MSP Cost-Containment Measure

The state's Medical Security Program (MSP) is a subsidized health insurance option for those receiving Massachusetts unemployment assistance who meet certain income guidelines. There are two types of MSP: lower income individuals (below 150% FPL) on MSP receive direct coverage through Blue Cross and others receive assistance with their COBRA premiums.

Rising unemployment and federal unemployment assistance extensions have put a strain on this program, and the state has enacted several changes that are intended to contain costs. I wanted to share some information on one of these program changes that directly impacts patients who are on this program.

Effective January 1st, the individuals on MSP direct coverage were enrolled into a Blue Cross plan called Network Blue Options v3 Deductible. This plan uses a tiered network design, and requires members to pay higher cost sharing amounts at the highest tier providers. You can refer to this website for more information and to check which providers fall into which tiers: https://www.bluecrossma.com/staticcontent/tiered_network_ben_des.htm

There are three tiers: enhanced, standard, and basic. (Editor’s note: Careful! The tier names are counter-intuitive) Members pay the highest amounts to see providers that are in the “basic” tier, which includes BWH, MGH, and NSMC. Individual PCPs don't seem to always be listed in accordance with their location or their hospital affiliation, so it's worth checking by clicking “select a provider.” There is a big difference in cost sharing by tier. For example, a PCP visit to a provider in the enhanced tier is $15, compared with $50 for a visit to a provider in the basic tier.

MSP direct coverage members are in the process of receiving a member packet and a new insurance card from Blue Cross.

-From: “Medical Security Program: UPDATES”, Kim Simonian, MPH, Associate Director, Patient Access, Partners HealthCare Community Benefit Programs, January 21, 2010.

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