Health insurance plan opens up

The state's health insurance reform takes a major step forward today, with a host of moderate- to low-income residents suddenly eligible for a subsidized insurance program that looks and feels like private health insurance.

Under the law passed last year, those making 300 percent or less of the federal poverty level can now sign up for Commonwealth Care, a health insurance plan that is subsidized by more than $130 million in state funds.

For a single person, that means anyone making $29,400 a year or less. For a family of four, it's $60,012 or less. Only those who don't have insurance and don't have access to a reasonable plan at work are eligible.

Deadline is July 1

Not only are these people eligible for coverage, but they must obtain it by July 1, according to the law passed last year. Those who don't will risk losing their state income tax exemption this year and could face fines next year.

Premiums will vary, depending on income and the type of plan. There will be two offerings: One will have higher monthly premiums and lower co-pays for office visits and services. The other will have lower premiums but higher co-pays.

private health insurance companies are offering Commonwealth Care in the state, Berkshire County residents will have only one choice: the BMC HealthNet Plan, which is affiliated with Boston Medical Center.

The less-expensive HealthNet plan will cost $21 for individuals who make less than $14,700 a year but more than $9,800; $43 a month for those making less than $19,600; $72 a month for those below $24,500; and $108 a month for those under $29,400.

Comparable to private coverage

Harry Castleman, HealthNet's director of marketing and communications, said the plan will be comparable to what one might find on the private market. It includes coverage for routine office visits, emergency care, X-rays and MRIs, vision exams, and a host of other procedures one would expect from comprehensive insurance.

"It's real health insurance," Castleman said. "It includes the basic, core benefits that are important for any health plan to deliver."

In addition, he said, members have access to a 24-hour hot line where they can get answers to their medical questions from a registered nurse. And there are special programs to help those with chronic conditions, such as diabetes and asthma, manage their illnesses.

All county hospitals

Patients will be able to seek treatment at any of the county's three hospitals, Castleman said, and from most of the Berkshires' physicians.

HealthNet already insures more than 60,000 people west of I-91 who receive MassHealth, the state's Medicaid program that covers the poor and disabled.

Beginning in November, HealthNet was available to those at 100 percent or less of the poverty level but who did not qualify for MassHealth; that plan has about 800 members in Berkshire County.

All Commonwealth Care offerings are brokered by the new health insurance connector, a state agency created last year to serve as a middleman between residents and health plans. It also is charged with ensuring that those plans are affordable and adequate, a responsibility that includes approving premiums and co-pays.


» Contact numbers


With today's expansion of the state's health insurance law, the BMC HealthNet Plan will be available to any Berkshire resident who earns 300 percent or less of the federal poverty level and doesn't have other insurance options. Here are numbers to call for information and assistance.

The following local nonprofits help residents find health coverage:
North County: Ecu-Health Care, (413) 663-8711.
Middle Berkshire: Advocacy for Access (413) 445-9480.
South County: Advocacy for Access (413) 528-5045.
BMC HealthNet, the private, nonprofit insurance plan that will be available in Berkshire County: (800) 792-4355.
Commonwealth Care, the state agency that oversees the health plans being offered and authorizes individuals to participate: (877) 623-6765.


'A large number'

Charles Joffe-Halpern is a member of the board overseeing the connector as well as executive director of Ecu-Health Care in North Adams, a nonprofit that helps the uninsured find health coverage. He estimates that roughly 5,000 Berkshire residents will be eligible for the plans that debut today.

"This is a large number of individuals, particularly in Berkshire County, where we have a predominance of small businesses, service industries and hundreds of employers who can't afford insurance," Joffe-Halpern said. "These are people who will finally be eligible for health care."