MassHealth Essential

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What is MassHealth Essential?

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 Essential?

MassHealth Essential is health insurance coverage for adults who are long-term unemployed and do not qualify for MassHealth Basic, and for certain noncitizens with special status.

Am I eligible?

MassHealth Essential is for adults aged 19 through 64 who:

• are not eligible for MassHealth Basic
• have been unemployed (or underemployed) for more than one year
• are not eligible for unemployment compensation
• are U.S. citizens or eligible non-citizens
  Note: Noncitizens with special status qualify for Essential only if they are disabled.
• If there is a spouse, the spouse must be working no more than 100 hours per month.

This coverage type is also for:

• noncitizens with special status who are 65 or older and meet all of the eligibility requirements for MassHealth Standard except for immigration status.

MassHealth Essential has two forms:

• Premium assistance, for those with private health insurance, where MassHealth pays all or part of your private health insurance premiums. Your health insurance must meet MassHealth's standards.

• Purchase of medical benefits, for the uninsured, who must enroll with a primary care doctor to receive MassHealth benefits.

Note: There is an enrollment cap for long-term unemployed adults applying for MassHealth Essential. Applicants will be put on a waiting list if necessary.

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?

To be eligible for MassHealth Essential, your family's gross income must be less than or equal to 100% of the Federal Poverty Guidelines (FPG).

For dollar amounts, see Financial Eligibility Requirements: What are the income limits?

For noncitizens with special status who are 65 or older, there is an asset limit of $2000 for an individual and $3000 for a married couple living together.

What benefits will I get?

If you qualify for premium assistance, MassHealth will pay all or part of your private health insurance premiums. You will get whatever health care benefits your private health insurance offers. (Your private insurance must meet the basic standards of MassHealth.)

If you do not have private health insurance, you must enroll with a primary care doctor to get benefits. Benefits are similar to MassHealth Basic, but somewhat more limited. They include:

• inpatient and outpatient hospital services
• doctor, nurse practitioner, and clinic visits
• pharmacy services
• mental health and substance abuse services
• podiatrist services
• prosthetic services
• abortion and family planning services
• rehabilitation and therapy services (physical, occupational, speech/language)
• speech and hearing services
• vision exams
• 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.

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?

If you qualify for premium assistance, MassHealth Essential will pay all or part of your private health insurance premiums. However, you are still responsible for any co-payments or deductibles charged by your private health insurance company.

If you qualify for direct purchase of medical benefits, you do not have to pay a monthly premium. However, there is a co-payment for prescription drugs and for an acute inpatient hospital stay.