Getting the MassHealth Senior Medical Benefit Request

The Senior Medical Benefit Request package contains the application form (the "Senior Medical Benefit Request for Seniors and People Needing Long-Term-Care Services"), which contains Supplement A: Long-Term-Care Questions," Supplement B: "Help Getting Proof of U.S. Citizenship for Persons Born in Massachusetts," the "Personal-Care-Attendant Supplement," the "MassHealth Eligibility Representative Designation Form," and the "MassHealth and You" Guide.

Please keep the "MassHealth and You" Guide when you get one. It contains important information you may want to look up after you apply for MassHealth and while you are a MassHealth member.

There are two ways to get the Senior Medical Benefit Request (SMBR) so you can apply for MassHealth:

1. By downloading

2. By calling the MassHealth Customer Service Center at 1-800-841-2900
(TTY: 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled) or a MassHealth Enrollment Center (MEC) at 1-888-665-9993 (TTY: 1-888-665-9997 for people who are deaf, hard of hearing, or speech disabled). They can also answer your questions and help you fill out the application.

Note: Adults and children registered with the Massachusetts Commission for the Blind (MCB) should contact MCB's MassHealth unit at 1-800-392-6450 (ask for medical assistance) (TTY: 1-800-392-6556 for people who are deaf, hard of hearing, or speech disabled) to apply for MassHealth.

Important: If you want someone to act on your behalf or if you want to share your personal health information, you need to complete the MassHealth Eligibility Representative Designation Form.

How to Apply

1. Fill out the Senior Medical Benefit Request (SMBR) (orange form).

2. Send the filled-out and signed SMBR with proof of:
 

  • citizenship/national status and identity;
  • your monthly income before taxes and deductions (like a copy of your
    pension stub or award letter). You do not need to send us proof of your
    social security income; and
  • the current value of your assets (like copies of your current bank statements).

3. Send the filled-out SMBR, any supplements, and any needed papers to the one MassHealth Enrollment Center (MEC) listed below that is closest to where you live.
 

Chelsea MECTaunton MEC
45-47 Spruce Street21 Spring Street
Chelsea, MA 02150Suite 4
 Taunton, MA 02780
 
Springfield MECTewksbury MEC
333 Bridge Street367 East Street
Springfield, MA 01103Tewksbury, MA 01876

Where to call

1. Call the MassHealth Customer Service Center at 1-800-841-2900.
(TTY: 1-800-467-4648 for people who are deaf, hard of hearing, or speech disabled) if you need a Senior Medical Benefit Request.

2. Call a MassHealth Enrollment Center at 1-888-665-9993
(TTY: 1-888-665-9997 for people who are deaf, hard of hearing, or speech disabled)
 

  • if you need help filling out the SMBR;
  • if you need interpreter services; and
  • if you have any questions about the application process.

This information is provided by MassHealth .