Not insured? Need help paying for health insurance? You may be able to get free or low-cost health care even if you work or have health insurance. MassHealth Commonwealth of Massachusetts EOHHS 1.800.841.2900 www.mass.gov/masshealth What is MassHealth? MassHealth is a state and federal program that pays for health care for qualified people living in Massachusetts with low and medium incomes. Even if you have other health insurance, you may be able to get MassHealth. If you qualify, MassHealth can give you health-care benefits directly or pay part or all of your health-insurance premiums. What does MassHealth offer? MassHealth offers a broad range of health-care services by paying for part or all of a MassHealth member’s health insurance, or paying medical providers for services given to MassHealth members. MassHealth covers doctor visits, prescription drugs, hospital stays, and many other important services. Other health-care programs Massachusetts has other health-care programs, including Commonwealth Care and the Health Safety Net, as described below. Commonwealth Care is a program administered by the Commonwealth Health Insurance Connector Authority (“the Health Connector”) for certain adults who are not eligible for MassHealth. Commonwealth Care helps pay for health-insurance premiums for health plans that are approved by the Health Connector. The Health Safety Net (HSN) pays hospitals and community health centers for certain services provided to low-income patients. The HSN is administered by the Executive Office of Health and Human Services. Providers may be paid for eligible services to low-income patients. Who can get MassHealth? MassHealth offers benefits to a wide range of people who meet eligibility rules. We look at your family size and income to decide if you or your family can get MassHealth. If you are aged 65 or older or in need of long-term-care services, we also count some of your assets. Even if you or your family already has other health insurance, you may be eligible if your family’s income is low or medium, and you meet one of the following descriptions: you are a parent living with your children under age 19; you are an adult caretaker relative living with children under age 19 to whom you are related by blood, adoption, or marriage, or are a spouse or former spouse of one of those relatives, and you are the primary caretaker of these children when neither parent is living in the home; you are under age 19, whether or not you live with your family; you are pregnant, with or without children; you have been out of work for a long time; you are disabled; you are an adult who works for a qualified employer; you are HIV positive; you are aged 65 or older and living at home; you are any age and need long-term-care services in a medical institution; or you are eligible under certain programs to get long-term-care services to live at home. All uninsured children who cannot get MassHealth are eligible, regardless of income, for preventive health-care coverage from the Children’s Medical Security Plan (CMSP). Pregnant women who do not qualify for MassHealth Standard may qualify for Healthy Start. How do I apply? To apply for MassHealth, the Children’s Medical Security Plan (CMSP), Healthy Start, Commonwealth Care, or the Health Safety Net, you must fill out either a Medical Benefit Request (MBR) or a Senior Medical Benefit Request (SMBR), or fill out an electronic application through the Virtual Gateway available at many hospitals and community health centers in Massachusetts. You can also get an MBR or SMBR by calling MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled). You must send proof of your income and U.S. citizenship/national status and identity or immigration status. You do not need to send proof of your immigration status if you are applying only for MassHealth Limited, CMSP, Healthy Start, or the Health Safety Net. Once we have the information we need, we will decide if you can get MassHealth, CMSP, Healthy Start, Commonwealth Care, or the Health Safety Net. If you are eligible, you will get the most complete health-care coverage the law allows. Where can I call for more information? For more information, call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled). Income Levels for MassHealth, Commonwealth Care, and the Health Safety Net If your income is less than or equal to the amounts listed below, you may qualify for health-care benefits. The income amounts listed below are for the Health Safety Net. MassHealth and Commonwealth Care have lower income limits. Additional rules and restrictions may apply. If you are pregnant, we count your unborn child (or children) as a member of your family. Some people who have incomes higher than the amounts below may still get benefits after they have spent a certain amount on medical bills or if they pay a premium. Family Size: 1 Maximum Monthly Income (400% Federal Poverty Level): $3,830 Family Size: 2 Maximum Monthly Income (400% Federal Poverty Level): $5,170 Family Size: 3 Maximum Monthly Income (400% Federal Poverty Level): $6,510 Family Size: 4 Maximum Monthly Income (400% Federal Poverty Level): $7,850 Family Size: 5 Maximum Monthly Income (400% Federal Poverty Level): $9,190 NOTE: The above income levels are effective on March 1, 2013. These amounts are before taxes and deductions. OP-3 (Rev. 03/13)