About the program
This coverage type offers coverage to certain unemployed adults who are not eligible for MassHealth Basic by:
- paying for all or part of the cost of your other health-insurance premium; or
- allowing you to choose a MassHealth doctor if you do not have other health insurance.
If MassHealth decides you can get MassHealth Essential, you can get coverage in one of two ways.
- Under premium assistance, MassHealth will pay part or all of your other health-insurance premium. Your benefits will include all those services covered by your other health insurance.
- If you do not have other health insurance, you must choose a MassHealth doctor to manage your health-care needs.
After you have chosen a doctor, you may get the services listed below. There may be some limits. Your health-care provider can explain them.
- inpatient hospital services
- outpatient services: hospitals, clinics, doctors, dentists, and family planning
- medical services: lab tests, X rays, therapies, pharmacy services*, and medical equipment and supplies
- 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
- ambulance services (emergency only)
- 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.
Some of the services not covered
- eyeglasses and hearing aids
- home-health care
- adult day health and adult foster care
- hospice services
- nursing-facility services
A more detailed description of the services covered and any limitations on this coverage 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.
You may be eligible for MassHealth Essential if you are under the age of 65 and:
- you are currently not working;
- you have not worked in more than one year or, if you have worked, you have not earned enough to collect unemployment;
- you are not eligible to collect unemployment benefits;
- you have an immigration status that prevents you from getting MassHealth Standard, are long-term unemployed, and meet MassHealth disability rules; and
- you are not eligible for MassHealth Basic.
Note: The following people are not eligible for MassHealth Essential:
- a college student who can get health insurance from his or her college or university; and
- a person whose spouse works more than 100 hours a month.
You must give us proof of your monthly income before taxes. Your family's income before taxes and deductions can be no more than 100% of the federal poverty level.
Call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648 for people who are deaf, heard of hearing, or speech disabled) to request a Medical Benefit Request (MBR), or download a Medical Benefit Request:
Submit the completed application to
MassHealth Enrollment Center
Central Processing Unit
P.O. Box 290794
Charlestown, MA 02129-0214
MassHealth Customer Service: 1-800-841-2900
(TTY: 1-800-497-4648 for people who are deaf, heard of hearing, or speech disabled)
Office hours: Monday through Friday 9 A.M. to 5 P.M.
This information is provided by MassHealth.