MassHealth Basic

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What is MassHealth Basic?

Am I eligible?

What are the income and asset limits?

What benefits will I get?

How do I apply?

How much does it cost?

What is MassHealth Basic?

MassHealth Basic is health insurance that offers a full range of health care benefits or premium assistance. MassHealth Basic is for EAEDC recipients and for low-income Department of Mental Health clients who are long-term unemployed.

Am I eligible?

MassHealth Basic coverage is for:

• individuals or members of a couple who receive EAEDC cash assistance

• Department of Mental Health clients (or on the waiting list) less than 65 years of age who are not eligible for unemployment compensation, and have been unemployed or underemployed for more than a year. If there is a spouse, he/she must be working less than 100 hours a month.

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: What are the income limits?

• For Department of Mental Health clients, family gross income must be less than 100% of the FPG. There is no asset limit.

• EAEDC recipients do not have to meet any additional income requirements.

What benefits will I get?

Benefits are available either through:

• direct coverage: for Basic members without health insurance, or whose health insurance is not approved by MassHealth, or

• premium assistance: for Basic members with health insurance that meets MassHealth guidelines and who pay a premium.

Direct coverage benefits include:

• inpatient and outpatient hospital services
• doctor, nurse practitioner, nurse midwife, and clinic visits
• pharmacy services
• mental health and substance abuse services
• audiologist services and hearing aids
• vision care including eyeglasses and magnifying aids
• chiropractor services
• podiatrist services and orthotics
• prosthetic services
• abortion and family planning services
• rehabilitation and therapy services (physical, occupational, speech/language)
• speech and hearing services
• renal dialysis
• smoking cessation services 
• x-rays and laboratory work
• durable medical equipment and supplies
• oxygen and respiratory equipment
• dental services including checkups, cleanings, fillings, dentures, and other approved services
• ambulance and wheelchair van service

• Your coverage may also include other benefits not listed above. Call the MassHealth Customer Service Center at 1-800-841-2900 (TTY: 1-800-497-4648) if you have any questions about your benefits.

Under premium assistance, MassHealth will pay for part or all of your insurance premium.

If you are no longer eligible for Basic coverage because of your employment, you may be able to continue to receive MassHealth Basic for up to six months after the date of employment if you still need assistance.

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?

MassHealth Basic is free of charge. Basic members with direct coverage do not have to pay for covered benefits and services. Prescription medicines are available with a co-payment.

Under premium assistance, you may still have to pay a part of your private health insurance premium, and you are responsible for any co-payments or deductibles charged by your private health insurance company.