What’s Included in MassHealth Coverage?
For Massachusetts residents who can’t afford the healthcare they need, MassHealth steps in to fill the gap. But MassHealth carefully controls costs, and not everyone gets everything covered. The program assigns applicants different coverage types depending on factors including income and immigration status. It can be hard to know exactly what MassHealth will pay for until you’ve been approved. Luckily, for many members, MassHealth coverage is comprehensive and includes everything from eyeglasses to long-term care.
How MassHealth Coverage Works
Each state administers its own Medicaid program. In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined under the heading of the MassHealth program. MassHealth works to give low- and moderate-income Massachusetts residents of all ages access to healthcare services.
Anyone enrolled in MassHealth may be eligible for certain benefits, including:
- Prescription drug coverage.
- Transportation services (which may include both emergency ambulance trips and non-emergency visits to receive MassHealth services).
- Treatment for behavior health and substance use disorders.
- Medically necessary therapies like physical and occupational therapy.
- Out-of-state emergency services.
These are just general services for MassHealth recipients (and even then, not all members will be eligible for all of them). If you’re approved for MassHealth coverage, what specific services you’ll be able to access depends on factors including your age, your disability status, your income and your household size. These factors will determine the coverage type you’re approved for, and your coverage type determines what MassHealth will pay for.
MassHealth coverage can definitely seem more than a little confusing when you’re first navigating the program. Here’s how this works. MassHealth uses two general application types: One for people who are 65+ and/or need long-term care, and another for other applicants. When you submit an application, MassHealth determines if you’re eligible for services, and then assigns you a coverage type based on your specific circumstances. Two applicants who are both the same age and have roughly the same income and health status could end up being approved for different MassHealth coverage types.
What’s Included in MassHealth Coverage?
For Massachusetts residents who are 65 or older, or who need long-term care, MassHealth coverage is available in five basic types.
- Standard: This is the most comprehensive kind of MassHealth coverage you can get as a senior or someone who needs long-term care. MassHealth Standard may cover a wide range of inpatient and outpatient services, hospice care, lab tests, equipment such as dentures and hearing aids, long-term care services, home health services, adult day care and more.
- CommonHealth: Disabled working adults who can’t qualify for Standard coverage may be eligible for CommonHealth, which covers many of the same services Standard does. It also covers well-child screenings for members caring for children under 21. Depending on the member’s income, they may be required to pay a monthly premium.
- Family Assistance: This MassHealth coverage type is for members who don’t meet the immigration requirements for Standard coverage. If you’re approved for Family Assistance, you’ll have many inpatient, outpatient, mental health and pharmacy services covered, but won’t be eligible for long-term care services.
- Limited: MassHealth Limited is also for seniors who don’t meet the immigration status criteria for Standard coverage. It only covers medical emergency services.
- Buy-In/Senior Buy-In: For MassHealth members who have Medicare, this kind of coverage may pay for Medicare premiums and/or copays.
For other MassHealth members who are younger than 65 and don’t need long-term care, available coverage is broken into six types. Four of these coverage types—Standard, CommonHealth, Family Assistance and Limited—are essentially the same types available to seniors. Again, Standard is the most comprehensive type, CommonHealth is available for disabled members, Family Assistance is for people who aren’t eligible for Standard, and Limited covers medical emergencies only. (One key difference: For non-seniors, these coverage types generally cover healthcare services for kids.) There’s also CarePlus, a MassHealth coverage type available to adults without minor children who don’t qualify for Standard, and Premium Assistance, a kind of coverage that pays for health insurance premiums that members incur.
We help clients navigate the MassHealth system all the time, so we know that applying for MassHealth coverage isn’t as straightforward as you might hope. Having a professional help you prepare gives you the best possible chance of being approved for comprehensive coverage, without having to sacrifice all your assets to meet MassHealth’s income requirements.
Bring all your MassHealth coverage questions to Ladimer Law. We’re here to help you at every step in the process. Contact me today!
Julie Ladimer is the founder of Ladimer Law. She has been helping people complete their estate planning since 2014. She has been named a Rising Star by Super Lawyers three years running and received a Boston Magazine Five Star Professional award.