25. How much does ConnectorCare cost?

The ACA established income-based premium and cost-sharing standards, but these minimum federal standards would have resulted in coverage that was less affordable than the former Commonwealth Care program administered by the Health Connector from 2006-2014. In order to maintain affordable coverage for individuals with income not over 300% FPL, Massachusetts contributes added state-funded subsidies towards the costs of ConnectorCare. 

There are two kinds of member costs in ConnectorCare: Monthly premium contributions and copayments. Monthly premium contributions are paid directly to the Connector and it distributes the member contribution and state subsidies to the insurance plans. Federal advance premium tax credits are sent directly from the IRS to the health plans. Member premium contributions vary by income/plan type, by choice of HMO, and by region. Premiums are per member per month.

Copayments are charges to the member that are collected by the provider at the point of delivering certain services.  Once copays reach the annual out of pocket maximum or cap, the member is relieved from further copays for the year. Copayments vary only by income/plan type. ConnectorCare HMOs do not have deductibles or coinsurance.  The following costs are in effect through December 31, 2019 and also shown in the ConnectorCare Overview in Appendix 3:

• Gross family income does not exceed 100% FPL (Plan Type 1)— 
  • At least one HMO with no premium charge;  in many regions there is a choice among two HMOs with no premium charge; premium charges for other HMO choices; 
  • Copayments no higher than MassHealth, i.e., $3.65 for most drugs, $250/$500 (individual/family) annual cap for drug copayments.
• Gross family income over 100 but not over 150% FPL (Plan Type 2A)— 
  • At least one HMO with no premium charge;  in many regions there is a choice among two HMOs with no premium charge; premium charges for other HMO choices; 
  • copayments less than in average commercial plans, e.g., $10 for an office visit. Maximum medical out of pocket $750/$1500 (individual/family); maximum drug out of pocket $500/$1000. 
• Gross family income over 150 but not over 200% FPL (Plan Type 2B)— 
  • at least one HMO for $44 per month; higher premiums for other HMO choices; 
  • copayments same as Plan Type 2A.
• Gross family income over 200 but not over 250 % FPL (Plan Type 3A)— 
  • at least one HMO for $85 per month; higher premium for other HMO choice; 
  • copayments higher than Plan Type 2  e.g., $15 for an office visit; maximum medical out of pocket $1500/$3000 (individual/family), maximum drug out of pocket $750/$1500.
•  Gross family income over 250 but not over 300 % FPL (Plan Type 3B)— 
  • at least one HMO for $126 per month; higher premium for other HMO choice;
  • copayments same as Plan Type 3B.

​The minimum premium contribution and copayment and benefits schedules are determined annually by the Board of the Connector and published by posting on www.mahealthconnector.org. Premiums and copayments are adjusted annually for the benefit year (Jan 1 to Dec 31). 

956 C.M.R. 12.04 (Plan Types) See Appendix 3 for the minimum premium contributions and copayment schedules by Plan Type through Dec 31, 2019. A map showing ConnectorCare premium contributions by HMO, Plan Type and  Region for 2019 is available here: https://www.masslegalservices.org/system/files/library/ConnectorCare%20Enrollee%20Contribution%20by%20Region%202019.pdf