19. How is ConnectorCare renewed?

ConnectorCare, like MassHealth, has an annual renewal process. In the Health Connector renewal occurs at the same time each year in the run-up to the next open enrollment period for coverage in the following calendar year. In early fall, the Health Connector updates information from available data sources and sends a preliminary determination to all current members with a preview of their income and Plan Type for the following year and a request that individuals update information that may not be correct or no longer an accurate projection for the following year. Individuals may do this directly through an online account or by other means. Mixed households --ConnectorCare members who live in a household with MassHealth members--who need to take action to renew MassHealth, will be sent a single notice from both the Health Connector and MassHealth directing them to complete the MassHealth renewal process. Later in the fall, individuals will receive a final eligibility determination based on updated data or any changes the individual has reported.  They will also be notified that they will be renewed into the same ConnectorCare HMO they have now (if it is available in the following year) unless they make a different selection and what their new premium will be. 

Loss of subsidy at renewal. If people are no longer eligible for ConnectorCare but remain eligible for a QHP without a subsidy, they will remain enrolled with the same HMO (if it is available in the following year) but at full premium cost. 

Advocacy Reminder:

Individuals who lose their subsidies and who have authorized automatic payments for their ConnectorCare premium contribution should be warned to cancel automatic payments unless they want the full premium amount for an unsubsidized QHP deducted from their bank account.

Current enrollees may lose eligibility for subsidized coverage for a variety of reasons including:

• No income data is available
• The Health Connector is unable to use data matching because the individual has no SSN and the individual did not supply updated income information
• At application, the individual did not authorize on-going data match with IRS for purposes of renewal
• The IRS data match flagged the case for “Failure to Reconcile” (FTR) i.e. failure to file a federal return and reconcile APTC received in prior years
  • IRS privacy rules prevent the Health Connector from explicitly identifying this reason. Notices will include it among a menu of possible reasons why the individual is no longer eligible for subsidies.
• Data show the individual is now enrolled in Medicare, MassHealth or other MEC
• Data show income over 300% FPL (ConnectorCare) or over 400% FPL (PTC with QHP)

Even if individuals remain eligible for ConnectorCare, they may experience a premium increase based on:

• Change in income or family size resulting in higher Plan Type, or
• Current HMO no longer being one of the lowest cost plans for which only the minimum premium contribution is charged

Advocacy Reminder:

Many of the problems described above can be remedied by supplying updated information and obtaining a new determination, or taking other steps such as filing a federal return for a past period, or changing to a lower cost plan. 

956 CMR 12.07 (Eligibility Review)