Most members who are under the age of 65 and have no other health insurance will need to enroll in a health plan and choose a MassHealth doctor. In some cases, you must enroll in a health plan before you can receive health-care services. Everyone who has to enroll in a health plan will receive an enrollment package in the mail that explains the enrollment process. Once you are enrolled, you will get most of your health-care services through your plan.

If you are aged 65 or older or you have other health insurance, you are not required to enroll in a health plan and you may use the services of any doctor who takes MassHealth.

To get and keep MassHealth, you must:

  • enroll in any health insurance that is available to you at no cost, including Medicare;
  • enroll in health insurance when MassHealth determines it is cost effective for you to do so; or
  • keep any health insurance that you already have.

You must also give MassHealth information about any health insurance that you or a family member already have or may be able to get. We will use this information to determine:

  • if the services covered under your private health insurance meet MassHealth standards; and
  • what we may pay toward the cost of your private health insurance.

MassHealth may pay part or all of your health-insurance premiums if you work for a qualified employer. A health plan meets the Basic Benefit Level if it provides comprehensive medical coverage to its members including MassHealth-required health-care benefits.

MassHealth may buy group health insurance through its MassHealth Standard/CommonHealth Premium Assistance (MSCPA) Program for an eligible MassHealth member. MassHealth will decide when to do this, based on the cost and services covered under the health insurance.

If you have Medicare, Medi-Gap, or any other kind of health insurance, your health-care provider must bill the other insurers first. MassHealth will pay any remaining copays or deductibles. Your health-care provider must not bill you for any service or part of a service that is covered by MassHealth.

For more information, call the MassHealth Customer Service Center.


This information is provided by MassHealth.