MassHealth and Medicare are two separate programs

No, MassHealth is not Medicare. They are two different health insurance programs run by different government agencies. Medicare is a federal program run by the Centers for Medicare & Medicaid Services (CMS). MassHealth is Massachusetts's state Medicaid program, run by the state. You may have one, both, or neither — it depends on your age, income, and citizenship status.

The confusion is understandable because both programs help pay for medical care and both are government-run. But they cover different groups of people, have different rules about what they pay for, and work differently when you have both at the same time.

Key Takeaways

  • Medicare is a federal program for people 65 and older, regardless of income, and for some younger people with disabilities or end-stage renal disease.
  • MassHealth is a state program for Massachusetts residents with lower incomes, regardless of age.
  • You can have both Medicare and MassHealth at the same time — this is called being "dual may be able to access."
  • If you are 65 or older and live in Massachusetts, you are enrolled in Medicare automatically; MassHealth is separate and has its own income limits.
  • The programs pay for different services and have different out-of-pocket costs, so understanding which one covers what matters for your medical bills.

Who Medicare covers

Medicare covers people who are 65 or older, no matter what their income is. It also covers some people under 65 who have been on Social Security Disability Insurance (SSDI) for at least two years, and people of any age with end-stage renal disease or ALS (amyotrophic lateral sclerosis).

Medicare is the same program everywhere in the United States. If you turn 65, you become may be able to access for Medicare whether you live in Massachusetts, Florida, or any other state. You do not have to be a U.S. citizen, but you do have to have been a permanent resident for at least five years.

Who MassHealth covers

MassHealth covers Massachusetts residents with lower incomes. The income limits change each year and depend on your household size and whether you are pregnant, a parent, a child, or an adult without dependents. MassHealth also has different programs for different groups — some have no income limit at all if you meet other criteria.

You must be a Massachusetts resident and either a U.S. citizen or a may have access to immigrant to enroll in MassHealth. Unlike Medicare, MassHealth is only available in Massachusetts. If you move to another state, you will lose MassHealth coverage and will need to look into that state's Medicaid program instead.

What happens if you have both Medicare and MassHealth

If you are 65 or older and have a low income, you may have both programs. This is called being dual may be able to access. When you have both, Medicare is your primary insurance — it pays first — and MassHealth pays some of the costs that Medicare does not cover, like copayments and deductibles.

Having both programs can lower your out-of-pocket costs significantly. MassHealth may also cover services that Medicare does not, such as dental care, vision care, and hearing aids. However, you must stay enrolled in both programs and follow the rules of each one. If your income goes up, you may lose MassHealth but keep Medicare.

How to know which program you are in

If you are 65 or older, you are automatically enrolled in Medicare when you turn 65 — you do not have to do anything. You will receive a Medicare card in the mail. MassHealth is separate; you must explore for it through the state.

To check whether you have MassHealth, look for a MassHealth card in the mail or log into your account on the MassHealth website. If you are not sure whether you are enrolled, you can call MassHealth at 1-800-841-2900 to ask. For Medicare questions, you can call 1-800-MEDICARE (1-800-633-4227).

What each program pays for

Medicare covers hospital stays, doctor visits, lab tests, imaging, and some preventive care. It has four parts: Part A (hospital), Part B (doctor and outpatient), Part D (prescription drugs), and Part C (an alternative plan). You pay premiums, deductibles, and copayments for most services.

MassHealth covers many of the same services but often with lower or no copayments. MassHealth also covers dental, vision, and hearing services that Medicare does not. The exact coverage depends on which MassHealth program you are in — there are several, and they have different rules. If you have both programs, Medicare pays first, and MassHealth fills in gaps.

What to ask your doctor or insurance company

If you are not sure which program covers a service you need, ask your doctor's office or call the insurance company number on your card. You can also call MassHealth at 1-800-841-2900 or Medicare at 1-800-MEDICARE to ask whether a specific service is covered and what you will owe.

When you call, have your insurance card ready and be specific about what service you need — for example, "Is a hearing aid covered?" rather than "What do you cover?" This helps the person on the phone give you a faster answer.

Frequently Asked Questions

Do I have to choose between Medicare and MassHealth?

No. If you are 65 or older and have a low income, you can have both at the same time. Medicare is automatic at 65, and you can explore for MassHealth separately. Having both usually saves you money on medical bills.

What if I am under 65 and live in Massachusetts?

You may be able to enroll in MassHealth if your income is low enough. You are not may be able to access for Medicare unless you have been on SSDI for at least two years, have end-stage renal disease, or have ALS. Check the MassHealth website or call 1-800-841-2900 to learn about programs for your age group.

If I move out of Massachusetts, do I lose both programs?

You will lose MassHealth because it is only for Massachusetts residents. Medicare will stay with you because it is a federal program. You will need to look into your new state's Medicaid program if you have a low income.

Can MassHealth pay my Medicare premiums?

Yes. If you are dual may be able to access, MassHealth may pay your Medicare Part B and Part D premiums as well as some of your out-of-pocket costs. The exact amount depends on your income and which MassHealth program you are in.

How do I explore for MassHealth if I already have Medicare?

You can explore online at mass.gov/MassHealth, by mail, or in person at a local MassHealth office. You will need to provide proof of income, residency, and citizenship or immigration status. The process takes about 30 minutes to complete.