Commonwealth Care

What is Commonwealth Care?

Commonwealth Care is a health insurance program for low and moderate-income Massachusetts residents who don't have health insurance. Commonwealth Care members get free or low cost health services through managed care health plans. There are several health plans to choose from. The plans are offered by private health insurance companies. Some plans cost more than other plans.

Commonwealth Care is run by the Commonwealth Health Insurance Connector Authority and funded by the state. The Connector Authority was created as part of the Health Care Reform Act of 2006. The Connector helps Massachusetts residents and businesses find and pay for health insurance.

Am I eligible?

You are eligible for Commonwealth Care if:

• you are age 19 or older
   
• you are uninsured; or paying full premium costs (e.g. under COBRA); or in a waiting period for coverage
   
• you cannot get coverage as a dependent on a family member's group plan
   
• you are not eligible for MassHealth, TriCare, the Insurance Partnership, the Unemployment Medical Security Program, the Fishing Partnership Health Plan, or mandated SHIP college student insurance
   
• you meet the income limits
   
• you are a citizen or eligible noncitizen
   
• your current employer (or a family member's employer) has not offered you group health insurance in the past six months where:
  • the employer covered at least 20% of the annual premiums for the family plan
  • and 33% of the annual premiums for the individual plan

Please note:

• Special status legal immigrants who lost Commonwealth Care coverage as of August 31, 2009 due to changes in state law can get health benefits from the new Commonwealth Care Bridge program. Special status legal immigrants not eligible for CommCare Bridge can get health benefits from the Health Safety Net.
   
• Undocumented noncitizens cannot get Commonwealth Care. See Can noncitizens get MassHealth? for more information.

Commonwealth Care is only for adults. Children get MassHealth instead of Commonwealth Care.

What are the income limits?

To be eligible for Commonwealth Care, your household's gross income (before taxes) must be no greater than 300% of the Federal Poverty Guidelines (FPG).

• If your income is 100% FPG or less, you do not have to pay monthly premiums.
   
• If your income is 150% FPG or less, you do not have to pay monthly premiums if you choose the lowest cost plan offered in your area. If you choose a higher cost plan, you will have to pay a monthly premium.
   
• If your income is more than 150% FPG but not more than 300% FPG, you must pay monthly premiums that depend on income, where you live, and the plan you choose.
   
• Everyone must pay copayments for prescription drugs.

Income limits for each plan type are shown in the table below:

Income limits usually change March 1 each year.

What benefits will I get?

Commonwealth Care members get health services by enrolling in health plans. There are several plans to choose from. Each health plan offers the same medical benefits, plus some extras. Some plans are only available in certain parts of Massachusetts. Some plans cost more than other plans.

All Commonwealth Care health plans include:

• outpatient medical care (doctor's visits, surgery, radiology and lab, abortion, community health center visits)
• inpatient medical care (hospitalization)
• mental health and substance abuse services (outpatient and inpatient)
• prescription drugs (pharmacy and mail service)
• rehabilitation services (cardiac rehabilitation, home health aide, therapies, inpatient services up to 100 days per year)
• vision care (exam and glasses every 24 months)
• dental care* (*this benefit is only for people with incomes at or below 100% FPG)
• emergency care including ambulance and out-of-state coverage
• wellness care (family planning, nutrition, prenatal and nurse midwife)

The health plan you choose may also offer extra services such as fitness center and weight loss club discounts.

How much does it cost?

The cost of Commonwealth Care health insurance depends on your household gross income (see Income Limits), where you live, and the health plan you choose.

• Plan Type 1 is for people with household incomes less than or equal to 100% of the Federal Poverty Guidelines (FPG).

  • There are no monthly premiums or deductibles.
  • There are small copayments for prescriptions.

• Plan Type 2 is for people with household incomes greater than 100% FPG but no more than 200% FPG.

  • People with incomes at or below 150% FPG (Plan Type 2A) do not have to pay monthly premiums if they choose the lowest cost plan offered in their region. If they choose a higher cost plan, they must pay a monthly premium. 
  • People with incomes above 150% FPG pay monthly premiums that vary by health plan and region.
  • There are co-payments for prescriptions and certain other services.

• Plan Type 3 is for people with household incomes greater than 200% FPG but no more than 300% FPG.

  • Type 3 plans have monthly premiums that vary by income, health plan, and region. People with incomes no greater than 250% FPG pay less than people with incomes above 250% FPG.
  • There are co-payments for prescription drugs and certain other services.

For information about monthly premiums and copayments, call Commonwealth Care Customer Service at 1-877-MA-ENROLL (1-877-623-6765).

For a complete list of costs, see Commonwealth Care Health Benefits and Copays and Enrollee Premium Contributions on the Commonwealth Connector web site (PDF format).

*The Commonwealth Care benefit year starts July 1 and ends June 30.

How do I apply?

You must fill out the Medical Benefits Request (MBR) form to apply for Commonwealth Care. The Medical Benefits Request is a joint application for Commonwealth Care, MassHealth, and several other health insurance programs.

Get an application: To get an application for Commonwealth Care:

• Call the Commonwealth Care Customer Service line at 1-877-MA-ENROLL (1-877-623-6765) (TTY: 1-877-623-7773) and ask them to mail an application to you.

• Apply at a community health center or other community organization with online applications.

  For community health center locations, see Find a Health Center on the Massachusetts League of Community Health Centers web site. To find other locations with online applications, call Commonwealth Care at 1-877-623-6765.

• Download an application from the Commonwealth Care Applications web site:

  • Commonwealth Care application in English
  • Commonwealth Care application in Spanish
    (These forms require Adobe Reader)

  Mail the completed form to the address shown on the form.

Coverage dates: In most cases, coverage starts on the first day of the month following the date you enroll. Coverage is not retroactive to the application date.

Recertification: Your eligibility will be checked each year. Also, you must report any changes in income, family status, or address, within two weeks.

Questions: For more information, call Commonwealth Care at 1-877-MA-ENROLL (1-877-623-6765) (TTY: 1-877-623-7773). Customer service is available from 8:00 AM to 5:00 PM, Monday through Friday.

E-mail: You may also send an e-mail to the Commonwealth Connector's Public Information Unit at Connector@state.ma.us. Include your name and a clear explanation of your problem or question. They will get back to you within 48 business hours.

How do I use my benefits?

Commonwealth Care members must enroll in a health plan to get benefits. There are five plans to choose from:

• Boston Medical Center HealthNet Plan
  Customer Service Non-members: 1-800-792-4355
  Customer Service Members: 1-888-566-0010 (English); 1-888-566-0012 (Spanish)
  TTY: 1-866-765-0055
  Web site: BMC HealthNet Plan Commonwealth Care

• CeltiCare Health Plan
  Customer Service: 866-895-1786
  TTY: 866-614-1949
  Web site: CeltiCare Health Plan Commonwealth Care

• Fallon Community Health Plan
  Customer Service: 1-800-868-5200
  TTY: 1-877-608-7677
  Web Site: Commonwealth Care FCHP Direct Care

• Neighborhood Health Plan
  Customer Care Center: 1-800-462-5449
  TTY: 1-800-655-1761
  Web site: NHP Commonwealth Care Plan

• Network Health
  Customer Service: 1-888-257-1985
  TTY: 1-617-806-8196
  Web site: Network Health Forward: a Commonwealth Care Plan

All plans offer the same medical benefits. Extra services vary from one plan to another. For details about the plans, see Commonwealth Care Benefits and Plan Information. You can also call the Customer Service numbers or visit the health plan web sites for more information.

Not all plans are available in all areas of Massachusetts. See Plans by Region. Your Commonwealth Care enrollment package will have information about the health plans in your area.

Some health plans have higher monthly premiums than others. See Enrollee Premium Contributions effective July 1, 2009 for details.

Once you choose a plan, you should select a primary care doctor from your plan's provider list. Your primary care doctor will be in charge of your health care. The health plan's customer service representative can help you choose a primary care doctor.

How do I enroll in a health plan?

Once you choose a plan, you must enroll in the plan to get benefits. You can mail the enrollment form to the Commonwealth Care address listed on the form, or you can enroll by phone or online:

• Phone: 1-877-MA-ENROLL (1-877-623-6765)
  TTY: 1-877-623-7773
  Hours: Monday through Friday, 8 AM to 5 PM

• Online: Register for a Commonwealth Care online account
  You will need your Member ID from your approval letter or your Social Security number.
  (If you already have an account, go to the Login page)

In most cases, your coverage starts on the first day of the month following the date you enroll. You may be eligible for Health Safety Net services while you are waiting for your coverage to begin.

You can change plans any time within 60 days of your enrollment date. After 60 days, you can change plans once a year during the annual open enrollment period, usually in May or June.

You can also change plans if you move out of your plan's service area, your plan does not meet your health care needs, or your primary care provider leaves your plan.

Useful links

These links are external links to web sites that are not part of MassResources.org. When you click on these links, you will leave our site. Click "Back" on your browser to return.

1. Welcome to Commonwealth Care
   Official information about Commonwealth Care health insurance, including:

   • Commonwealth Care Program Guide
   • Benefits and Plans
   • Applications
   • Eligibility
   • Frequently Asked Questions
   • Register or Login
   • Contact Us
   • Eligibility and Hearing Process for Commonwealth Care - 956 CMR 3.00 (PDF)

2. Health Care for All - Commonwealth Care Health Insurance Program
   Detailed information about Commonwealth Care health insurance, including benefits, eligibility, enrollment, fee scales, and other costs. Anyone with questions can call the Health Care for All Helpline at 1-800-272-4232.

3. Commonwealth Care - MassLegalServices
   Updates, eligibility rules, regulations, and other information about Commonwealth Care. From MassLegalServices.

Commonwealth Care section last updated on 6/14/10