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Health
Insurance Coverage for End of Life Needs
Many people assume that health insurance will cover their medical needs
at the end of life. While in many cases this is true, it is important
to explore the specific terms of each health insurance policy. Most health
insurers cover only "medically necessary" services, and payment
for others may be denied. Ultimately, the contract with your insurer will
specify what is and what is not a covered benefit, so it is important
that you fully understand your insurance coverage.
Under Massachusetts
law, all insurers, including Medicare and managed care organizations,
now pay for hospice care. However, up to 40% of insured consumers in Massachusetts
are not protected by this law because their health benefits are provided
through an employer who is self-insured.
Health insurance
also does not typically cover long-term care, including certain nursing
home or home healthcare services. Long-term care insurance is available
as a separate policy sold by many insurance companies. The Massachusetts
Division of Insurance publishes Your Options for Financing Long-Term
Care: A Massachusetts Guide, available at: www.mass.gov/doi/Consumer/css_health_LTCGuide.html
If you believe
that your health insurer is not paying for covered services, including
end of life care, first contact the company directly. Massachusetts law
requires that health plans have a formal internal grievance process. Call
your insurer's customer service center for further information. If you
are dissatisfied with your insurer's final determination regarding coverage
for your treatment, you may:
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Request
an external review through the Department of Public Health's Office
of Patient Protection, if you are a member of an insured health plan.
You must make this request within 45 days of receiving the final determination
from your insurer. |
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Contact
your employer if you are in an employer-funded health benefit plan. |
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Contact
Medicare or MassHealth (Medicaid) if you are enrolled
in either of these programs. |
If you are
planning to leave a job that has health benefits, you may be able to continue
your health coverage for a period of time through your employer, as long
as you pay the premium. Contact your employer or the Massachusetts Division
of Insurance for further information about this benefit, which is known
as COBRA or mini-COBRA.
The Massachusetts
Executive Office of Elder Affairs administers SHINE (Serving the Health
Information Needs of Elders), a program specifically designed to assist
elders in obtaining and understanding information about health insurance
and health care options. SHINE counselors are available throughout the state
to provide assistance regarding Medicare, Medigap, Medicaid, long-term
care insurance, and pharmacy coverage.
If you
don't have health insurance coverage
If you are uninsured and have a life-threatening condition, obtaining
health insurance may be difficult, but it is worth making every effort
to try. If you are employed, talk to your employer. If your employer does
not offer health insurance, you might suggest that your employer call
the Division of Medical Assistance to get information about the Insurance
Partnership Plan.
You may obtain
non-group health insurance on a guaranteed issue basis if you are uninsured,
although it may be costly. Contact the Division of Insurance for further
information.
If you are
disabled or low-income, you may qualify for MassHealth, the Massachusetts
Medicaid program.
Families
with major health-related expenses resulting from a child's medical condition
may be eligible for financial assistance through the Massachusetts Catastrophic
Illness in Children Relief Fund.
If you have
hospital expenses, you may be eligible for free or partial free care to
cover hospital bills through the state's Uncompensated Care Pool. Contact
the hospital for information and a free care application.
Depending on your condition, there may be voluntary organizations that
deal with your specific disease that can direct you to help with specific
services.
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other information and resources: |
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Massachusetts
Executive Office of Elder Affairs
SHINE Program
Call your local Council on Aging or contact the statewide
SHINE program
Phone:
800-243-4636
TTY: 800-872-0166
website: www.mass.gov/elder select SHINE from Health Care menu |
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Massachusetts
Division of Insurance
One South Station
Boston, MA 02110-2208
Consumer service lines and to request publications:
Phone:
617-521-7794
website: www.mass.gov/doi |
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Massachusetts
Department of Public Health (MDPH)
250 Washington Street
Boston, MA 02108
Phone: 617-624-6000 (connecting all programs)
website: www.mass.gov/dph
MDPH, Office of Patient Protection
Phone: 800-436-7757
website: www.mass.gov/dph/opp
MDPH, Division of Perinatal, Early Childhood, and Special Health Needs
250 Washington Street
Boston, MA 02108
Phone: 617-624-5070
TTY: 617-624-5992
FAX: 617-624-5990
website: www.mass.gov/dph/fch/dpech.htm |
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Massachusetts
Division of Health Care Finance and Policy
Two Boylston Street
Boston, MA 02116
Phone:
617-988-3100
Toll free:
800-888-2250
TTY:
617-988-3175
website: www.mass.gov/dhcfp |
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Health
Care for All
Health Helpline
Phone: 617-350-7279
Toll free:
800-272-4232
TTY: 617-350-0974
website: www.hcfama.org |
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Mayor's Health Line, City of Boston
1010 Massachusetts Avenue, 2nd Floor
Boston, MA 02118
Phone: 617-534-5050 or 800-847-0710 (outside Metro Boston)
website: www.bphc.org/mayorshealthline |
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The Insurance Partnership
354 Turnpike Street, Box 204
Canton, MA 02021
Toll free: 800-399-8285 (Within Massachusetts only)
Phone: 781-830-8282
FAX: 781-830-8283 |
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Executive Office of Health and Human Services
MassHealth (Medicaid) Program
One Ashburton Place
(The McCormack Building)
Boston, MA 02108
Phone: 800-841-2900
TTY: 800-497-4648
email: contactmasshealth@state.ma.us
website: www.mass.gov/masshealth |
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Group
Insurance Commission (GIC)
19 Staniford Street, Fourth Floor
Boston, MA 02108
Phone: 617-
727-2310
TDD/TTY: 617-
227-8583
website: www.mass.gov/gic |
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Center for
Medicare and Medicaid (CMS)
Boston Regional Office
JFK Federal Building, Room 2325
Boston, MA 02203
Phone:
617-565-1185
CMS website: www.cms.hhs.gov/about/regions/consumers1.asp |
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