Paul Sanchez
MassHealth and Medicare are both health insurance programs that provide coverage for a range of healthcare services, with MassHealth serving residents of Massachusetts and Medicare being a federal program. While there have been discussions of spending cuts and changes to these programs, there are no indications that they will be stopped entirely. In fact, recent developments suggest that both programs are being expanded and strengthened to improve access to healthcare for their respective beneficiaries. For example, MassHealth has received federal approval to expand eligibility and lower insurance costs, while Medicare Savings Programs have been extended to benefit more low-income individuals. Additionally, both programs have collaborated to offer One Care, which provides beneficiaries with a simplified way to access their benefits through a single plan and coordinator. While specific coverage details and eligibility criteria may evolve, the ongoing efforts indicate a commitment to sustaining and enhancing these vital health insurance programs.
| Characteristics | Values |
|---|---|
| Medicare in Massachusetts | Government-run and sponsored health care insurance program |
| Medicaid (MassHealth) | Pays for health care for certain low and medium-income people living in Massachusetts |
| MassHealth coverage types | MassHealth Standard, MassHealth CommonHealth |
| MassHealth Standard coverage | Lab tests, X-rays, therapy, prescription drugs, dentures, eyeglasses, hearing aids, medical equipment and supplies |
| MassHealth CommonHealth coverage | Similar benefits to MassHealth Standard for disabled adults who cannot get MassHealth Standard |
| MassHealth and Medicare financing programs | Program for All-inclusive Care for the Elderly (PACE), Qualified Medicare Benefit, Senior Care Options (SCO) |
| PACE goal | Allow participants to live safely in their homes instead of in nursing homes |
| MassHealth and out-of-state emergency treatment | MassHealth may pay for emergency treatment for members out of state |
| MassHealth and Medicare expansion | Federal approval to expand eligibility and lower insurance costs for Massachusetts families through December 2027 |
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What You'll Learn
Medicare and MassHealth Savings Program
The Medicare Savings Program (MSP), formerly known as the MassHealth Senior Buy-In and Buy-In programs, is a program that helps Massachusetts residents with their Medicare costs. The program is administered by MassHealth and offers savings of up to $3,000 per year on premiums and other healthcare costs, including prescriptions. To qualify for the MSP, residents must be on Medicare and meet certain income requirements.
As of March 1, 2024, the Executive Office of Health and Human Services expanded eligibility for the MSP by removing the asset limit. Previously, owning a home or having savings could impact a Medicare member's eligibility. Now, residents with an income at or below 225% of the Federal Poverty Level may qualify for assistance, and they do not need to be on MassHealth to apply.
The MSP has two levels, depending on income. At the first level, MassHealth pays for the Medicare Part A premium (which most people have) and the Medicare Part B premium, as well as some costs like copays, deductibles, and/or premiums. At the second level, for Qualifying Individuals (QI), MassHealth pays for the Medicare Part B premium, and individuals are enrolled in Health Safety Net for coverage at acute care hospitals and community health centers.
MassHealth also offers coverage for seniors and people who need long-term care services. Covered services include lab tests, X-rays, therapy, prescription drugs, dentures, eyeglasses, hearing aids, medical equipment, and supplies. MassHealth may also cover emergency treatment for members who are out of state. Additionally, MassHealth has received federal approval to expand eligibility and lower insurance costs for Massachusetts families, making healthcare more accessible and affordable for residents.
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MassHealth coverage for seniors
MassHealth is a health-care program for Massachusetts residents who get medical care in the state. It offers different types of coverage, including for seniors and people of any age who need long-term care services.
Eligibility for MassHealth Coverage for Seniors
To be eligible for MassHealth coverage as a senior, you must be 65 years or older. Your eligibility will also depend on factors such as income, citizenship or immigration status, and special circumstances.
Types of Coverage for Seniors
There are several types of MassHealth coverage offered to eligible seniors:
- MassHealth Standard is the most comprehensive coverage option. It pays for a wide range of healthcare benefits, including long-term care services, lab tests, X-rays, therapy, prescription drugs, dentures, eyeglasses, hearing aids, and medical equipment.
- MassHealth Limited is available to people 65 and older who meet the income and asset rules for MassHealth Standard but have an immigration status that prevents them from qualifying. However, MassHealth Limited does not cover long-term care services.
- MassHealth Family Assistance is available to seniors who meet the income and asset rules for MassHealth Standard but are ineligible due to their immigration status. Covered services include lab tests, X-rays, therapy, prescription drugs, dentures, medical equipment, and supplies.
- MassHealth CommonHealth offers similar benefits to MassHealth Standard but is for disabled adults who cannot get MassHealth Standard. To qualify, you must meet specific work requirements or have a mental or physical condition that severely limits your ability to work or perform certain activities for at least 12 months.
- Medicare Savings Program (formerly MassHealth Senior Buy-In) is available to those with Medicare who qualify. MassHealth will pay for your Medicare Part B premium.
Applying for MassHealth Coverage for Seniors
You can apply for MassHealth coverage for seniors by completing and submitting the Massachusetts Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (SACA-2). The application can be completed electronically using Adobe Acrobat or printed, completed by hand, and mailed or faxed to the MassHealth Enrollment Center.
MassHealth Coverage Benefits
MassHealth coverage has allowed Massachusetts residents to seek care without delaying it due to financial considerations. It provides over 2 million people with the resources to support and manage their healthcare needs. MassHealth covers a range of healthcare services, including doctor visits, hospital stays, rehabilitation, therapy services, prescription drugs, and substance use disorder services. It also provides non-emergency and emergency transportation services and emergency ambulance services.
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MassHealth and Medicaid cuts
MassHealth is a healthcare program for people living in Massachusetts who get medical care in Massachusetts. It covers doctor visits, hospital stays, rehabilitation, therapeutic services, and behavioral health and substance use disorder services. It also covers prescription drugs, nonemergency transportation services, and emergency ambulance services. Medicare Savings Program, formally MassHealth Senior Buy-In, is also available.
Medicaid is a federal program, of which MassHealth is the state-specific version in Massachusetts. About 72 million people rely on Medicaid nationally, with approximately 2.1 million residents of Massachusetts having some form of coverage through MassHealth. Public payers, including MassHealth, Medicare, and the Health Safety Net, account for 65% of all hospital gross revenue in Massachusetts.
In 2025, the House budget resolution called for $880 billion in spending cuts over the next decade, with reductions expected to fall heavily on Medicaid, Medicare, and nutrition programs. The Senate budget resolution called for $1 billion in cuts from the Finance Committee, which also includes Medicaid and Medicare.
The potential cuts to MassHealth and Medicaid have been described as "very difficult choices" by Walsh, the state's representative. The cuts could result in the loss of healthcare coverage for more than 250,000 Massachusetts residents, with negative impacts on nursing homes, community health centers, and hospitals. It could also lead to increased healthcare costs for everyone and put the jobs of healthcare professionals at risk.
The proposed cuts have faced opposition from Governor Healey, Senator Warren, and Senator Markey, who have fought against the Medicaid Cuts. They argue that the cuts will undermine their efforts to keep people healthy and costs low, and that states do not have the resources to make up for the dramatic reduction in federal funding.
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MassHealth coverage for non-emergency transport
MassHealth is a health-care program for people living in Massachusetts who get medical care in Massachusetts. It covers non-emergency transportation services for eligible members living in the community who are travelling to and from medical appointments with MassHealth providers to receive MassHealth-covered services.
To be eligible for non-emergency transportation, you must not be able to access public transportation or private means of transportation. Your medical provider must authorise your need for transportation by completing a Prescription for Transportation (PT-1) form for community-based services or a Medical Necessity Form (MNF) for institutionally-based services.
Once you are approved for transportation, MassHealth assigns a transportation broker to you based on your city or town. The broker is a regional transit authority that manages non-emergency medical transportation and matches transportation requests with the right vehicles, routes, and schedules. Only your broker can arrange rides for you. After transportation is set up for the first time, the broker will send you a welcome letter with their contact information, as well as information on scheduling, filing complaints, and other helpful resources.
You can schedule transportation by contacting your transportation broker. You can also schedule trips through an app or online through a portal. Members should schedule transportation at least three business days before a medical appointment. If a member needs transportation sooner, they can contact MassHealth Customer Service.
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MassHealth coverage for incarcerated individuals
Incarcerated individuals cannot buy a Marketplace health insurance plan. However, they can apply for Medicaid while incarcerated, and they may be able to get care more quickly after their release. Medicaid does not pay for medical care while incarcerated individuals are in prison or jail.
MassHealth is a health-care program for people living in Massachusetts who get medical care in Massachusetts. It is a key reason Massachusetts has achieved near-universal health coverage. It covers doctor visits, hospital stays, rehabilitation, therapeutic services, behavioral health services, substance use disorder services, and prescription drugs. It also provides non-emergency and emergency ambulance services.
MassHealth coverage allows people to seek care without delay due to financial considerations. It provides more than 2 million people with the resources to support and manage their healthcare needs. It has also led investments in primary care and behavioral health.
MassHealth Standard is the most complete coverage offered by MassHealth. It pays for a wide range of health care benefits, including long-term care services. MassHealth Limited, on the other hand, only covers medical emergencies.
MassHealth Senior Buy-In, also known as the Medicare Savings Program, is available for seniors and people needing long-term care services. MassHealth CommonHealth is another option for disabled adults who cannot get MassHealth Standard.
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Frequently asked questions
No, Medicare is not going to stop. However, the House budget resolution calls for spending cuts over the next decade, which may fall heavily on Medicare.
No, MassHealth is not going to stop. In fact, MassHealth recently received federal approval to expand eligibility and lower insurance costs for Massachusetts families.
Medicare will provide most of your prescription drug coverage. If you are eligible for both Medicare and MassHealth, MassHealth may also cover prescription drugs if there is no generic drug available.
Medicare and MassHealth will continue to cover medically necessary therapy services. However, after 20 visits within a 12-month period, your therapist must get prior authorization from MassHealth for further coverage.
