Program Highlight: MassHealth Enhanced Coordination of Benefits (ECOB) Program

 

MassHealth, through its contracted provider, Umass Medical School, provides an onsite worker at the major medical centers throughout the state to ensure that residents access the most complete health insurance coverage and services available to them. Anna Giunta is the Health Benefit Coordinator with the Enhanced Coordination of Benefits (ECOB) program who is based at MGH.

ECOB Enables People to Enroll in Private Health Insurance

ECOB ensures that MassHealth members (or those eligible) who are under 65 and have access to private insurance coverage access it. Many people don’t take the health insurance coverage offered through their employer because they can’t afford the premiums. For those who are MassHealth eligible, ECOB can help them apply for MassHealth’s Premium Assistance program, which would cover the premium. They would retain MassHealth as a secondary insurance that would cover services not covered by the private plan, deductibles and co-pays (patients would still be responsible for the $1 or $3 MassHealth Prescription Drug co-pays).

ECOB also will cover COBRA premiums which are typically 102% of the cost of a former employer’s group health insurance premium.

ECOB can in some cases enroll people outside of open enrollment periods.

Eligibility

Patients must

• Be under 65 and not eligible for Medicare
• Be a MassHealth member or MassHealth eligible (MassHealth Standard or CommonHealth only)
• Have access directly or through a family member to private health insurance

ECOB works with those who have catastrophic illness, chronic disease, complex medical needs and long or repeated hospitalizations. Typical diagnoses include cancer, extreme prematurity (NICU babies), cardiac diagnoses, organ transplants, accident/trauma, and high cost disability. Through a related program they also serve those with HIV, Cystic Fibrosis, and Cerebral Palsy. They also are particularly interested in reaching those with hemophilia.

ECOB Helps Family Members Not Otherwise MassHealth Eligible

Many families have “mixed MassHealth status”- some members are eligible and some are not. This may be for financial reasons, such as a family with an income level where the children qualify, but the parents do not. Or it could be for reasons related to immigration status. The Premium Assistance Program can pay for the private insurance’s family premium- enabling those who are not MassHealth eligible on their own to get full insurance coverage (note: these members would not get MassHealth wrap-around services such as coverage of co-pays).

How Does Premium Assistance Work?

Patients are issued a check in advance that they use to pay the private insurance premium or compensate for the insurance premium deductions from their paycheck. It is known as “reimbursement”, but the patient/family have the money in advance of the payment due date and so do not need to cover the payment with their own funds.

How do Patients Benefit?

In addition to more complete insurance coverage, ECOB coordinators help members to understand and use benefits to which they are entitled. They can answer questions, explain MassHealth notices and what the member needs to do to comply, and offer information and referrals to community agencies. If one is applying for disability, they even may be able to expedite the disability review process because Disability Determination Services is also housed at UMass Medical School.

How does MGH Benefit?

The MGH, and other health institutions, benefit from this program because it helps people access private insurance which generally offers more generous reimbursement than MassHealth. It also may offer private insurance coverage to family members who were not MassHealth eligible; so those members would have private coverage when otherwise they would be Health Safety Net (HSN) cases. If you recall how HSN is funded- by contributions from health insurers and health care institutions, you can see the benefit to these parties.

What Happens When Someone Becomes Medicare Eligible?

When a member becomes Medicare eligible either due to length of disability or age, the Premium Assistance program helps transition them to Medicare. If they qualify financially, MassHealth covers the cost of the Medicare Part B and Medicare Part D (drug coverage) premiums.

For more information contact Anna Giunta, at 617-886-8037, or anna.giunta@umassmed.edu

-Thanks to Barb Luby for bringing this program to our attention, and to Anna Giunta for her help with this article.

 

4/11