Massachusetts Medicaid (MassHealth)
Updated April 9, 2021 Medicaid
Massachusetts Medicaid (MassHealth) pays for health care for certain low and medium income people living in Massachusetts. MassHealth offers health-care benefits directly or by paying part or all of your health-insurance premiums.
MassHealth offers different types of coverage based on your age, whether you are a parent, pregnant, disabled, HIV positive or have breast or cervical cancer, and whether you work for a small employer. MassHealth will decide if you are eligible and give you the most complete coverage that you qualify for.
| Program Name | MassHealth |
| Expanded Medicaid | Yes |
| Website | https://www.mass.gov/orgs/masshealth |
| Phone | (800) 841-2900 |
| Apply Online | https://www.mahealthconnector.org/ |
| Appeal a Denial | Fair Hearing Request |
| Find a Local Office | MassHealth Enrollment Centers |
Eligibility Requirements
To be eligible for Massachusetts Medicaid, you must be a resident of the state of Massachusetts, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. ACA Medicaid expansion covers eligible low-income adults.
There is no income limit for individuals with disabilities who may have to pay a premium and a one-time deductible to qualify.
Annual Household Income Limits (before taxes)
| Household Size* | Maximum Income Level (Per Year) |
| 1 | $17,131 |
| 2 | $23,169 |
| 3 | $29,207 |
| 4 | $35,245 |
| 5 | $41,284 |
| 6 | $47,322 |
| 7 | $53,360 |
| 8 | $59,398 |
*For households with more than eight people, add $6,038 per additional person.
Available Services Include:
| Acute inpatient hospital | Hospice |
| Adult day health | Hospital services |
| Adult foster care | Laboratory |
| Ambulatory prenatal care | Medical/surgical supplies |
| Ambulatory surgery center services | Nurse practitioner |
| Audiologist/hearing services | Nursing facility services |
| Behavioral health | Pharmacy |
| Chiropractor | Physician |
| Dental services | Podiatrist |
| Dialysis services | Prosthetic |
| Durable medical equipment | Radiology and diagnostic services |
| Family planning | Therapy (physical, occupational, and speech) |
| Hearing aids | Transportation services |
| Home health | Vision care |
Copayments
Prescription drugs are the only benefit that may have copayments. There are no copayments for other covered services and benefits.
- $1.00 for certain covered generic drugs and over-the-counter drugs mainly used for diabetes, high blood pressure, and high cholesterol. These drugs are called antihyperglycemics (such as metformin), antihypertensives (such as lisinopril), and antihyperlipidemics (such as simvastatin)
- $3.65 for each prescription and refill for all other generic, brand-name, and over-the-counter drugs covered by MassHealth
You do not have to pay a MassHealth copayment if:
- Your income is at or below 50% of the federal poverty level
- You are eligible for MassHealth because you are getting certain public assistance benefits such as Supplemental Security Income (SSI)
- You are younger than 21 years of age
- You are pregnant
- You are getting benefits under MassHealth Limited (emergency MassHealth)
- You are an American Indian or Alaska Native
- You are getting hospice care
- You have reached a copayment cap
