What Is MassHealth?
NOTE: Glossary words are highlighted. Click on any glossary word to see its definition.
What is MassHealth?
MassHealth is a public health insurance program for low- to medium-income residents of Massachusetts. The national health insurance program called Medicaid, and the Children's Health Insurance Program (CHIP) are combined in one program in Massachusetts called MassHealth.
The MassHealth health insurance program is for:
- children
- parents and caretakers of children
- adults working for small employers
- unemployed individuals
- pregnant women
- disabled individuals
- Department of Mental Health clients
- HIV positive individuals
- elderly people
- women with breast or cervical cancer
- people in need of long-term care
If you have health insurance, you may still be eligible for MassHealth. Generally, eligibility is based on family income. MassHealth may provide you with health insurance coverage directly, or may pay part or all of your private health insurance premiums.
Who runs MassHealth?
MassHealth is a state agency that is overseen by the Executive Office of Health and Human Services. The Federal government pays half of the cost of MassHealth and the state government pays most of the rest.
Is MassHealth the same as Medicare?
MassHealth is a different program from Medicare. Medicare is a health insurance program run by the Social Security Administration that pays for medical care for the disabled and for people over 65 years of age who get Social Security benefits. You do not have to have low income to be eligible for Medicare.
MassHealth is a public need-based health insurance program.
If you are low-income, it is possible to get MassHealth while you have Medicare. People who are eligible for both MassHealth and Medicare are called dual eligibles. For dual eligibles, MassHealth pays all or part of Medicare premiums and deductibles, and medical bills that Medicare does not cover. Dual eligibles must join a Medicare Drug Plan to get prescription drug coverage.
How can I report MassHealth fraud?
MassHealth has a 24-hour toll-free fraud hotline where you can report fraud, waste, or abuse relating to MassHealth:
- MassHealth Fraud Hotline: 1-877-437-2830
Hotline hours are Monday through Friday, 9 AM to 5 PM, to speak to a person. At all other times, you can leave a voicemail message.
You can use the hotline to report member or provider fraud, identification theft, or any other concern about misuse of MassHealth benefits and services.
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