Jeffrey Wade
MassHealth is a public health insurance option available to eligible individuals in Massachusetts. It is a state and federal-funded health insurance program that provides health benefits and helps pay for them to qualifying children, families, seniors, and people with disabilities. To be eligible for MassHealth, you must be a resident of Massachusetts and meet specific income, disability, or health condition requirements. MassHealth offers different types of coverage, including Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, and Limited. Individuals can apply for MassHealth coverage at any time during the year and may qualify for a Special Enrollment Period if they experience a qualifying life event, such as marriage or the birth of a child.
| Characteristics | Values |
|---|---|
| Type of Insurance | Public health insurance |
| Coverage | Medical services, long-term services, and support |
| Eligibility | Residents of Massachusetts with low to medium income, disability, or health condition status |
| Application Process | Online or through Enrollment Centers |
| Coverage Types | Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, Limited |
| Benefits | Doctor visits, dental, prescription drugs, behavioral health services |
| Additional Services | Integrated Care Options (ICO), Senior Care Options (SCO), Program of All-inclusive Care for the Elderly (PACE) |
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What You'll Learn
MassHealth eligibility requirements
MassHealth is a public health insurance option available to eligible Massachusetts residents. It covers medical services as well as long-term services and support. To qualify for MassHealth, you must meet the residency requirements and have your citizenship or satisfactory immigration status verified.
There are six MassHealth coverage types offered to eligible individuals, families, and people with disabilities: Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, and Limited. MassHealth Standard provides a full range of health care benefits, including medical services such as lab tests, X-rays, therapies, pharmacy services, eyeglasses, hearing aids, and medical equipment and supplies. It also covers well-child screenings (for children under 21) and includes medical, vision, dental, hearing, mental health, and addiction services. MassHealth CommonHealth offers similar benefits to certain disabled adults and children who cannot get MassHealth Standard. MassHealth CarePlus offers a broad range of health care benefits to adults who are not otherwise eligible for MassHealth Standard.
To be eligible for MassHealth, you must also meet financial requirements. MassHealth considers income, disability, or health condition status when determining eligibility. For those who are 65 or older and live in the community, there are specific program financial guidelines used to determine eligibility. Additionally, MassHealth may be an option for parents or adult caretakers living with children under the age of 19.
If you are enrolled in MassHealth, you can contact My Ombudsman to understand your benefits and services better. They can help mediate or resolve issues with accessing benefits and explain your rights as a member.
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MassHealth coverage types
MassHealth is a public health insurance option available to eligible Massachusetts residents. It covers medical services and long-term services and support. There are six MassHealth coverage types offered to eligible individuals, families, and people with disabilities:
- Standard: This plan provides a full range of health care benefits, including medical services such as lab tests, X-rays, therapies, pharmacy services, eyeglasses, hearing aids, and medical equipment. It also includes well-child screenings for children under 21, covering medical, vision, dental, hearing, mental health, and addiction services, as well as developmental screens and shots. MassHealth Standard is available to those who are medically frail, defined as having a medical, mental health, or addiction condition that limits their ability to work or go to school.
- CommonHealth: This plan offers similar health care benefits to MassHealth Standard but is designed for certain disabled adults and children who cannot qualify for MassHealth Standard. CommonHealth covers medical services, including lab tests, X-rays, therapies, pharmacy services, eyeglasses, hearing aids, and medical equipment. It also includes well-child screenings for children under 21, similar to those offered by MassHealth Standard. CommonHealth is an option for children with significant mental health needs or serious emotional disturbances who are not eligible for MassHealth Standard.
- CarePlus: This plan provides a broad range of health care benefits to adults who are not otherwise eligible for MassHealth Standard. While specific covered services may have limits, CarePlus generally includes medical services such as lab tests, X-rays, therapies, pharmacy services, eyeglasses, hearing aids, and medical equipment.
- Family Assistance: This plan provides coverage for families, including expanded services for those with special needs. For example, persons in Family Assistance with HIV will receive coverage for all medically necessary services, including chiropractor, dental, vision, orthotic, prosthetic, and tobacco-cessation services.
- Premium Assistance: Limited information is available on this plan, but it is one of the six coverage types offered by MassHealth.
- Limited: Limited information is available on this plan, but it is one of the six coverage types offered by MassHealth.
In addition to these six coverage types, MassHealth offers integrated care options through the Program of All-inclusive Care for the Elderly (PACE) and Senior Care Options (SCO). PACE is a collaborative effort between MassHealth and Medicare, providing a wide range of medical, social, recreational, and wellness services to eligible participants, allowing them to live safely in their homes. SCO is a comprehensive health plan that covers services normally paid for through Medicare and MassHealth, providing health services and social support through a senior care organization and its network of providers.
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MassHealth application process
MassHealth is a public health insurance option available to eligible individuals in Massachusetts. It offers health-care benefits directly or by paying part or all of the health insurance premiums. To apply for MassHealth, you must be a resident of Massachusetts and meet eligibility requirements based on income, disability, or health condition status.
- Determine your eligibility: Visit the official MassHealth website or contact the MassHealth Customer Service Center at (800) 841-2900 to understand the eligibility criteria and confirm if you qualify for coverage. Eligibility is typically based on factors such as income, disability, or health condition.
- Gather required information and documents: To complete the application process, you may need to provide Social Security numbers for all household members applying for coverage. Additionally, you will need to furnish employer and income information (such as pay stubs or wage statements) for everyone in your household. If you currently have health insurance or have access to it, you will need to provide information about that as well.
- Complete and submit the application: You can apply for MassHealth online at www.MAhealthconnector.org. The application is available in English and Spanish. Alternatively, you can download and print the application form, fill it out by hand, and mail or fax it to MassHealth along with any supporting documents. Remember that the online application must be completed in one sitting.
- Enroll in a health plan: Once your application is approved and MassHealth determines that you qualify for coverage, they will inform you if you need to enroll in a health plan. You can compare and choose health plans at MassHealthChoices.com.
- Seek assistance if needed: If you need help with the application process, you can contact the Massachusetts Health Connector Walk-In Centers for free assistance. These centers have trained individuals who can help you apply for coverage, shop for plans, and answer any questions about eligibility, payments, and plan details. You can also call the MassHealth Customer Service Center at (800) 841-2900 or TDD/TTY: 711 for assistance.
Remember that MassHealth offers six coverage types: Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, and Limited. Each type has different eligibility requirements and covered services. Make sure to review the coverage types to understand which one best suits your needs.
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MassHealth health benefits
MassHealth is a public health insurance option available to eligible Massachusetts residents. It provides health benefits and helps pay for them to qualifying children, families, seniors, and people with disabilities living in Massachusetts.
MassHealth offers health-care benefits directly or by paying part or all of the health insurance premiums. There are six MassHealth coverage types offered to eligible individuals, families, and people with disabilities: Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, and Limited.
MassHealth Standard
MassHealth Standard provides a full range of health care benefits. Covered services include:
- Lab tests
- X-rays
- Therapies
- Pharmacy services
- Eyeglasses
- Hearing aids
- Medical equipment and supplies
- Well-child screenings (for children under 21), including medical, vision, dental, hearing, mental health, and addiction services, developmental screens, and shots
MassHealth CommonHealth
MassHealth CommonHealth offers health care benefits similar to MassHealth Standard to certain disabled adults and disabled children who cannot get MassHealth Standard. Covered services include:
- Lab tests
- X-rays
- Therapies
- Pharmacy services
- Eyeglasses
- Hearing aids
- Medical equipment and supplies
- Well-child screenings (for children under 21): medical, vision, dental, hearing, mental health, and addiction services, developmental screens, and shots
- Long-term services and supports at home or in a long-term care facility, including home health services
MassHealth CarePlus
MassHealth CarePlus offers a broad range of health care benefits to adults who are not otherwise eligible for MassHealth Standard. Covered services include:
- Lab tests
- X-rays
- Therapies
- Pharmacy services
- Eyeglasses
- Hearing aids
- Medical equipment and supplies
MassHealth Limited
MassHealth Limited provides emergency health services to people with an immigration status that keeps them from getting more services. Covered services include:
- Inpatient hospital emergency services, including labor and delivery
- Outpatient hospital emergency services and emergency visits to emergency rooms
- Certain medical services provided by doctors and clinics outside of a hospital
- Pharmacy services for treating an emergency medical condition
- Ambulance transportation for an emergency medical condition only
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MassHealth customer service
MassHealth is a public health insurance option available to eligible Massachusetts residents. It covers medical services as well as long-term services and support. MassHealth offers health-care benefits directly or by paying part or all of an individual's health insurance premiums.
The MassHealth Customer Service Center can be reached at (800) 841-2900, TDD/TTY: 711. The center is open Monday to Friday, from 8 a.m. to 5 p.m. Self-service options are available 24 hours a day in English and Spanish, and interpreter services can also be accessed.
MassHealth has Enrollment Centers open for limited walk-in appointments. These centers can provide assistance with applications, but not with enrolling in a health plan. The centers are located at the following addresses:
- Quincy: 100 Hancock Street, 1st floor, Quincy, MA 02171
- Springfield: 88 Industry Avenue, Suite D, Springfield, MA 01104
- Taunton: 21 Spring Street, Suite 4, Taunton, MA 02780
- Worcester: 50 SW Cutoff, Suite 1A, Worcester, MA 01604
The Massachusetts Health Connector is the state's health insurance marketplace. The Health Connector Customer Service Call Center can be reached at (877)-MA-ENROLL ((877) 623-6765) or TTY: 711. This line is open Monday to Friday, from 8:00 a.m. to 5:00 p.m.
My Ombudsman is a separate program that can help enrolled members understand their MassHealth health plan benefits and rights, address concerns, and explain how to file a grievance or appeal. My Ombudsman can be contacted at (855) 781-9898 or by videophone at (339) 224-6831, Monday through Friday, from 9 a.m. to 4 p.m.
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Frequently asked questions
MassHealth is a public health insurance option available to eligible individuals in Massachusetts. It covers medical services as well as long-term services and support.
Eligibility for MassHealth is based on income, family criteria, disability, or health condition status. You must be a resident of Massachusetts to get MassHealth.
MassHealth provides health benefits and helps pay for them to qualifying children, families, seniors, and people with disabilities. This includes doctor visits, dental, prescription drugs, and behavioral health services.
You can apply for MassHealth at any time during the year. You can apply online, by phone, or by mailing in your application.
