MassHealth Standard
NOTE: Glossary words are highlighted. Click on any glossary word to see its definition.
What is MassHealth Standard?
MassHealth Standard is comprehensive health insurance, including long-term-care, for low-income children, parents, the elderly, the disabled, and certain other groups. MassHealth Standard coverage includes preventive and medical services, prescription drugs, and hospitalization.
Am I eligible?
To be eligible for MassHealth Standard, you must be:
AND in one of these categories:
- parents living with children under the age of 19
- adult caretaker relatives who live with children under the age of 19 years to whom they are related and for whom they are the main caretaker when neither parent is living in the home
- pregnant women
- children under 19 years of age
- disabled individuals
- children and infants under age 1
- people who are 65 years of age and over
- noncitizens ages 18-64 taking part in the Massachusetts Refugee Resettlement Program (MRRP)
- adopted and foster children
- young adults under age 21 who were in DCF (DSS) care at age 18
- individuals age 55 and older living in medical institutions and needing long-term care
- SSI recipients
- former SSI recipients
- women under 65 in need of treatment for breast or cervical cancer
Undocumented noncitizens cannot get MassHealth Standard. Noncitizens who qualify for MassHealth as MRRP paticipants can only get MassHealth Standard for eight months from the date they entered the U.S.
For more information about MassHealth eligibility, see Am I Eligible?
You can use the MassHealth Eligibility Check to see if you are likely to qualify for MassHealth benefits.
What are the income and asset limits?
Income limits are based on percentages of the Federal Poverty Guidelines (FPG). For dollar amounts, see Financial Eligibility Requirements: What are the income limits?
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For parents and adult caretaker relatives living with children under the age of 19 years, family income must be less than or equal to 133% of the Federal Poverty Guidelines and there is no asset limit. Caretaker relatives may decide if they want to be considered a part of the family or not.
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For pregnant women, income must be less than or equal to 200% of the FPG and there is no asset limit.
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For children under 19 years of age, the family's income must be less than or equal to 150% of the FPG and there is no asset limit.
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For disabled individuals, income must be less than or equal to 133% of the FPG and there is no asset limit.
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For children under age 1, the family's income must be less than or equal to 200% of the FPG and there is no asset limit.
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For people who are 65 years of age and over, income must be less than or equal to 100% of the FPG. For an individual, the asset limit is $2000. For a couple, the asset limit is $3000.
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For noncitizens ages 18-64 who qualify for MassHealth because they take part in the Massachusetts Refugee Resettlement Program (MRRP), the income limit is equal to 100% of the FPG.
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For adoptive and foster children, MassHealth is given automatically and there is no asset limit.
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For individuals 55 years old and older living in medical institutions such as nursing homes or chronic hospitals, or living at home and receiving care equal to that provided in a nursing home, there are special programs, rules and applications. Ask MassHealth about these programs.
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SSI recipients are automatically eligible.
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Former SSI recipients age 65 and over continue to get coverage until MassHealth determines they are no longer eligible.
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EAEDC recipients age 65 or older (except for noncitizens with special status) are automatically eligible.
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For women under 65 in need of treatment for breast or cervical cancer, income must be no greater than 250% of the FPG. See Breast and Cervical Cancer Treatment Program.
Note: Individuals 65 and older whose income and/or assets exceed the above limits may become eligible by reducing their assets, by meeting a deductible, or both.
What benefits will I get?
MassHealth Standard allows you to get medical care from doctors, hospitals, pharmacies, and other medical providers who accept MassHealth payments. Standard coverage includes:
If you are eligible for MassHealth Standard and Medicare Part A and/or Part B, MassHealth will pay your Medicare premiums, co-payments, and deductibles. You must join a Medicare Drug Plan to get prescription drug coverage.
MassHealth Standard is the only coverage type that provides long-term care to people in medical institutions.
Families and individuals who get medical treatment within 10 days before the date they apply for MassHealth and who were eligible during that time can request retroactive coverage for their medical bills. Also, clients might continue to receive MassHealth for 12 months after their income has gone above the income limit because of a raise or because they have gone back to work through Transitional Medical Assistance (TMA).
There are special programs under MassHealth Standard for people living at home and needing long-term-care services:
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Children under the age of 18 who are severely disabled may be eligible for the Kaileigh Mulligan Program. This allows them to live at home while receiving care equal to that provided in a nursing home. In determining financial eligibility, parents’ income and assets are not counted. See Kaileigh Mulligan Home Care Program.
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Elder Service Plans (also called PACE) allow frail people 55 and older who need the level of care equal to that received in a nursing home to live at home and have all health care services provided by one community-based program. To take part in this program, you must live in an Elder Service Plan service area and meet the income and asset limits. Generally, your doctor will make a referral for this program. See Elder Service Plans.
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The Home- and Community-Based Services (HCBS) Waiver is a program that allows frail people age 60 and older who need the level of care equal to that received in a nursing home to live at home and still receive the care necessary. If the person requiring the care is married, the spouse’s income and assets are not counted in determining eligibility.
How do I apply?
You must file a MassHealth application, called the Medical Benefit Request (MBR). For application information, see How Do I Apply?
How much does it cost?
Most MassHealth Standard members do not have to pay monthly premiums. Women with breast or cervical cancer with incomes above 150% FPG pay monthly premiums based on a sliding scale depending on income.
Most adult MassHealth Standard members must pay small co-payments for prescription drugs and some services.
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