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.
|Appeal a Denial||Fair Hearing Request|
|Find a Local Office||MassHealth Enrollment Centers|
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)|
*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|
|Durable medical equipment||Radiology and diagnostic services|
|Family planning||Therapy (physical, occupational, and speech)|
|Hearing aids||Transportation services|
|Home health||Vision care|
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