About the program
This coverage type offers a full range of health-care benefits.
In MassHealth Standard, covered services include the ones listed below. There may be some limits. Your health-care provider can explain them.
- 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:
- under age 19;
- a parent living with your children under age 19*;
- disabled according to the standards set by federal law. This means you have a mental or physical condition that limits or keeps you from working for at least 12 months. MassHealth decides if you meet the disability standards; or
- eligible based on special income and asset rules under Section 1931 or the Social Security Act, which lets you keep these benefits for up to 12 months after you have gone back to work or gotten a raise, no matter how much your new earnings are. *
(*These benefits are also available for parents and caretaker relatives who are aged 65 or older.)
- for pregnant women: 200% of the federal poverty level
- for children under age one: 200% of the federal poverty level
- for children aged one through 18: 150% of the federal poverty level
- for parents or caretaker relatives of children under age 19: 133% of the federal poverty level
- for disabled adults: 133% of the federal poverty level
Call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648 for people with partial or total hearing loss) 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 with partial or total hearing loss)
Office hours: Monday through Friday 9 A.M. to 5 P.M.
This information is provided by MassHealth.