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, a 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 the SMBR

2. By calling MassHealth Customer Service 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) including Supplement A: Long-Term-Care Questions (blue sheet). (Note: If you are applying for MassHealth through the Kaileigh Mulligan or PACE program, you do not have to fill out Supplement A.)

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

  • 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;
  • the current value of your assets (like copies of your current bank statements); and
  • proof of citizenship and identity.

3. Give us your Social Security number or proof that you (and your spouse), if applying for MassHealth or Commonwealth Care, have applied for a Social Security number

4. If you are applying for long-term-care benefits in a long-term-care facility, 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
45-47 Spruce Street
Chelsea, MA 02150

Springfield MEC
333 Bridge Street
Springfield, MA 01103

Taunton MEC
21 Spring Street
Suite 4
Taunton, MA 02780

Tewksbury MEC
367 East Street
Tewksbury, MA 01876

Otherwise, if you are applying for health benefits, send your filled-out Senior Medical Benefit Request and any supplements and needed papers to

Central Processing Unit
P.O. Box 290794
Charlestown, MA 02129-0214.

Where to call

1. Call MassHealth Customer Service 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.