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Consumer information
   
 

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:

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.
Contact your employer if you are in an employer-funded health benefit plan.
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.

For other information and resources:
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
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

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

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
Health Care for All
Health Helpline
Phone: 617-350-7279
Toll free: 800-272-4232
TTY: 617-350-0974

website: www.hcfama.org
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
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
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
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
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