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• What the Law Says - Affordability The law says that insurance must be "affordable". This word is used 7 times in the law itself. See the definition for "affordable" What this means The State has decided what is affordable and will not take individual needs into account. The affordability rates are based on boardroom formulas that have nothing to do with real people in real life. The State doesn't care about your particular housing, heating, debt, education, transportation, retirement savings or other needs. • What the Law Says - The Appeals Process The law stipulates that there must be a "generous" appeals process if a person believes they cannot afford the insurance. What this means You are guilty, and the road to proving you are innocent is long and arduous. Your life is no longer your own, and there are no sacred cows. There is no “generous” appeals process. Excerpt from the Connector Certificate of Exemption TY08 Application: “To be considered for a Certificate of Exemption, you must demonstrate that you cannot afford a Connector health insurance product [Commonwealth Choice] because you experienced at least one qualifying financial hardship event during the time you were uninsured. If you are eligible for Commonwealth Care, MassHealth, Medicare, Veteran's Administration Program Enrollment, Fishing Partnership Health Plan, TRICARE, Qualified Student Health Insurance Program or the Massachusetts Division of Unemployment Assistance Medical Security Program, you cannot apply for a Certificate of Exemption.” |
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Massachusetts-style health insurance |
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Persons who are eligible for Commonwealth Care and the other above programs will be denied an exemption because they are considered able to obtain health insurance. This means that, if you are eligible for Commonwealth Care, etc., but do not enroll in it, you will be subject to the penalty. |
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The only way to get around this if you are in the 0% to 300% FPL bracket is to file for a "hardship appeal." This part of the law stipulates that the individual will have already have paid a huge amount of his or her income for "allowable medical services." Otherwise, there is no way to appeal and show that you cannot afford the extra expense.
See the exact wording of the law here.
First you must prove that one of these catastrophic "hardships" has occurred. If the state decides that your "hardship" isn't real or bad enough, there can be severe legal and financial punishments. This is a deep and expensive bureaucratic maze meant to confuse, bewilder and deny. |
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Read the next "What the Law Says" topic |
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The Individual Mandate explained / The Connector Authority / Affordability / The Appeals Process |
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Religious Exemption / Income estimation / Tax enforcement and Criminal penalties / Data Gathering |
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Estate Recovery / Insurance plan "lock-in" / State as health insurance / Primary Care Shortage |
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