MassHealth CommonHealth Coverage and Costs Explained

MassHealth CommonHealth coverage and costs can be a bit overwhelming at first, but don't worry, I've got you covered.

MassHealth CommonHealth is a program that helps low-income individuals and families access affordable healthcare. This program is available to those who are eligible for MassHealth, which includes children, pregnant women, parents, and individuals with disabilities.

The costs of MassHealth CommonHealth vary depending on the individual's or family's income and household size. For example, a family of four with an income of $40,000 or less may pay no premium at all.

You'll also need to pay a small copayment for certain services, such as doctor visits and prescriptions. However, there are some services that are covered at no cost, including routine check-ups and preventive care.

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To be eligible for MassHealth CommonHealth, there's no income limit, but if your gross countable monthly income is above a certain amount, you may have to pay a premium or meet a one-time-only deductible.

Eligibility criteria vary by coverage type, so you'll receive the most complete coverage you qualify for. For families, pregnant women, and people under age 65, eligibility criteria apply.

To apply for MassHealth CommonHealth, call the MassHealth Customer Service Center at 800-841-2900 or 800-497-4648 (TTY) to request a Medical Benefit Request (MBR) or a MassHealth Application (MHA) for Seniors and People Needing Long-Term-Care Services.

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To qualify for MassHealth, your income level plays a significant role in determining your eligibility. There is no income limit for MassHealth CommonHealth.

The financial eligibility criteria for MassHealth vary depending on your family's income level. If your gross countable monthly income is above a certain amount, you may have to pay a premium or meet a one-time-only deductible.

For families, pregnant women, and people under age 65, eligibility criteria are determined by coverage type. You'll receive the most complete coverage you qualify for.

To learn more about the financial eligibility requirements, you can refer to the Division's regulations at 130 CMR 501.000 through 508.000.

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To apply for MassHealth, you can start by calling the MassHealth Customer Service Center at 800-841-2900 or 800-497-4648 (TTY) to request a Medical Benefit Request (MBR).

You can also call the MassHealth Customer Service Center at 800-841-2900 or 800-497-4648 (TTY) to request a MassHealth Application (MHA) for Seniors and People Needing Long-Term-Care Services.

Individuals of any age who reside or wish to reside in a long-term-care facility must complete the Long-Term-Care Supplement of the MassHealth Application.

For help completing the application forms, call the MassHealth Enrollment Center at 888-665-9993 or 888-665-9997 (TTY).

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MassHealth is a state-run health insurance program in Massachusetts, and it has two main options: MassHealth CommonHealth and MassHealth Standard. MassHealth Standard is the Medicaid program for residents in Massachusetts.

MassHealth Standard is a state-run health insurance program in Massachusetts that provides coverage for eligible residents. This program is available to individuals and families who meet specific income and eligibility requirements.

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MassHealth CommonHealth is a type of MassHealth that provides additional benefits to eligible residents. These benefits may include dental, vision, and pharmacy coverage.

To be eligible for MassHealth Standard, you must meet the state's income and eligibility requirements. This may include having a low income or being a family with children.

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MassHealth CommonHealth is a program that offers healthcare benefits to certain low- and medium-income individuals living in Massachusetts. MassHealth pays for healthcare directly or by paying part or all of your health insurance premiums.

If you're a disabled adult, you may be eligible for the CommonHealth program, which offers benefits similar to MassHealth Standard without the $2,000 countable asset limit. To qualify, you must be a resident of Massachusetts and either work 40 hours or more a month or have worked at least 240 hours in the 6 months immediately before applying.

The CommonHealth program determines eligibility based on federal and state law standards for being "disabled." This typically means having a mental or physical condition that severely limits your ability to work or perform daily activities for at least 12 months.

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If your household income exceeds 150% of the Federal Poverty Limit ($22,590 for a single person in 2024), you'll need to pay monthly premiums. The premium amount depends on your monthly income, household size, and whether you have other health insurance.

Here are the services covered by the CommonHealth program:

MassHealth CommonHealth offers a wide range of services to support your health and well-being.

The program covers essential services such as doctor visits, hospitalization, nursing facility services, medication, dental services, glasses and eye care, hearing aids, and rides to medical appointments.

Some services that MassHealth CommonHealth covers that Medicare doesn't fully cover include prescription drugs, personal care attendant services, and some types of home health care.

The program also offers comprehensive coverage when combined with Medicare, helping to extend your Medicare coverage in areas where it lacks.

Here are some of the specific services that MassHealth CommonHealth covers:

MassHealth CommonHealth offers a wide range of services to its members.

You can visit a doctor for any medical issue.

Hospitalization is also covered, including stays in nursing facilities.

Medication is another essential service, as well as dental services and glasses/eye care.

Hearing aids are also covered, and you'll have access to rides to medical appointments.

Additionally, MassHealth CommonHealth covers mental health and substance abuse services, and other medical services.

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MassHealth CommonHealth can provide more comprehensive health coverage when combined with Medicare. This is often referred to as a "last payer" and can help extend your Medicare coverage in areas that it lacks.

Medicare generally doesn't cover certain services, but MassHealth CommonHealth can fill in the gaps. For example, it can cover doctor visits, hospitalization, nursing facility services, medication, dental services, glasses and eye care, hearing aids, rides to medical appointments, mental health/substance abuse services, and other medical services.

Here are some specific benefits that MassHealth CommonHealth offers:

In some cases, MassHealth CommonHealth may provide access to a larger network of healthcare providers than Medicare alone. This can be especially helpful if you need to see a specialist or have a specific medical condition that requires ongoing care.

You'll need to meet a one-time only deductible to get MassHealth CommonHealth if you have income too high for MassHealth Standard. This deductible is calculated based on your countable income and family size.

The deductible amount is determined by subtracting the Division's deductible income standard from your countable income and multiplying the result by 6 months. For example, a family of two with a monthly income of $1400 would have a deductible amount of $4,380.

The deductible can be met with medical bills that are not covered by other health insurance, unpaid bills, and the cost of health insurance premiums for your family over the six-month period. Only one deductible is required per family.

Here's a breakdown of the Division's deductible income standard for different family sizes:

You might be surprised to learn that MassHealth can help lower out-of-pocket costs.

MassHealth CommonHealth can cover Medicare premiums, deductibles, and co-payments, which can add up quickly.

The amount of these costs varies, but Medicare has premiums, deductibles, and co-insurances, even for Part C Advantage plans.

If you're not currently paying these costs, you might not think they're a big deal, but when you get sick, you'll soon see how quickly they can add up.

The good news is that MassHealth CommonHealth can help you avoid some of these costs, making it easier to get the care you need.

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The one-time only deductible is a crucial factor to consider when navigating the MassHealth system. This deductible applies to certain adults with disabilities who have income too high to qualify for MassHealth Standard, but still need to access MassHealth CommonHealth.

To calculate the deductible, you'll need to determine the countable income of your MassHealth family group for a six-month period. The amount you need to calculate is the difference between your countable income and the Division's deductible income standard for your family size.

The Division's deductible income standards vary depending on family size. Here's a breakdown of the standards for different family sizes:

For example, if you're a family of two with a monthly income of $1400, your deductible amount would be $730. Multiply this by 6 months, and you'll get a deductible amount of $4,380. This means you'll need to have medical bills that total at least $4,380 before you can access MassHealth CommonHealth.

The deductible amount can be made up of several things, including the cost of health insurance premiums for your family over the six-month period, unpaid bills received before or during the deductible period, and additional family members.

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MassHealth CommonHealth offers specialized coverage for services not fully covered by Medicare, such as prescription drugs, personal care attendant services, and some types of home health care.

If you're taking expensive prescription drugs, MassHealth CommonHealth may help reduce the cost. You can also consider enrolling in a Medicare Part C Advantage Plan to remedy the cost of prescription drugs.

MassHealth CommonHealth can cover certain home modifications for those who qualify, helping individuals live more independently and safely in their own homes.

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MassHealth Standard and CommonHealth are two types of Medicaid programs in Massachusetts.

MassHealth Standard is the Medicaid program for most people, including those with low income, children, and people with disabilities. It provides comprehensive coverage for medical and dental care.

CommonHealth is a Medicaid program for people who are uninsured or underinsured, but don't qualify for MassHealth Standard. It offers limited coverage for medical and dental care.

MassHealth Standard and CommonHealth have different eligibility requirements. MassHealth Standard has a higher income limit, making it more accessible to a wider range of people.

Medicare Supplement Coverage is a crucial aspect of healthcare for many individuals. MassHealth CommonHealth can cover services not fully covered by Medicare, such as prescription drugs, personal care attendant services, and some types of home health care.

If you take expensive prescription drugs, MassHealth CommonHealth may help reduce the cost. Prescription drug coverage is typically Part D under Original Medicare, but this plan can provide additional assistance.

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MassHealth CommonHealth can also cover certain home modifications to help individuals live more independently and safely in their own homes. This can be a game-changer for those who need to make changes to their living space.

Combining MassHealth CommonHealth with Medicare can provide more comprehensive health coverage, often referred to as a “last payer.” This can help extend Medicare coverage in areas that it lacks.