Is MassHealth Medicaid or Medicare? Understanding the Difference

MassHealth is Medicaid, not Medicare

MassHealth is Massachusetts's version of Medicaid, the joint federal and state health insurance program for people with lower incomes. It is not Medicare, which is the federal program for people 65 and older or those with certain disabilities, regardless of income. The two programs have different rules, different costs, and different coverage — and it matters which one you're on.

MassHealth covers doctor visits, hospital care, prescription drugs, and other services. You do not pay premiums for most MassHealth plans, though some plans have small copays when you use services. Medicare, by contrast, requires you to pay premiums, deductibles, and copays, even if you may have access to for help paying them.

If you live in Massachusetts and have a low income, you may be on MassHealth. If you are 65 or older or have been on Social Security Disability Insurance (SSDI) for 24 months, you are on Medicare. Some people are on both — this is called "dual may be able to access" — and the rules for how the two programs work together are specific and worth understanding.

Key Takeaways

• MassHealth is Medicaid (a state program for low-income residents), while Medicare is a federal program for people 65 and older or those with certain disabilities.
• MassHealth has no premiums for most plans and covers a broad range of services; Medicare requires premiums and has deductibles and copays.
• You can be on both MassHealth and Medicare at the same time if you meet the age or disability requirements and have a low enough income.
• Your may be able to access for MassHealth depends on your income and household size; your may be able to access for Medicare depends on your age or disability status, not income.

How MassHealth and Medicare differ in cost

MassHealth is free or very low cost. Most people on MassHealth pay no monthly premium. Some plans have small copays — usually $1 to $5 — when you see a doctor or fill a prescription, but many services are covered with no copay at all. Dental, vision, and hearing care are often included at no extra charge.

Medicare costs money every month. In 2024, the standard Part B premium (for doctor and outpatient care) is $164.90 per month, though the amount changes each year. Part D (prescription drug coverage) costs extra, and if you choose a Medigap or Medicare Advantage plan, those have their own premiums. You also pay deductibles and copays when you use services.

If you are on both MassHealth and Medicare, MassHealth typically pays the Medicare premiums, deductibles, and copays for you — this is one of the main reasons people on both programs stay on both. But the rules for this vary depending on which MassHealth plan you are on.

How MassHealth and Medicare differ in who can join

MassHealth is for Massachusetts residents with a low income. The income limit depends on your household size and which MassHealth plan you are explore for. A single person might have a limit around $1,500 per month; a family of four might have a limit around $3,000 per month. These numbers change yearly. You do not have to be 65 or disabled to join MassHealth — age and disability status do not matter for MassHealth.

Medicare is for people 65 and older, people under 65 who have been on SSDI for 24 months, and people with end-stage renal disease or ALS. Income does not matter for Medicare — you can be wealthy and still join Medicare at 65. You do not have to be a U.S. citizen, but you do have to be a permanent resident or have lived in the United States for at least five years.

Massachusetts residents can be on MassHealth alone (if they are under 65 and have a low income), on Medicare alone (if they are 65 or older and do not have a low income), or on both (if they are 65 or older, or disabled and on SSDI, and also have a low income).

What happens if you are on both MassHealth and Medicare

If you turn 65 while on MassHealth, you will be moved to Medicare automatically. MassHealth will stay active and will help pay your Medicare costs. This is called being "dual may be able to access." You will have a Medicare card and a MassHealth card, and you will use both.

When you see a doctor or go to the hospital, you show your Medicare card first. Medicare pays its share. Then MassHealth pays what Medicare does not cover — the premiums, deductibles, and copays. This means you often pay nothing out of pocket.

If you are under 65 and on SSDI, you will move to Medicare after 24 months of receiving SSDI. If your income is still low enough, you will stay on MassHealth at the same time. The process is automatic; you do not have to do anything.

How to find out which program you are on

Check your insurance card. A MassHealth card will say "MassHealth" or "Commonwealth Care Alliance" or the name of another MassHealth managed care plan. A Medicare card will say "MEDICARE" and have a red, white, and blue design. If you have both, you will have both cards.

You can also call MassHealth directly at 1-800-841-2900 to ask which programs you are on and what your coverage includes. Have your Social Security number ready. If you are on Medicare, you can call 1-800-MEDICARE (1-800-633-4227) to confirm your coverage.

If you are not sure whether you should be on MassHealth, on Medicare, or on both, a local aging agency or a community health center can help you sort this out. Many offer free counseling about health insurance options.

What to do if you think you should be on MassHealth

You can learn about MassHealth by visiting the official MassHealth website or calling 1-800-841-2900. You will need to provide information about your income, household size, and citizenship or immigration status. The process takes a few weeks.

If your income is very low or you are homeless, you may be able to join MassHealth right away without waiting. If you are pregnant, a child, or over 65, you may have different income limits than other adults.

If you are already on Medicare and think you should also be on MassHealth, call the same number. You can be on both at the same time, and MassHealth can help pay your Medicare costs.

Frequently Asked Questions

Can I have both MassHealth and Medicare at the same time?

Yes. If you are 65 or older, or if you have been on SSDI for 24 months, and your income is low enough, you can be on both. MassHealth will pay your Medicare premiums and help cover your copays and deductibles. This is called being dual may be able to access.

If I turn 65, will I lose MassHealth?

No. You will move to Medicare automatically, but if your income is still low enough, MassHealth will stay active and will help pay your Medicare costs. You will have both programs working together.

Does MassHealth cover the same things Medicare covers?

MassHealth and Medicare cover many of the same services — doctor visits, hospital care, prescription drugs — but the details are different. MassHealth often covers more, including dental and vision care. If you are on both, Medicare pays first, then MassHealth fills in gaps.

What if my income goes up — will I lose MassHealth?

If your income rises above the MassHealth limit for your household size, you may lose MassHealth. The income limits change yearly. You can call MassHealth at 1-800-841-2900 to find out the current limit for your situation and what will happen if your income changes.

How do I know if my income is low enough for MassHealth?

Income limits depend on your household size and which MassHealth plan you are looking at. A single person's limit is different from a family's limit. Call 1-800-841-2900 or visit the MassHealth website to find the current limits and to learn whether your income qualifies.