Masshealth: Private Insurance Or Public Option?

In Massachusetts, Medicaid and the Children's Health Insurance Program (CHIP) are combined into one program called MassHealth. MassHealth members can have both MassHealth and private health insurance at the same time. Private health insurance could be from employment, a family member, or a parent with or without custody. If a member has both types of insurance, the private health insurance is considered the primary insurer and MassHealth is the secondary coverage.

MassHealth members can have both MassHealth and private health insurance

In Massachusetts, MassHealth is a combination of Medicaid and the Children's Health Insurance Program (CHIP). MassHealth members can have both MassHealth and private health insurance at the same time. Private health insurance could be obtained through employment, a family member, or a parent with or without custody. If a member has private insurance, it is considered a liable third party or "TPL", making it the primary insurer, with MassHealth serving as the secondary coverage.

Having both private health insurance and MassHealth does not mean that members need to pay more for coverage than they did with MassHealth alone. The same copay amounts still apply. However, when utilising both types of insurance, members must see a provider who is in the private health insurance plan's network and is also a MassHealth provider. The private health insurance should be billed first, followed by MassHealth. This is the case even if the private health insurance does not cover a particular service, as long as the service is covered by MassHealth.

For adults aged 21 or older, all benefits from MassHealth will be provided through healthcare professionals who are part of both the private health insurance plan's network and the MassHealth provider network. This may exclude certain providers who were previously part of the MassHealth Managed Care Organisation (MCO) or Accountable Care Organisation (ACO) network. For those under 21, medical benefits will be provided through providers who are part of both networks, while behavioural health services will be covered through the Massachusetts Behavioural Health Partnership network of providers.

When visiting a healthcare provider, MassHealth members with private health insurance must present both their private health insurance ID card and their MassHealth ID card. If a member does not have their MassHealth ID number, they can be identified in the system using their social security number or their name and date of birth.

Private health insurance is considered a liable third party or TPL

MassHealth is a government-run health insurance program in Massachusetts. MassHealth members can have both MassHealth and private health insurance at the same time. Private health insurance could be obtained through employment, a family member, or a parent with or without custody. If a member has both MassHealth and private health insurance, the private health insurance is considered a liable third party or "TPL". This means that the private health insurance is billed as the primary insurer, and MassHealth is the secondary coverage.

Private health insurance may also be known as "commercial health insurance", "employer-sponsored insurance (ESI)", or "other insurance". If a member has both types of insurance, their private insurance will be the primary insurer and will pay first for their healthcare. MassHealth will then pay for any MassHealth-covered services that the private health insurance does not, including out-of-pocket costs like copays or deductibles.

If a member was receiving their MassHealth through a MassHealth managed care organization (MCO) plan, an accountable care organization (ACO) plan, or through the Primary Care Clinician (PCC) Plan, they will be disenrolled from the MassHealth MCO, ACO, or PCC Plan once they become enrolled in their private health insurance. An MCO, ACO, or PCC Plan disenrollment notice will be mailed to the member's address. The member will still have MassHealth benefits, but how they receive them will change.

If a MassHealth member has or may have access to private health insurance, they may be required to:

• Supply information about the private insurance plan to see if it would be cost-effective for MassHealth to require them to enroll
• Enroll in insurance through their job if MassHealth determines it is cost-effective
• Maintain any private health insurance that is available to them at no cost (including Medicare)

Unless they are pregnant or under 21 years old, a MassHealth member could lose their benefits if they do not enroll in private health insurance when required to do so by MassHealth.

MassHealth members will not lose their MassHealth coverage if they have private insurance

MassHealth is a program in Massachusetts that combines Medicaid and the Children's Health Insurance Program (CHIP). Members of MassHealth can have both MassHealth and private health insurance at the same time. Private health insurance could be obtained through employment, a family member, or a parent with or without custody. If a member has both types of insurance, the private health insurance is considered the primary insurer and MassHealth is the secondary coverage.

If you are a MassHealth member with private health insurance, you will not lose your MassHealth coverage as long as you are still eligible for MassHealth. Your private insurance will be the primary insurer and will be billed first for your healthcare. MassHealth will pay for any remaining costs, including out-of-pocket expenses such as copays or deductibles. It is important to note that you will never have to pay more than you did when you were solely on MassHealth.

When you have both MassHealth and private insurance, the way you receive your benefits may change. For adults aged 21 or older, all benefits from MassHealth will be provided through providers who are in the network of both the private health insurance plan and MassHealth. For those under 21, medical benefits will be provided through similar providers, while behavioral health services will be covered through the Massachusetts Behavioral Health Partnership network of providers.

It is important to carry both your private health insurance ID card and your MassHealth ID card whenever you visit a healthcare provider. By having both types of insurance, you can benefit from a wider range of covered services and ensure that you receive the necessary care.

MassHealth is the secondary coverage when a member has both types of insurance

In Massachusetts, MassHealth members can have both MassHealth and private health insurance at the same time. Private health insurance could be from employment, a family member, or a parent with or without custody. If a member has both types of insurance, the private health insurance is considered a liable third party or "TPL". This means that the private health insurance is billed as the primary insurer, and MassHealth is the secondary coverage.

When a MassHealth member has private insurance, their private insurance will be the primary insurer and will pay first for their healthcare. MassHealth will then pay for any remaining MassHealth-covered services, including out-of-pocket costs like copays or deductibles. It is important to note that the member will never have to pay more than they did when they were only on MassHealth.

When a member has both MassHealth and private insurance, they will still have MassHealth benefits, but the way they receive them will change. For adults aged 21 or older, all their benefits from MassHealth will be through providers who are in both the private health insurance plan's network and are MassHealth providers. This may exclude some providers who were part of their previous MassHealth MCO or ACO network. For those under 21, their medical benefits will be through providers who are in both the private health insurance plan's network and are MassHealth providers. Their MassHealth behavioral health services will be through the Massachusetts Behavioral Health Partnership network of providers.

When seeing a healthcare provider, a member with both types of insurance must show both their private health insurance ID card and their MassHealth ID card. It is also important to note that when a member with private insurance and MassHealth requires a service, they must see a provider who is in both the private health insurance plan's network and is a MassHealth provider. The private health insurance should be billed first to cover what they can, and then MassHealth will be billed second. This applies even if the private health insurance does not cover a service, as long as the service is covered by MassHealth.

MassHealth members must use providers that are in the private health insurance plan's network and are also MassHealth providers

In Massachusetts, Medicaid and the Children's Health Insurance Program (CHIP) are combined into one program called MassHealth. MassHealth provides health plans so that members can get the healthcare they need. Members can have both MassHealth and private health insurance at the same time. Private health insurance could be from employment, a family member, or a parent with or without custody. If you have both types of insurance, the private health insurance is considered a liable third party or "TPL". This means that the private health insurance is billed as the primary insurer, and MassHealth is the secondary coverage.

When you have MassHealth and private insurance, you will still have MassHealth benefits, but the way you receive them will change. If you are an adult aged 21 or older, all your benefits from MassHealth will be through providers who are in both the private health insurance plan's network and are MassHealth providers. This may not include some providers who were part of your previous MassHealth MCO or ACO network. If you are under 21, your medical benefits will be through providers who are in both the private health insurance plan's network and are MassHealth providers. Your MassHealth behavioral health services will be through the Massachusetts Behavioral Health Partnership network of providers.

When you see a healthcare provider, you must always show both your private health insurance ID card and your MassHealth ID card. It is important to note that having private health insurance and MassHealth does not mean you need to pay more for coverage than you did when you only had MassHealth. The same copay amounts still apply.

Frequently asked questions