Members often have questions about their health plan, from the definition of terms to how to best utilize their coverage. Our Term Talk series aims to answer commonly asked questions to help you better understand health insurance and empower you to make decisions about your coverage that best fits your needs.
A common dilemma: I’ve always enrolled in a health plan through my employer but am considering quitting my job to start working for myself as a freelancer. I’m curious what my options are when it comes to enrolling in a health plan now that I won’t have an employer to enroll with. For context, I live in Massachusetts.
Options for health insurance enrollment
While it’s safe to say eligible employees across the United States have the option to enroll in a health plan if offered through their employer, the other options for enrollment can vary depending on state. To keep it simple and to answer the reader’s question, we’ll look specifically at Massachusetts.
Here are the more common ways to enroll in health insurance across the Bay State:
Through your employer or union: A common scenario is enrolling for a health plan through your employer. Those eligible (typically full-time employees between 26 and 64) will participate in an Open Enrollment period where the employer will offer one or more health plans to choose from. With employer-sponsored health plans, most employers pay a portion of the premium.
Through an insurance company: For individuals and families, health plans can also be purchased directly through an insurance company. Sometimes the purchase is done through an intermediary, which is a company that handles enrollment and premiums. If you’re considering purchasing through Harvard Pilgrim Health Care, learn more about our plan options.
Through the Connector: You may be able to purchase a health plan from the Connector if you do not work for an employer paying 33% or more of your premium. These plans are offered by Massachusetts HMOs that the Connector has selected, and you may be eligible for subsidies to help with premium payment depending on income. While Massachusetts residents can enroll in Connector health plans during the annual open enrollment period, there are always special circumstances for enrollment including recently moving to the state or losing your health insurance.
Through MassHealth: MassHealth is a program that provides health benefits and help paying for benefits to those who qualify. It is paid for by the state and federal taxes for eligible individuals. Those meeting certain income requirements may be eligible for MassHealth. For those living in other New England states, be sure to look into Connecticut Medicaid, MaineCare, New Hampshire Medicaid or RIte Care.
Through Medicare: Those 65 and older, as well as those with certain disabilities or health conditions, may be eligible for Medicare, which is a federal health insurance program. Learn if you’re eligible for Medicare or explore plan options through Harvard Pilgrim or another Point32Health company, Tufts Health Plan.
Through a qualified Student Health Insurance Plan (SHIP): Health plans can be purchased through your school if enrolled as a student in a Massachusetts college or university. All Massachusetts colleges and universities are required to offer student health insurance to full-time students. Learn more about SHIP options.
Health plan guidance
If you’re a member that has a question about your Harvard Pilgrim health plan or are interested in one of our health plans, contact member services at (888)-333-4742 or by sending a secure email. And for benefit documents and other member resources, log in to the secure member account.
