Medicaid Eligibility in Massachusetts

Calendar Icon Updated February 11, 2019
Medicaid

Known as MassHealth, Massachusetts offers a Medicaid program  to low-income individuals and families who need assistance with  healthcare. The federal government partners with the state to ensure  enough funding gets provided to those who truly need the insurance.  Residents across Massachusetts facing financial difficulties can apply  for state health insurance and see if they qualify. Certain stipulations  exist for those hoping to get approved.

Massachusetts’s Requirements for Medicaid Qualification

Enrollees must meet the requirements set forth by the state. Using the MassHealth website,  applicants can discover if they would qualify or if they should skip  the process. A summary of eligibility requirements is listed on the  site, including being a resident of Massachusetts, having citizenship of  the United States, and meeting income requirements. Children under age  19 and women who are pregnant may qualify more easily.

How to Apply for Medicaid in Massachusetts

The main method currently available for applying for Medicaid in Massachusetts is through the online interface.  You may also call the service center at (800) 841-2900 24 hours a day  to use the self-service option. If you want to speak with someone, you  will have to call between the hours of 8 am and 5 pm Monday through  Friday. Several enrollment centers also exist in Massachusetts if you  wish to apply in person. They open at 8:45 am and remain open until 5  pm.

If you prefer to download and fill out a copy of the form,  that option is available as well. It can then be mailed to the Health  Insurance Processing Center. Be aware that this option takes the  longest, as the mailed application needs to be received, get looked over  by a worker, and given approval or denial before you can receive  notification of your status.

Massachusetts Medicaid Application

The  Medicaid application is fairly standard, asking for personal details  such as full name, address, and telephone number. You must also disclose  who all the members of your household are and which assets each of them  has. The amount of financial and other assets in anyone’s name gets  added and divided to determine if you all meet the income eligibility  requirements. Bank account information must also get disclosed.

What Does Medicaid Cover in Massachusetts?

The  Massachusetts Medicaid program covers various services. Children and  adults alike can receive annual well-check exams. Emergency room or  urgent care visits are also allowed, as well as emergency dental  services, such as cracking a tooth or experiencing terrible pain. People  can look into their specific plan details to see a full list of  services covered by their insurance.

Income Requirements for Massachusetts Medicaid

Families  applying for Medicaid in Massachusetts must meet certain income  requirements. They have to fall below 100% of the Federal Poverty Rate,  which equates to roughly $973 per month for a single adult. The more  members of the family, the higher the income limit becomes to  accommodate more people.

How Much Does Medicaid Cost in Massachusetts?

The state of Massachusetts and the federal government work together to pay for the cost of Medicaid. More than $17 billion gets spent on the health care of eligible residents each year, with  projections expected to grow in the future. The state spends more than  23 percent of their total budget on Medicaid funding.

Cost and Coverage of Medicaid in Massachusetts

Most  Medicaid recipients do not have to pay much towards their care. Many  are extremely low-income and therefore cannot cover the extravagant  costs associated with healthcare expenses. There is, however, a copay amount designated for various services. For a prescription drug, for example,  members may have to spend up to $3.65 to pick up their prescriptions.  There is also a $3 charge for acute inpatient stays.

Prescription Drugs with Medicaid in Massachusetts?

The  Medicaid plans of Massachusetts cover prescription drugs, however,  pharmacists are obligated to fill prescriptions with a generic version  first if applicable. A doctor must request prior authorization from the  insurance company if a brand-name version must get utilized in its  place. There is more likely to be a copay involved with a brand-name  drug than with a generic kind.

Which Medicaid plan is best in Massachusetts?

Tufts Health Public Plans, Inc. was  rated as one of the best Medicaid choices in the state of  Massachusetts. With a score of 4.5, this HMO plan has a strong pull with  the people of the state. The National Committee for Quality Assurance  rates all insurance plans across the board, giving them each a score of 0  out of 5.

Eligibility Team

Read More