthly premiums and a low deductible, while another might have a low premium, but more out-of-pocket expenses.
  • To pick the best coverage, calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medication, and any procedures you might be planning. Then make a list of the premiums, out-of-pocket expenses and benefits under each plan. Co-payments, coinsurance, deductibles and additional charges for wellness care or certain services, such as alternative medicine and cosmetic surgery, are examples of out-of-pocket expenses that you may pay. Remember, if you use a provider that is out-of-network, you will generally pay more out-of-pocket expenses. Add those fees to your calculated costs. Finally, decide how much you can afford to pay.

Other things to look for:health insurance

  • Check for any annual limits and prior authorization requirements.
  • If you take prescription medications, check them against the list of approved drugs in each plan booklet. Some prescription medications have higher co-payments than others and they might vary from plan to plan. Mail-order might be available for maintenance drugs at a lower cost to you.
  • If your dependents have health insurance coverage through their employer, school, or the Veteran’s Administration, compare their costs and benefits to the family plans you are considering to ensure that you choose the best plan for every member of your family. Make the same types of comparisons for any dental or vision care plans that you are considering.

Remember: Once enrolled in a health plan, you will not be able to make changes until the next Open Enrollment, unless there is a qualifying event. If you do not receive insurance cards and/or enrollment information, contact your insurance company. More online resources can be found on the Division of Insurance’s online consumer guide to health care coverage.

If you have additional questions, contact the Office of Consumer Affairs and Business Regulation by calling our Consumer Hotline at (617) 973-8787, or toll-free in MA at (888) 283-3757, Monday through Friday from 9 am-4:30 pm. Follow the Office on Facebook and Twitter, @Mass_Consumer. The Baker-Polito Administration’s Office of Consumer Affairs and Business Regulation along with its five agencies work together to achieve two goals: to protect and empower consumers through advocacy and education, and to ensure a fair playing field for all Massachusetts businesses. The Office also oversees the State’s lemon laws, data breach reporting, and home improvement contractor programs, and the State’s Do Not Call Registry.

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