Orlando Harmon
MassHealth is a public health insurance option for eligible Massachusetts residents. It is a federal and state-funded program that covers medical services and long-term care services for individuals, families, seniors, and people with disabilities. MassHealth offers a range of coverage types, including MassHealth Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, and Limited. Eligibility for MassHealth is based on income, disability, health condition status, and immigration status. It is often compared to other programs like Medicare and Medicaid, but MassHealth is specifically designed to meet the needs of Massachusetts residents who require financial assistance for their healthcare expenses.
| Characteristics | Values |
|---|---|
| Type | Public health insurance |
| Coverage | Medical services, long-term services and support, prescription drugs, dental, vision, hearing, mental health and addiction services, developmental screens, shots |
| Eligibility | Massachusetts residents with low and medium income, disability, or specific health conditions |
| Coverage Types | Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, Limited |
| Other Services | My Ombudsman helps members understand their benefits and services, Medicare Savings Program, Senior Care Options |
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What You'll Learn
MassHealth Standard
MassHealth is a government-sponsored health insurance program for Massachusetts residents, including seniors, individuals, and families with disabilities. MassHealth Standard is one of the coverage types offered by MassHealth. It provides a full range of health care benefits to eligible individuals, including medical services such as lab tests, X-rays, therapies, pharmacy services, eyeglasses, hearing aids, and medical equipment.
Medically frail individuals may be eligible for MassHealth Standard. To be considered medically frail, an individual must have a medical, mental health, or addiction condition that limits their ability to work or go to school. They may also require assistance with daily activities such as bathing or dressing, or regular medical care and health services at home or in a community setting.
In conclusion, MassHealth Standard is a comprehensive health insurance program offered by MassHealth that provides a wide range of health care benefits to eligible Massachusetts residents, including individuals who are medically frail and children under 21.
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MassHealth CommonHealth
MassHealth is a government-run health insurance programme in Massachusetts that provides health care coverage to eligible individuals, families, and people with disabilities. MassHealth CommonHealth is one of the six MassHealth coverage types offered to eligible individuals, families, and people with disabilities.
Eligibility
Benefits
Application
There is one application (the ACA-3) for all MassHealth and Health Connector Plans. To apply for CommonHealth, individuals younger than 65 must complete the Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3). Those aged 65 and older must complete the Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (SACA-2). If you are applying for CommonHealth after age 65, write “CommonHealth” across the top of your application or renewal application to let MassHealth know what type of coverage you are looking for.
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MassHealth Limited
MassHealth is a health insurance program offered by the state of Massachusetts. It provides a range of coverage options for individuals and families, including those with disabilities. One of the coverage options offered by MassHealth is MassHealth Limited.
It is important to note that MassHealth Limited does not cover long-term care services. The program only covers care for medical emergencies, which are defined as conditions that could cause serious harm if left untreated. There may also be some limits within these covered services.
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MassHealth Family Assistance
MassHealth is a government-run health insurance programme for Massachusetts residents, including individuals and families with disabilities. MassHealth Family Assistance is available to Massachusetts residents who do not qualify for MassHealth Standard.
- Outpatient services: hospitals, clinics, doctors, dentists, family planning, and vision care
- Medical services: lab tests, X-rays, therapies, pharmacy services, eyeglasses, hearing aids, and medical equipment and supplies
- MassHealth may also pay all or part of a household's health insurance premiums if they have or have access to other health insurance
MassHealth Standard Coverage
MassHealth Standard provides a full range of health care benefits, including:
- Medical services: lab tests, X-rays, therapies, pharmacy services, eyeglasses, hearing aids, and medical equipment and supplies
- Well-child screenings (for children under 21): medical, vision, dental, hearing, mental health, addiction services, and developmental screens
- Long-term services and supports at home or in long-term care facilities, including home health services
- For disabled adults who also receive Medicare Part B, MassHealth will pay the Medicare premium and, if applicable, the coinsurance and deductibles
MassHealth CommonHealth Coverage
MassHealth CommonHealth offers healthcare benefits similar to MassHealth Standard for certain disabled adults and children who cannot obtain MassHealth Standard. CommonHealth provides certain behavioural health services for eligible children and youth under 21. If a child is not eligible for MassHealth Standard and a behavioural health evaluation shows significant mental health needs or serious emotional disturbance, they may be eligible for MassHealth CommonHealth.
MassHealth Limited Coverage
MassHealth Limited provides emergency health services to people with an immigration status that prevents them from obtaining other services. Covered services include:
- Inpatient hospital emergency services, including labour and delivery
- Outpatient hospital emergency services and emergency room visits
- Certain medical services provided by doctors and clinics outside of a hospital
- Pharmacy services for treating emergency medical conditions
- Ambulance transportation for emergency medical conditions only
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MassHealth Premium Assistance
MassHealth is a health insurance program for Massachusetts residents. It offers a range of coverage types for individuals and families, including people with disabilities. MassHealth members who have access to employer-sponsored health insurance (ESI) may be eligible for the MassHealth Premium Assistance (PA) program. This program reimburses eligible members for some or all of the premium costs of private insurance.
Eligibility for MassHealth Premium Assistance
To be eligible for MassHealth Premium Assistance, members must have access to ESI from a job or another source, such as a household member. At least one person covered by the ESI must be eligible for MassHealth Premium Assistance, and the ESI policyholder must live with the eligible MassHealth member or be the eligible member themselves. Certain MassHealth members with access to ESI are required to enroll and maintain their ESI coverage as long as they meet the eligibility rules.
Applying for MassHealth Premium Assistance
The application process for MassHealth Premium Assistance involves completing and submitting the necessary forms. The "Additional Information about Your Access to Employer-Sponsored Health Insurance (ESI) Coverage" form must be completed by both the member and their employer. The completed application, along with the Summary of Benefits from the employer, must be returned to the Premium Assistance Unit. It can take up to 45-60 days for the application to be processed, during which time the member retains their existing MassHealth benefits if their eligibility status remains unchanged.
Benefits of MassHealth Premium Assistance
MassHealth Coverage Types
MassHealth offers various coverage types, including MassHealth Standard, CommonHealth, Family Assistance, CarePlus, and Limited. Each type provides different benefits, such as medical services, outpatient services, behavioral health services for eligible children and youth, and emergency health services for those with limited immigration status. MassHealth may also pay all or part of a household's health insurance premiums if they have or have access to other health insurance.
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Frequently asked questions
MassHealth is a public health insurance option available to eligible Massachusetts residents. It covers medical services as well as long-term services and support.
Eligibility for MassHealth depends on factors such as income, citizenship or immigration status, age, and special circumstances. MassHealth is available to Massachusetts residents who meet these eligibility requirements.
There are six types of MassHealth coverage offered: Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, and Limited. Each type of coverage provides different benefits and services, with Standard being the most comprehensive option.
