MassHealth is Medicaid, but it's Massachusetts's version of it

MassHealth is Massachusetts's Medicaid program. It is not Medicare. Medicaid is a joint federal and state program that covers low-income people, and each state runs its own version under federal rules. Massachusetts calls theirs MassHealth, just as California calls theirs Medi-Cal and New York calls theirs Medicaid.

The confusion happens because Medicare and Medicaid sound similar and both are government health insurance. But they are completely different programs with different rules, different costs, and different people they cover. Medicare is federal only and covers people 65 and older, plus some younger people with disabilities. Medicaid covers low-income people of any age, and each state decides who qualifies and what services are covered.

If you live in Massachusetts and you are under 65 and low-income, you would look at MassHealth, not Medicare. If you are 65 or older, you would look at Medicare first, though you might also may have access to for MassHealth to help pay Medicare costs.

Key Takeaways

  • MassHealth is Massachusetts's Medicaid program — it is state-run Medicaid, not a separate thing.
  • Medicaid covers low-income people; Medicare covers people 65 and older and some younger people with disabilities.
  • If you are under 65 and low-income in Massachusetts, you would look at MassHealth, not Medicare.
  • Some people may have access to for both MassHealth and Medicare at the same time, and MassHealth can help pay Medicare costs.
  • MassHealth income limits and covered services are set by Massachusetts, not by the federal government alone.

How MassHealth differs from Medicare

Medicare is a federal program that you pay into through payroll taxes during your working years. You become may be able to access at 65, or earlier if you have been on Social Security Disability for two years or have end-stage renal disease. Medicare has the same rules and costs everywhere in the country.

MassHealth is Medicaid, which means it is funded by both the federal government and Massachusetts. It covers people based on income and household size, not age. The income limits, the services covered, and the cost to you all depend on which MassHealth plan you are in — and Massachusetts offers several. A person on MassHealth might pay nothing for a doctor visit, or a small copay, depending on their plan and income.

If you are 65 or older and have low income, you might be on both Medicare and MassHealth at the same time. MassHealth would then pay some of your Medicare premiums and cost-sharing, which is why it is sometimes called a "buy-in" program in that situation.

The different MassHealth plans and who they cover

MassHealth has several separate programs, each with its own income limits and rules. MassHealth Standard covers low-income adults, children, and families. MassHealth Essential is for people who do not may have access to for Standard but have higher income. MassHealth Senior Care is for people 65 and older with low income. MassHealth Disability is for working-age people with disabilities.

Each plan has different income cutoffs. For example, a single adult might may have access to for MassHealth Standard at one income level but would need to look at Essential if their income is higher. A family of three has a different cutoff than a single person. Massachusetts publishes these limits, and they change each year.

Some people also may have access to for MassHealth CarePlus, which is for people who are may be able to access for both Medicaid and Medicare — the "dual may be able to access" group. This plan coordinates coverage between the two programs and often has lower out-of-pocket costs than being on Medicare alone.

What MassHealth covers that Medicare does not

MassHealth covers many services that Medicare does not, including dental care, vision care, and hearing aids. MassHealth also covers long-term services like nursing home care and home health aides, which Medicare covers only in limited situations. Prescription drug coverage is included in MassHealth, whereas Medicare requires a separate Part D plan.

MassHealth also covers transportation to medical appointments, which Medicare does not. For low-income people, this can be the difference between getting to a doctor and missing the appointment.

On the other hand, Medicare covers some things MassHealth does not, such as certain preventive screenings and some mental health services. The two programs overlap in many areas but have gaps in different places.

How to know which program you might may have access to for

If you are under 65, you cannot may have access to for Medicare based on age alone. You would look at MassHealth if your income is low enough. If you are 65 or older, you are may be able to access for Medicare, but you might also may have access to for MassHealth to help pay the costs.

Income is the main factor for MassHealth. You will need to report your household income and household size. MassHealth counts income differently than some other programs — for example, it may not count certain types of income, or it may count income from a spouse differently depending on your situation. The MassHealth website has a tool to estimate whether you might may have access to, but the only way to know for certain is to submit information to MassHealth directly.

If you are on Social Security, that counts as income for MassHealth purposes. If you are working, your wages count. If you receive unemployment or disability payments, those count too. Some income sources, like Supplemental Security Income (SSI), may not count, or may count differently.

How to contact MassHealth

You can reach MassHealth by phone at 1-800-841-2900. You can also apply online through the MassHealth website or through the Massachusetts Health Connector, which is the state's health insurance marketplace. Some people also apply through their local board of health or a community health center.

MassHealth processes applications and can tell you whether you may have access to. If you do, they will tell you which plan you are in and what your costs are. The process usually takes a few weeks, though it can be faster if you apply online.

If you are already on Medicare and think you might also may have access to for MassHealth, you can contact MassHealth directly. They can review your situation and tell you whether you may have access to for a plan that works with Medicare.

Frequently Asked Questions

Can I have both MassHealth and Medicare at the same time?

Yes. If you are 65 or older or may have access to for Medicare for another reason, and you also have low income, you can be on both. MassHealth will coordinate with Medicare and may pay some of your Medicare costs. This is called being "dual may be able to access."

Does MassHealth cost money?

It depends on which MassHealth plan you are in and your income. Some plans have no premium, no copays, and no deductible. Others have small copays for doctor visits or prescriptions. MassHealth will tell you the exact costs when you are determined to be in a plan.

What is the difference between MassHealth and the Health Connector?

The Health Connector is Massachusetts's marketplace for private health insurance plans. MassHealth is a government program. Some people may have access to for both and have to choose, while others may have access to for only one. The Health Connector website can help you compare options.

If I move out of Massachusetts, do I keep MassHealth?

No. MassHealth is only for Massachusetts residents. If you move to another state, you would need to look at that state's Medicaid program. You should contact MassHealth before you move to understand your options.

Does MassHealth cover prescription drugs?

Yes. MassHealth includes prescription drug coverage as part of the plan. You may have a small copay for some drugs, depending on which plan you are in. MassHealth publishes a list of covered drugs, called a formulary, and you can check whether a specific medication is covered.