What Benefits Will I Get?

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What benefits do Low Income Patients get?

What services are not covered?

How much do Low Income Patients pay?

How much do I pay with Health Safety Net - Partial?

How is the Partial deductible computed?

What benefits do Medical Hardship patients get?

What benefits do Low Income Patients get?

For Low Income Patients who are uninsured, the Health Safety Net will pay for medically necessary services that are on the list of MassHealth Standard covered services, as long as the services are provided by Massachusetts community health centers or hospitals. Covered services include:

• Massachusetts community health center (CHC) services, such as:
  • medical visits
  • lab, diagnostic testing, and radiology services
  • obstetrics and family planning
  • surgical procedures
  • audiology
  • podiatry
  • pharmacy services
  • behavioral health
  • diabetes self-management
  • tobacco cessation services
  • dental services
  • vision care
  • medical nutrition therapy
     
• inpatient services at Massachusetts hospitals
  
  Note: The Health Safety Net will pay for hospital charges, but will not pay fees that are billed separately, for example, private doctor or lab fees. Check ahead of time to make sure all of your costs will be covered.
   
• certain outpatient services at Massachusetts hospitals:
  
  • for emergency care, urgent care, and maternity care
  • if the patient needs specialty care or complex care not available at a CHC
  • or if there is no CHC within 5 miles

• The Health Safety Net does not cover fees from private doctors or specialists, independent labs, home health care, hospice care, or any other health services not provided by community health centers or hospitals.

• The Health Safety Net will pay all of the charges for these services or part of the charges, depending on your age and income.

• The Health Safety Net will pay for services you received up to 6 months before your application date.

For Low Income Patients with private insurance, the Health Safety Net will pay for:

• services not covered by the private insurance, if provided by Massachusetts CHCs and hospitals and on the list of MassHealth Standard covered services

• deductibles and coinsurance for covered services
  Note: The HSN will not pay private insurance co-payments.

For Low Income Patients with Medicare, the Health Safety Net will pay for allowed services not covered by Medicare, as well as Medicare co-pays, coinsurance, and deductibles.

For Low Income Patients with Commonwealth Care, the Health Safety Net will pay for allowed dental services not covered by Commonwealth Care.

For MassHealth members age 21 or older who qualify for dental services, the Health Safety Net will pay for allowed dental services not covered by MassHealth.

What services are not covered?

Services not covered by the Health Safety Net for Low Income Patients include:

• private doctor's fees, when not part of hospital or CHC costs
• private pharmacy services
• services that are not medically necessary (for example, most cosmetic surgery)
• extra charges for a private hospital room
• experimental or unproven procedures
• outpatient services at Massachusetts hospitals (except for emergencies or urgent care, or if not available at a CHC within 5 miles)
• telephone consultations
• out-of-state services
• non-medical services (for example, social services or vocational rehabilitation)
• infertility treatments
• sex reassignment therapy or surgery
• cancelled or missed appointments

For questions about covered services, please contact MassHealth or your community health center.

How much do Low Income Patients pay?

Patients with family incomes between 0% and 400% of the Federal Poverty Guidelines qualify as Low Income Patients for the Health Safety Net.

• Patients with family income from 0% to 200% (inclusive) of the FPG get full benefits.
• Patients with family income from 201% to 400% (inclusive) of the FPG get Partial benefits.
• For eligibility information, see Health Safety Net: Am I eligible?

Low Income Patients must pay these costs:

*Generic antihypertensives for high blood pressure, antihyperlipidemics for high cholesterol, and antihyperglycemics for diabetes cost $1. Other covered generic, brand-name, and over-the-counter drugs cost $3.

For Family Income dollar amounts, see Health Safety Net - Income Eligibility Table.

How much do I pay with Health Safety Net - Partial?

If you qualify for Safety Net Partial, you must pay an annual deductible amount, based on your family income. Your Health Safety Net advisor will tell you the amount of your deductible, or see How is the deductible computed?. You pay one deductible per year per family. It does not matter how many people in your family use the Health Safety Net.

• For hospital fees, you must pay your entire deductible amount before Health Safety Net coverage begins.

• For community health center fees, you must make a co-payment for each visit until you meet your deductible. Your co-payment is a percentage of your bill, based on your family income. Co-payments range from 20% of the bill to 80% of the bill, using a sliding fee scale. The higher your income, the higher the percentage you must pay.

Once you have paid your deductible, the Health Safety Net pays for all covered medical services for the rest of the year for all family members.

You must continue to make small co-payments for prescription drugs.

Important: You must keep track of the amount you and other family members have paid toward your deductible. It is your responsibility to show proof that you have met your deductible. Once you reach your deductible, show your proofs so that your CHC or hospital does not charge you or other family members for services.

How is the Safety Net Partial deductible computed?

The Safety Net Partial deductible is computed using this formula:

What benefits do Medical Hardship patients get?

For Medical Hardship patients, the Health Safety Net (HSN) pays for all HSN-eligible medical expenses that are beyond the family's ability to pay:

• Patients are required to pay a certain percentage of their family income for medical expenses. Families with higher incomes pay a higher percentage than families with lower incomes. For income levels and percentages, see How do I qualify for Medical Hardship?

• If the family's allowed medical bills are higher than their percentage contribution, the Health Safety Net pays the rest of the HSN-eligible expenses.

  While the Health Safety Net counts allowed medical bills from any health provider when determining eligibility for Medical Hardship, it will only pay for services covered by the Health Safety Net. HSN-eligible services are medically necessary services provided at Massachusetts community health centers or hospitals, and on the list of MassHealth Standard covered services.

• Unpaid medical bills incurred up to twelve months prior to the date of application can be included.

• Massachusetts residents can get Medical Hardship benefits more than once if they have additional medical expenses that they cannot pay. However, unpaid bills from one Medical Hardship application cannot be included in a subsequent application.