About the program
This coverage type offers a full range of health-care benefits and is the only coverage type that pays for long-term-care services.
In MassHealth Standard, covered services include the ones listed below. There may be some limits. Your health-care provider can explain them to you.
- inpatient hospital services
- outpatient services: hospitals, clinics, doctors, dentists, family planning, and vision care
- medical services: lab tests, X rays, therapies, pharmacy services*, eyeglasses, hearing aids, medical equipment and supplies, adult day health, and adult foster care
- behavioral health (mental health and substance abuse) services
- well-child screenings (for children under the age of 21): including medical, vision, dental, hearing, behavioral health (mental health and substance abuse), and developmental screens, as well as shots
- long-term-care services at home or in a long-term-care facility, including home-health services
- transportation services
- quit-smoking services
*If you are eligible for both Medicare and MassHealth, Medicare will provide most of your prescription drug coverage through a Medicare prescription drug plan. Visit www.medicare.gov or call 1-800-MEDICARE for information about whether you need to enroll in a Medicare prescription drug plan, and, if so, how to choose one that is best for you.
Note: For disabled adults who also get Medicare Part B, MassHealth will pay the Medicare premium, and if applicable, the coinsurance and deductibles.
A complete listing and a more detailed description of the services covered can be found in the MassHealth regulations at 130 CMR 450.105. You may have copayments for some services. More information on copayments may be found in the MassHealth regulations at 130 CMR 450.130.
Additional services for children under the age of 21
Children, teens, and young adults under the age of 21 who are determined eligible for MassHealth Standard are also eligible for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services, which include all medically necessary services covered by Medicaid law. See 42 U.S.C. §§1396a(a)(10), 1396d(a), and 1396d(r). This means that MassHealth pays for any medically necessary treatment that is covered by Medicaid law, if it is delivered by a provider who is qualified and willing to provide the service. If the service is not already covered by the child's MassHealth coverage type, the prescribing clinician can ask MassHealth for prior approval (PA) to determine if the service is medically necessary. MassHealth pays for the service if prior approval is given.
You may be able to get MassHealth Standard if you are:
- any age and in need of long-term-care services at home or in a facility.
For parents and caretaker relatives for children under age 19, please see MassHealth Standard for Applicants and Members Under Age 65 and Families.
Any age and in need of long-term-care services in a facility:
- asset standard: $2,000 or less for an individual; for married couples in which one member is institutionalized, the institutionalized spouse may keep $2,000 and the spouse at home may keep up to a certain amount (certain rules apply).
- income standard: There is no income limit, but you may have to pay a patient-paid-amount. Your patient-paid-amount will be determined using certain income deductions.
Any age and in need of long-term-care services in the home:
Though these special programs are available under MassHealth Standard, each program has its own eligibility rules (including income and asset rules) that may be different from other MassHealth eligibility rules. Please call MassHealth Customer Service for more information about these programs.
Call a MassHealth Enrollment Center at 1-888-665-9993 (TTY: 1-888-665-9997 for people with partial or total hearing loss) to request a Senior Medical Benefit Request, or click here to download a Senior Medical Benefit Request:
Submit the completed application to the one MassHealth Enrollment Center (MEC) listed below that is closest to where you live.
300 Ocean Avenue
Revere, MA 02151
21 Spring Street
Taunton, MA 02780
333 Bridge Street
Springfield, MA 01103
367 East Street
Tewksbury, MA 01876
MassHealth Enrollment Center: 1-888-665-9993
(TTY: 1-888-665-9997 for people with partial or total hearing loss)
Office hours: Monday through Friday 9 A.M. to 5 P.M.
This information is provided by MassHealth.