Massachusetts Application for Health and Dental Coverage and Help Paying Costs [ACA-3 (07/17)]

Application for health coverage and help paying costs.

Available Formats

Application for Health Coverage for Seniors and People Needing Long-Term-Care Services [SACA-2 (07-17)]

An application for seniors and people needing long-term-care services.

Available Formats

MassHealth Buy-In [MHBI-1 (03/16)]

An application and brochure for people who are eligible for Medicare.

Available Formats

Application for Waiver or Reduction of MassHealth Premium [HW (Rev. 10/09)]

An application for members who are having trouble paying their MassHealth, Children's Medical Security Plan, or CommonHealth premiums.

Available Formats

Voter Registration

If you are a US citizen, a resident of Massachusetts, and 18 years old on or before election day, you can register to vote. Just print out this voter registration form and bring or mail it to your town or city hall. If you need help, you can call 1-800-841-2900 (TTY: 1-800-497-4648 for the deaf, hard of hearing, and speech disabled).


This information is provided by MassHealth.