Medicare and MassHealth are two separate programs that serve different purposes

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). It covers people age 65 and older, some younger people with disabilities, and people with end-stage renal disease. MassHealth is Massachusetts's state Medicaid program, which covers low-income residents of any age.

They are not the same program. Medicare is federal; MassHealth is state. Medicare is based on age or disability; MassHealth is based on income. You can have one, the other, or both at the same time. Many seniors in Massachusetts have both — this is called "dual coverage" — and understanding how they work together matters for your out-of-pocket costs and which doctors you can see.

Key Takeaways

  • Medicare is a federal program for people 65 and older; MassHealth is Massachusetts's state program for low-income residents of any age.
  • You can have both programs at the same time, and many Massachusetts seniors do.
  • If you have both, Medicare is your primary insurance and MassHealth covers some costs Medicare does not pay.
  • To get MassHealth while on Medicare, you must meet Massachusetts income and asset limits, which change yearly.
  • The MassHealth office or your local Area Agency on Aging can tell you whether you may be may be able to access based on your income.

How Medicare and MassHealth work together when you have both

If you are on Medicare and also have MassHealth, Medicare pays first. MassHealth then covers some of the costs Medicare does not — such as the Part B deductible, copayments, and coinsurance. This arrangement reduces what you pay out of pocket.

However, not all doctors accept both programs. Some doctors accept Medicare only, some accept MassHealth only, and some accept both. When you have dual coverage, you need to check that your doctor takes both before you schedule an appointment. If your doctor takes only one program, you may have to pay out of pocket or find a different provider.

Prescription drug coverage also works differently depending on which program you use. If you are on Medicare Part D (prescription drug coverage) and MassHealth, the two programs coordinate. MassHealth may cover drugs that Medicare Part D does not, or it may cover a larger share of the cost.

Who can have both Medicare and MassHealth

You must meet two sets of requirements: you must be may be able to access for Medicare (usually age 65 or older), and you must meet MassHealth's income and asset limits for Massachusetts residents.

MassHealth has different categories for seniors. The most common is the MassHealth Senior Care program, which covers people age 65 and older with income below a certain level. The income limit changes each year. As of 2024, the monthly income limit for a single person is around $1,500, but this varies. You also have a limit on assets (savings, investments, property other than your home) — typically around $2,000 for a single person.

These limits are set by Massachusetts and reviewed annually. Contact the MassHealth office or your local Area Agency on Aging to learn the current limits and whether your income and assets fall within them. Do not rely on last year's numbers.

How to learn about you may be may be able to access for MassHealth

Start by contacting the MassHealth Customer Service Center at 1-800-841-2900 (TTY: 1-800-497-4648). You can also visit the MassHealth website at mass.gov/masshealth. Have your Social Security number, income information, and a list of your assets ready when you call.

Another route is your local Area Agency on Aging. These agencies help seniors with benefits and programs. You can find your local agency by calling the Eldercare Locator at 1-800-677-1116 or visiting the Eldercare Locator website. The staff there can walk you through what information you need and help you understand whether you may be may be able to access based on your situation.

If you are already on Medicare, you do not need to give it up to explore for MassHealth. You can have both at the same time. The process process for MassHealth is separate from Medicare.

What happens to your Medicare coverage if you get MassHealth

Your Medicare coverage does not change. You keep your Medicare card, your Medicare benefits, and your Medicare provider network. MassHealth straightforward adds a layer of coverage on top. You will receive a MassHealth card in addition to your Medicare card, and you may need to show both when you go to the doctor.

Some people worry that adding MassHealth will affect their Medicare. It will not. Medicare is federal and does not depend on state programs. Your Medicare benefits continue exactly as they were.

Costs and out-of-pocket expenses with dual coverage

If you have only Medicare, you pay the Part B deductible (currently $240 per year), copayments for doctor visits, and coinsurance for hospital stays. These costs add up, especially if you have chronic conditions that require frequent care.

If you have both Medicare and MassHealth, MassHealth typically covers the Part B deductible and reduces or eliminates copayments and coinsurance. This means your out-of-pocket costs drop significantly. However, you still need to make sure your doctor accepts both programs — if your doctor takes only Medicare, you may have to pay the full copayment yourself.

Prescription drugs are another area where dual coverage helps. If you are on Medicare Part D and your copayment for a drug is high, MassHealth may cover part or all of the cost above what Medicare pays.

When to contact MassHealth or your doctor

Contact MassHealth if your income or assets change, if you move, if you change doctors, or if you have questions about whether a specific service is covered. You should also contact them if you receive a notice about your MassHealth status — these notices require a response, and missing a important date can end your coverage.

Contact your doctor's office before your appointment to confirm they accept both Medicare and MassHealth. If they accept only one, ask whether they can bill the other program or whether you will need to pay out of pocket. Do not assume your current doctor takes both programs just because they took Medicare before you applied for MassHealth.

If you are denied MassHealth or your coverage ends, you have the right to request a hearing. The MassHealth notice will explain how to do this. You can also ask your Area Agency on Aging or a legal aid organization to help you appeal.

Frequently Asked Questions

Can I have Medicare and MassHealth at the same time?

Yes. Many Massachusetts seniors have both. Medicare is your primary insurance, and MassHealth covers costs Medicare does not pay. You will have two insurance cards and may need to show both at the doctor's office.

Will getting MassHealth affect my Medicare benefits?

No. Medicare is a federal program and does not change based on state programs. Your Medicare coverage, benefits, and provider network stay the same. MassHealth straightforward adds additional coverage on top.

What if my doctor does not accept MassHealth?

Ask your doctor's office whether they accept MassHealth before your appointment. If they accept only Medicare, you may have to pay the full copayment yourself or find a different provider. Some doctors accept both programs but bill them differently.

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

Income limits change each year and depend on whether you are single or married. Call MassHealth at 1-800-841-2900 or your local Area Agency on Aging to learn the current limit and whether your income qualifies. Have your recent pay stubs or tax return ready.

What if I am denied MassHealth?

The denial notice will explain why and how to request a hearing. You have the right to appeal. Contact your local Area Agency on Aging or a legal aid organization for help with the appeal process.