Commonwealth Care is a government subsidized insurance program for low-income individuals run by the Connector.  Coverage is provided by four Medicaid managed care organizations. 

When can I get coverage from commonwealth care?

• You must meet certain qualifications to be eligible for Commonwealth Care. You may be eligible for this subsidized health insurance if your family income is at or below 300% FPL, and you are uninsured, and at least 19 years old. In addition, you cannot have been offered coverage by your current employer (or dependent coverage by a family member’s employer) within the last 6 months, for which the employer would have paid at least 33% of the premium (20% for family coverage).

what will commonwealth care cover?

• Commonwealth Care offers four plan options. All plans offered by Commonwealth Care are considered “qualified coverage.” These plans must provide coverage for outpatient and inpatient care, hospitalization, prescription drugs, mental health services, emergency care, rehabilitation, vision and wellness.

Plan 1 is available to individuals at or below 100% FPL.  Plan 1 has a $36 out-of-pocket cap for all services other than prescription drug coverage and a $200 out-of-pocket cap for prescription drug coverage.  Co-payments range from $1 to $3.

Plan 2 is available to individuals between 100% and 200% FPL.  Plan 2 does not have an out-of pocket cap for most services; however there is a $250 out-of-pocket cap for prescription drug coverage.  Co-payments for most services are between $5 and $30.

Plan 3 is available to individuals between 200% and 300% FPL.  Plan 3 does not have an out-of-pocket cap for most services.  There is a $500 out-of-pocket cap for inpatient medical care or outpatient surgical services and a separate $500 out-of-pocket cap for prescription drug coverage.

Plan 4 is available to individuals between 200% and 300% FPL.  Plan 4 does not have an out-of-pocket cap for most services.  There is a $250 out-of-pocket cap for inpatient medical care or outpatient surgical services and a separate $250 out-of-pocket cap for prescription drug coverage.

What can I be charged for Commonwealth Care coverage?

• Premiums for this coverage are subsidized by the state, depending on your annual income. Coverage for individuals who are below 100% FPL is free. Individuals earning between 100% and 300% FPL will have to contribute between $18 and $106 per month. You may also be responsible for co-payments (typically between $5 and $100, depending on what plan you select).

For more information about eligibility and enrollment, contact the Connector at 1-877-MA-Enroll (623-6765) or visit their website at https://www.macommonwealthcare.com/goalmind/login/external/intro.jsp.