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Insurdinary specializes in finding quality insurance for clients looking for exceptional policies at affordable rates. We also help Massachusettsans understand their state’s Medicaid program. Insurdinary provides eligible citizens useful information about Massachusetts Medicaid, also called MassHealth, and its benefits.
Permanent Massachusetts residents younger than 65 living outside a nursing facility qualify for MassHealth and can reduce the cost of specific medical services.
Many Massachusetts residents need an efficient insurance plan that provides exceptional coverage for various medical services. The Massachusetts Medicaid plan, a.k.a. MassHealth offers extensive medical coverage to approximately 2,000,000 people state wide, and can make doctor visits, prescriptions, and other healthcare services more affordable.
This guide will explain MassHealth, its eligibility requirements, provided coverage, how to enroll in the program, and more.
Enrolling in additional insurance policies can enhance your medical coverage and ensure you receive the services you need without unreasonably high medical bills. Insurdinary can optimize your coverage to include a more comprehensive range of benefits and services by way of private health insurance. Understanding MassHealth and other available insurance plans will make finding the perfect policy for your needs easier.
MassHealth is a federally and state-funded insurance policy that helps Massachusetts residents pay for various medical services. It combines the Children’s Health Insurance Program and Massachusetts Medicaid to form a comprehensive insurance plan. MassHealth covers multiple medical bills, services, and medications, allowing enrollees to receive quality healthcare at more affordable rates.
Massachusetts bases a MassHealth enrollee’s premiums on family size, monthly income, and whether they have additional health insurance policies. However, premiums never surpass more than 3% of a household’s monthly income unless they are CommonHealth members.
MassHealth consists of three primary policies:
MassHealth also offers limited, family assistance, and buy-in plans to residents who don’t qualify for Massachusetts Medicaid. It’s best to research each policy and determine which plan works best for your needs. You may also contact the MassHealth Customer Service Center for more information about each policy.
A MassHealth card is a medical ID proving your enrollment in a MassHealth policy. It features the enrollee’s MassHealth identification number and grants access to various healthcare services. Every member must show their MassHealth card to their pharmacy or healthcare provider to receive benefits.
However, MassHealth enrollees who meet the following criteria won’t receive a card:
Massachusetts residents can learn how to apply for MassHealth by visiting one of their city’s MECs (MassHealth Enrollment Centers). These centers offer limited walk-in appointments and can make enrolling much smoother. You can also schedule an appointment with an MEC via MassHealth’s online appointment scheduler since walk-in appointments aren’t always available.
Many Massachusetts cities also have designated enrollment assisters to help you complete MassHealth applications, enroll in a MassHealth plan, and apply for benefits. These assisters often make the process less stressful while explaining each policy in an easily digestible manner.
However, you don’t have to apply for MassHealth in person. You can also apply using one of the following methods:
Massachusetts requires residents to meet specific criteria to become eligible for MassHealth:
To request a MassHealth card, contact the MassHealth Customer Service Center at (800) 841-2900 between 8 a.m. and 5 p.m. A representative will ask for your MassHealth ID number to verify your enrollment. If you don’t have your MassHealth ID number, provide your social security number or your name and date of birth to the representative.
After providing the necessary information, the representative will locate you in their system and order your MassHealth card. Most residents receive their MassHealth card within two weeks after their request.
It’s best to write down your MassHealth ID number in case you need medical services before your card arrives. Providing your ID number to your healthcare provider will allow you to access benefits and receive coverage despite not having a physical card. You can’t obtain benefits without providing your MassHealth ID or your MassHealth identification number.
Replacing your MassHealth card requires the same process as described above. Contact the MassHealth Customer Service Center and provide your MassHealth ID, social security number, or name and date of birth to the representative. The representative will then file a replacement request and send a new card within two weeks.
Massachusetts’ Medicaid program, MassHealth, covers various healthcare services such as doctor visits, inpatient hospital services, well-child screens, and transportation. It offers most essential medical necessities and makes multiple other services more affordable. Continue reading to learn about what MassHealth covers and its benefits.
MassHealth provides comprehensive dental care to all qualified enrollees. The program covers several adult dental services, including anesthesia, cavity-arresting medicament, cleanings, crowns, dentures, extractions, fillings, oral exams, oral surgery, root canal treatments (excluding third molars), X-rays, and some periodontal services.
The Massachusetts Medicaid program offers more expansive coverage to enrollees under 21. It covers braces, immediate dentures, sealant services, space maintainers, and other medically necessary dental care. While MassHealth offers dental coverage for qualified individuals, there are yearly limits to the plans. For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Massachusetts is advisable.
MassHealth covers most prescription drug costs. However, the program requires pharmacies to fill prescriptions with a genetic variation unless the doctor who prescribed the drug requests brand-name medication. Doctors must request prior authorization before the pharmacy fills prescriptions with brand-name drugs in most cases.
You can browse MassHealth’s prescription drug list to see whether it covers your medications.
Most MassHealth enrollees pay a copay for each medication. If you qualify for MassHealth and Medicare, Medicare will cover your prescriptions through a Medicare prescription drug plan.
MassHealth also offers free birth control to qualified enrollees. You can request up to a 12-month supply of birth control all at once or in monthly increments. However, if you want a 12-month supply all at once, you must talk to a pharmacist and your healthcare provider before putting in a request.
MassHealth offers several extended healthcare benefits that stretch beyond basic coverage. Adult enrollees have access to foster care and day health services, various medical supplies ranging from hearing aids to healthcare equipment, long-term care services at home or in a medical facility, and more. MassHealth also provides vision, dental, and hearing screenings, inpatient and outpatient mental health services, and development screens.
Enrollees under 21 also receive well-child screenings and EPSDT (early and periodic screening, diagnosis, and treatment) coverage.
The MassHealth plan provides emergency and non-emergency medical care transportation to MassHealth providers within the state but doesn’t cover out-of-state travel. For non-emergency transportation, beneficiaries must complete a PT-1 (Prescription for Transportation) form to obtain community-based transport or an MNF (medical necessity form) to qualify for institutional transportation.
Massachusetts designed MassHealth for people living in the state. Enrollees can only receive MassHealth’s benefits within Massachusetts.
If you experience a medical emergency out-of-state, MassHealth may cover emergency healthcare services outside of Massachusetts. The insurance plan recommends contacting your doctor or a MassHealth representative within 24 hours of the treatment if possible. If you are traveling outside of Massachusetts for leisure, invest in proper travelers insurance.
MassHealth doesn’t provide specific services for seniors and students. However, MassHealth includes multiple services that vastly benefit senior citizens, such as Senior Care Options (SCO).
For example, the policy offers personal care attendant services and long-term care in and out of the home that helps seniors with specific needs. MassHealth refers to its long-term care program as HCBS (home and community-based services).
The policy also covers various medical equipment that older enrollees might need to maintain their health.
It’s important to note that these services aren’t limited to senior citizens. Anyone who meets the policy’s age and eligibility requirements can receive coverage for various medical services.
MassHealth provides unique benefits to qualified subgroups. These subgroups include American Indian and Alaska Natives.
Massachusetts provides unique benefits to qualified American Indians and Alaska Natives. The policy exempts them from paying premiums and copays if they receive or are eligible to receive services from an Indian healthcare provider. The exemption also extends to services received from a non-Indian medical professional if an Indian healthcare provider provides a referral. Many American Indians and Alaska Natives also receive special monthly enrollment periods once they become MassHealth members.
Additionally, Alaska Natives and American Indians don’t have to pay premiums when receiving items or services from:
For full eligibility requirements, rules and federal and state mandates, be sure to visit the Massachusetts Health Connector’s page on American Indians and Alaska Natives.
MassHealth doesn’t provide additional benefits to current military members or veterans. Military members receive the same coverage as regular citizens enrolled in the program. However, MassHealth covers multiple healthcare services, like mental health treatment, physical therapy, transportation to healthcare facilities, and prosthetics.
However, Massachusetts offers other medical coverage for military veterans in need. These policies provide comprehensive benefits and services through EOVS (Executive Office of Veterans’ Services). MASSVETS is one such service and offers several medical benefits as well as housing opportunities, counseling, employment training, and more.
Although MassHealth provides vast coverage to eligible Massachusetts residents, it doesn’t cover certain medical services and items. Below are some services MassHealth doesn’t cover:
Burial assistance may be offered by the State of Massachusetts to individuals who qualify under specific Medicaid categories. Massachusetts provides a direct payment of up to $1,100 to the funeral home for expenses up to $3,500 if the deceased individual qualifies for MassHealth.The filing of claims on behalf of the deceased is limited to funeral homes and cemeteries, and these claims must be submitted within 90 days following the individual's passing. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
Massachusetts Medicaid does provide some coverage for those who become injured or ill either in the short or long term. Depending on the nature of the injury or illness, it’s wise to explore disability insurance options to ensure no unnecessary out-of-pocket costs are incurred.
The Massachusetts Medicaid program, MassHealth, covers a wide range of medical services and prescriptions. Understanding what MassHealth covers ensures you aren’t stuck with surprise medical bills after receiving treatment. The following are some healthcare services included in MassHealth coverage:
| Dental | |
|---|---|
| X-Rays and Exams | MassHealth covers most dental services, including teeth cleanings, extractions, fillings, oral exams, root canals, and oral surgery. The policy also includes dental X-rays without requiring prior authorization. |
| Wisdom Teeth | MassHealth covers multiple oral surgeries, including wisdom teeth removal and associated procedures. It covers non-wisdom tooth extraction as well. |
| Vision | |
|---|---|
| Eye Exams | The Massachusetts MassHealth program covers eye exams, including vision screenings, without requiring a referral. However, it limits enrollees under 21 to one exam per 12 months and members 21 and over to one every 24 months. It’s important to note that members may receive additional eye exam coverage if a physician provides a referral or they have specific medical conditions. |
| Glasses | MassHealth coverage includes one pair of eyeglasses or two pairs of bifocals (only for qualified beneficiaries) to members below 21 every 12 months and enrollees above 21 every 24 months. It also covers new frames, repair services, replacements, prescription updates, tinted lenses (Pink 1 and Pink 2), and contact lenses. However, members may need a referral to receive some of these services. |
| Laser Eye Surgery | MassHealth doesn’t include coverage for non-emergency or preventative vision services like LASIK or other laser eye surgeries. |
| Surgery | |
|---|---|
| Rhinoplasty | The MassHealth program only covers rhinoplasty and septoplasty surgeries with prior authorization. It only approves these procedures if they resolve breathing issues and functional problems. |
| Breast Reduction | MassHealth doesn’t provide breast reduction coverage unless it corrects medical issues caused by an overbearing breast condition, such as excessive back pain. It approves breast reductions on a case-by-case basis and requires prior authorization to qualify. |
| Hospital | |
|---|---|
| Hospital stays | The Massachusetts Medicaid program pays for medically necessary hospital stays and emergency room services. |
| Ambulance transportation | MassHealth provides emergency and non-emergency ambulance transportation services to MassHealth providers within Massachusetts. |
| Giving birth | MassHealth covers several pregnancy services, including labor and delivery care, prenatal care, postpartum care up to 12 months after delivery, and family planning counseling. It also provides milk storage containers and breast pumps upon request. |
MassHealth covers medically necessary therapy and counseling services within Massachusetts. However, the plan only covers 20 physical and occupational therapy appointments a year before requiring prior authorization, and only applies to practitioners who treat medicaid patients. It also limits you to 35 language/speech therapy sessions unless you have PA.
These restrictions apply to every MassHealth enrollee, including children.
| Sexual Health | |
|---|---|
| Gynecologist visits | MassHealth covers various reproductive health services for female members, including pap smears, breast exams, and STI (sexually transmitted infection) testing. |
| Erectile Dysfunction | Massachusetts residents enrolled in MassHealth can receive treatment for erectile dysfunction with prior authorization. MassHealth will evaluate the request and determine whether it qualifies for coverage. |
| Birth Control | MassHealth provides free birth control to enrollees for up to 12 months. You can order a 12-month supply in monthly increments or all at once, including pills, rings, injectables, and patches. However, it does not cover IUDs, vasectomies, or male condoms. |
| Fertility Treatment | Although MassHealth offers prenatal treatments, it doesn’t cover fertility treatments like artificial insemination or in-vitro fertilization. |
| Specialist Services | |
|---|---|
| Dermatology | MassHealth only covers medically necessary dermatology services. It doesn’t pay for cosmetic services like laser treatments, chemical peels, or Botox. |
| Physiotherapy | You can attend up to 20 physical therapy treatments for sports-related injuries, chronic pain, and stroke rehabilitation a year without cost while enrolled in MassHealth. Additional sessions require prior authorization from your medical provider. |
| Massage Therapy | The Massachusetts Medicaid program doesn’t cover massage therapy unless it’s medically necessary. MassHealth doesn’t pay for recreational massages. |
| Podiatry and Foot Care | MassHealth covers podiatric care if it treats a diagnosed medical condition, prevents or diminishes bed confinement, or increases your mobility. The podiatrist must document your treatments and record your progress. However, the policy doesn’t cover corn or callus removal or other routine foot services. |
| Allergy Testing | MassHealth only pays for allergy testing if your physician performs the test or supervises the process. However, it limits you to three pulmonary functions and blood tests a year. |
| Sleep Physician Services and CPAP Machines | MassHealth covers medically necessary sleep studies to diagnose disorders like sleep apnea. It also covers medical equipment such as CPAP machines once a physician diagnoses you with the condition. |
Obtaining third-party or private health insurance is an effective way to extend your medical coverage and diminish costs not included in MassHealth. It provides several benefits MassHealth and other federally and state-funded insurance plans can’t cover, ensuring you receive the care you need without cost or at a discounted rate. Below are just some benefits of private and third-party health insurance:
Massachusetts allows you to purchase a third-party or private insurance plan without voiding your MassHealth coverage. Once you purchase third-party or private insurance, the provider becomes the primary insurer, and MassHealth coverage becomes secondary.
Insurdinary offers exceptional health insurance plans to Massachusetts residents wanting to expand their coverage and will help you find the perfect policy for you and your family - even when it comes to protecting them with life insurance. Our team of dedicated insurance experts works with numerous leading insurance providers and will make finding quality insurance faster and less stressful. We understand how difficult finding insurance can be and will go above and beyond to find a top-quality plan that fits your needs without surpassing your budget.
Our insurance experts have helped countless citizens find quality health insurance plans, and they can do the same for you.
Whether you want to compare private and third-party medical insurance with MassHealth or browse other policies that better suit your family, Insurdinary is here for you. Reach out to us online and receive a free quote in Massachusetts today.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
