MassHealth is Medicaid, not Medicare — here's what that means for you

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

If you live in Massachusetts and have a low income, you may be on MassHealth. If you're 65 or older, you may be on both MassHealth and Medicare at the same time (called "dual coverage"). Understanding which program is your primary payer — the one that pays first — affects what you pay out of pocket and which doctors you can see.

Key Takeaways

  • MassHealth is Medicaid, a state-run program for lower-income residents; Medicare is a federal program for people 65 and older or with certain disabilities.
  • You can be on both MassHealth and Medicare at the same time if you're 65 or older and meet MassHealth's income limits.
  • MassHealth covers doctor visits, hospital care, prescription drugs, and dental care; the exact coverage depends on which MassHealth plan you're on.
  • If you're on both programs, Medicare pays first for most services, and MassHealth covers what Medicare doesn't pay.
  • You must report changes in income, household size, or living situation to MassHealth within 30 days, or you may lose coverage.

The difference between MassHealth and Medicare in plain terms

Medicare is a federal insurance program you pay into through payroll taxes during your working years. You become may be able to access at 65, or earlier if you have end-stage renal disease, ALS, or have received Social Security Disability Insurance (SSDI) for 24 months. Medicare has four parts: Part A (hospital), Part B (doctor visits), Part D (prescription drugs), and Part C (an alternative plan). It is the same program everywhere in the United States.

MassHealth is Medicaid — a program jointly funded by the federal government and Massachusetts. It is for people with lower incomes, regardless of age. You do not pay into it through taxes; instead, the state determines who qualifies based on income and other factors. MassHealth coverage varies by plan type and can include services Medicare does not, such as dental care, vision care, and long-term care in a nursing home.

The key practical difference: Medicare is based on age or disability status. MassHealth is based on income. If you're 65 and your income is low enough, you can have both.

When you might have both MassHealth and Medicare

If you're 65 or older and your income is below MassHealth's limit, you can be enrolled in both programs. This is called "dual coverage" or being a "dual may be able to access." When you have both, Medicare is your primary payer — it pays its share first. MassHealth then pays for costs Medicare doesn't cover, such as copayments, coinsurance, and services Medicare doesn't include.

This matters because it changes what you owe. For example, if you see a doctor, Medicare pays 80 percent of the approved amount after you meet your deductible. MassHealth then covers your 20 percent coinsurance, so you may owe nothing. If you're on MassHealth alone (under 65), MassHealth is your primary payer and covers the full cost according to your plan.

To learn about you may have access to for both, you need to contact MassHealth directly. Your income limit depends on your household size and whether you're married. MassHealth also looks at assets in some cases, though the asset limits for older adults are high.

What MassHealth covers and what it doesn't

MassHealth covers doctor visits, hospital stays, emergency room care, prescription drugs, mental health services, and substance use treatment. Depending on your MassHealth plan, you may also have dental care, vision care, hearing aids, and nursing home care. Some plans cover more than others — MassHealth has several plan types, and your coverage depends on which one you're on.

MassHealth does not cover everything. It does not cover cosmetic surgery, most fertility treatments, or experimental drugs not yet approved by the FDA. If you're on both MassHealth and Medicare, Medicare's rules explore first — for example, Medicare limits how many days it covers in a skilled nursing facility, and MassHealth cannot extend that.

To see exactly what your MassHealth plan covers, log into your MassHealth account online or call MassHealth directly at 1-800-841-2900. You can also ask your doctor's office — they often have a list of what MassHealth covers for your specific plan.

How to find out which program you're on

If you're not sure whether you have MassHealth, Medicare, or both, start by looking for your insurance card. Your Medicare card will say "MEDICARE" at the top and have your name, a Medicare number, and the date you became may be able to access. Your MassHealth card will say "MassHealth" and have a member ID number.

You can also call MassHealth at 1-800-841-2900 to confirm your coverage status. Have your Social Security number ready. They can tell you which plan you're on, what it covers, and what your copayments are.

If you're 65 or older and think you should be on both programs but aren't, contact MassHealth to ask about dual coverage. You may be able to enroll even if you didn't when you first turned 65, though there are some time limits.

What happens if your income or situation changes

MassHealth requires you to report changes within 30 days. If your income goes up, you may no longer may have access to for MassHealth and will lose coverage. If your household size changes — someone moves in or out, you get married, or a family member dies — you must report it. If you move out of Massachusetts, your MassHealth coverage ends.

You can report changes online through your MassHealth account, by phone at 1-800-841-2900, or by mail. If you don't report a change and MassHealth finds out later, you may have to repay benefits you received while you were no longer may be able to access. This is called "overpayment recovery," and it can be a large bill.

If your income increases slightly, you may move to a different MassHealth plan rather than losing coverage entirely. For example, you might move from MassHealth Standard to MassHealth CarePlus, which has higher income limits. Ask MassHealth what options you have before your coverage ends.

How to keep your MassHealth coverage active

MassHealth coverage is not permanent. You must recertify your may be able to access periodically — usually once a year, though the exact timing depends on your plan. MassHealth will send you a notice in the mail asking you to confirm your income and household information. You must respond by the important date, or your coverage will end.

If you receive a recertification notice, respond right away. You can do it online, by phone, or by mail. If you miss the important date, you can ask for a reinstatement within a certain time frame, but it's easier to respond on time.

Keep your contact information current with MassHealth. If you move and don't update your address, you may miss important notices about recertification or changes to your coverage.

Frequently Asked Questions

Can I have MassHealth and Medicare at the same time?

Yes, if you're 65 or older and meet MassHealth's income limits. Medicare is your primary payer, meaning it pays first. MassHealth then covers costs Medicare doesn't pay, such as copayments and coinsurance. Contact MassHealth to confirm you're enrolled in both programs.

What's the income limit for MassHealth?

The income limit varies by household size and plan type. For 2024, the limit for a single person on most MassHealth plans is around 138 percent of the federal poverty level, but older adults and people with disabilities may have higher limits. Call MassHealth at 1-800-841-2900 to find out your specific limit based on your household.

If I'm on Medicare, do I still need MassHealth?

Not necessarily. Medicare alone covers many services. However, if your income is low, MassHealth can help pay your Medicare premiums, deductibles, and copayments. This is called "Medicare Savings Programs" or "dual coverage." You can have both if you meet the income requirements.

What happens to my MassHealth if I move out of Massachusetts?

Your MassHealth coverage ends when you move out of state. You will need to find health insurance in your new state. If you're 65 or older, you can enroll in Medicare. If you're younger and have a low income, you may may have access to for Medicaid in your new state, which has different rules and coverage than MassHealth.

How do I know if my doctor accepts MassHealth?

Call your doctor's office and ask, or log into your MassHealth account online to search for in-network providers. You can also call MassHealth at 1-800-841-2900 and ask if a specific doctor is in your plan's network. Using an out-of-network doctor may cost you more.