MassHealth and Other Health Insurance

Help for MassHealth members to understand how to use their MassHealth and other health insurance also known as Third Party Liability (TPL).

You, as a MassHealth member, can have both MassHealth and other health insurance. This other health insurance could be private health insurance from employment, a family member, or a parent with or without custody. Private health insurance may also be known as commercial health insurance, employer-sponsored insurance (ESI), or other insurance. It could also be Medicare, the federal health insurance program for people 65 and older and younger people with disabilities.

If you have other insurance, it is considered a liable third party or TPL insurance. TPL or other health insurance is billed as the primary insurer and MassHealth is the secondary coverage.

Overview

MassHealth members can have MassHealth and other health insurance at the same time. If you have multiple types of insurance, the private health insurance or Medicare is considered a liable third party or TPL. Private health insurance or Medicare is billed first, as the primary insurer, and MassHealth is the secondary coverage. Private health insurance could be from your job, a family member, or a parent with or without custody. In some instances, MassHealth may require you to enroll in health insurance offered through work.

For more information on what you may need to do as a MassHealth member who has access to Medicare, go to MassHealth and Medicare.

If you are a MassHealth member and you have other health insurance

• Having other insurance will not cause you to lose your MassHealth as long as you remain eligible for MassHealth.
• Your other health insurance will be the primary insurer and pay first for your health care.
• MassHealth will pay for MassHealth-covered services if your other health insurance doesn’t, including out-of-pocket costs like copays or deductibles.
• You will never have to pay more than you did when you or your dependents were on MassHealth only.
• If you were receiving your MassHealth through a MassHealth managed care organization (MCO) plan (for example, BMC Health Net or Tufts Health Together), an accountable care organization (ACO) plan (for example, Fallon 365 or Partners HealthCare Choice), or through the Primary Care Clinician (PCC) plan, you will be disenrolled from the MassHealth MCO, ACO, or PCC plan once you become enrolled in your other health insurance. An MCO, ACO, PCC plan disenrollment notice will be mailed to the address that MassHealth has on record when this happens. You will still have MassHealth benefits but how you receive them will change.

If you are a MassHealth member and may have access to other health insurance

You may be required to do the following.

• Supply information about the private insurance plan to see if it would be cost effective for MassHealth to require you to enroll;
• Enroll in insurance through your job if MassHealth determines it is cost-effective. MassHealth will reimburse you for any costs in addition to those you had with MassHealth only; and
• Maintain any private health insurance that is available to you at no cost.

Unless you are pregnant or under age 21, you could lose your MassHealth benefits if you do not enroll in private health insurance when you are required to do so by MassHealth.

Frequently Asked Questions (FAQs) about health insurance and MassHealth

You can also download the FAQs below.

How do I make sure the costs of my care are covered when I have both private health insurance and MassHealth?
To have MassHealth pay for your care, including the cost of copays, deductibles and other out of pocket costs, you must follow the rules of your private health insurance plan and see a provider who is in both the private plan network and in the MassHealth network. Please make sure to ask all providers before scheduling an appointment if they accept MassHealth and your private health insurance. For more information, you can review the Coordination of Benefits (COB) information on the MassHealth website.

What if I decide I do not want to enroll in the private health insurance plan through my work? 
If MassHealth informs you that you must enroll in a private health insurance plan that you have access to and it is at no cost to you, you may lose your MassHealth benefits if you fail to enroll in the private plan.

Will I lose MassHealth if I have private health insurance through my spouse or non-custodial parent? 
No, you can have private health insurance and MassHealth. Many MassHealth eligible children have health insurance from a non-custodial parent. You can call the MassHealth Third Party Liability Unit at (888)-628-7526 if you are having difficulty obtaining private health insurance information for the non-custodial parent.

What if I do not want to use my private health insurance for fear of harm? 
If you believe signing up or using private health insurance will cause harm (i.e. domestic violence) to you or another person, or will not be in the best interest of your child, please call the MassHealth Third Party Liability Unit at (888)-628-7526 immediately. For example, using a private health insurance may cause an explanation of benefit (EOB) be sent to the private health insurance policyholder which may not be safe in the case of domestic violence.

How do I notify MassHealth if I have private health insurance or if it has ended? 
You can call the MassHealth Third Party Liability Unit at (888)-628-7526 to report the insurance update or complete the TPL Indicator Form.

What are the benefits of having private health insurance in addition to MassHealth?
Having two insurance plans can provide a more complete benefit package while having the same MassHealth out of pocket costs. Always present both your private health insurance and MassHealth ID cards to all providers, including your pharmacist. When you visit a provider that accepts both your private health insurance and MassHealth, MassHealth will pay any of your private health insurance plan’s copays, deductibles and/or coinsurance on your behalf. For more information, you may review the Coordination of Benefits information on the MassHealth website.

What if I see a provider that does not accept MassHealth? 
If you visit a provider in your private health insurance network who does not take MassHealth, you may be charged the copay, deductible, and/or coinsurance because this provider does not bill MassHealth. Please make sure to ask all providers before scheduling an appointment if they accept MassHealth and your private health insurance. In some cases, your provider may be willing and able to enroll in MassHealth. For MassHealth members under age 21, their behavioral health provider may be able to enroll in the Massachusetts Behavioral Health Partnership for purposes of billing for cost-sharing.

If you need help with coordinating benefits for MassHealth and your private health insurance, contact MassHealth Member Customer Service Center at (800)-841-2900 or review the Coordination of Benefits information (Link to Section 2.3 COB Examples) on the MassHealth website.

My doctor/drug store says I have other insurance coverage, but I don’t. What do I do?
Call the MassHealth Third Party Liability Unit at (888)-628-7526.

Do I have to use the private health insurance, or can I just use my MassHealth? 
You must use MassHealth and the private health insurance, and go to a provider who accepts both, otherwise you may be responsible for out-of-pocket costs like deductibles, co-pays, or co-insurance amounts.

The Pharmacy charged me a copay even though I have MassHealth and private health insurance. Can I get my money back? 
You can ask the pharmacy to bill the claim to MassHealth and be reimbursed by the pharmacy. Call the MassHealth Customer Service at (800)-841-2900 to update and correct the other insurance

If you have additional questions? Send us an email to [e-mail]

TPL Indicator Form

This form is for you or your providers to inform MassHealth about other health insurance or if your insurance has changed or ended.

Sample letters mailed to members

ACO/MCO disenrollment – sample letter
The purpose of this letter is to inform you that you are still eligible for MassHealth. However, your MassHealth accountable care organization (ACO), managed care organization (MCO), or PCC plan has ended because you have private health insurance coverage. You will still have MassHealth benefits but now your private health insurance will be primary insurer.

Third Party Liability (TPL) add letter – older than 18 and younger than 18 sample letters
The purpose of this letter is to inform you that you or your dependents are covered by another health insurance policy, in addition to MassHealth. If the health insurance information is incorrect or has ended, please call the Third Party Liability Unit at (888)-628-7526.

Qualified Medicare Beneficiary (QMB) outreach letter – sample letter
The purpose of this letter is to inform you that you may qualify for Medicare health insurance at no extra cost. As a Qualified Medicare Beneficiary (QMB), if you enroll in Medicare, MassHealth will pay for your premiums and cost-sharing. You will keep your MassHealth benefits and have Medicare benefits too. Call the Medicare Enrollment Support Project at [phone], TDD/TTY: 711 for help enrolling in Medicare. You must call by the deadline on your letter to keep your MassHealth coverage.

Qualified Medicare Beneficiary (QMB) follow-up notice – sample letter
The purpose of this letter is to inform you that you took steps to apply, but you are not yet enrolled in Medicare. You had a scheduled appointment 6 months ago with your local Social Security Office. Call the Medicare Enrollment Support Project at [phone], TDD/TYY: 711 for help enrolling in Medicare. If you don’t take action to enroll in Medicare, you could lose your MassHealth benefits.

Qualified Medicare Beneficiary (QMB) termination notice for failure to apply for Medicare – sample letter
The purpose of this letter is to inform you that you did not take steps to enroll in health insurance that is available at no cost to you from Medicare. See 130 CMR 517.008. You can still call us to get help enrolling in Medicare. If you call the Medicare Enrollment Project Hotline at [phone] and apply for Medicare, you may qualify for MassHealth again.

Contact the TPL Unit

Contact us to report insurance updates, new coverage, make corrections, or report terminations.

Monday and Tuesday from 8:00 am to 7:00 pm

Wednesday, Thursday, and Friday from 8:00 am to 5:00 pm

• By phone: [phone],TTY: [phone]
• By fax: [phone]

Have questions? Send us an email to [e-mail]

Need to mail us documents? Send them to:

Third Party Liability (TPL) Unit
519 Somerville Avenue, #372
Somerville, MA 02143

Reimbursement for mail order pharmacy expenses

MassHealth may reimburse members for out-of-pocket mail order pharmacy expenses for MassHealth covered services. This reimbursement may be available when a MassHealth member is required by their health insurer to fill a mail order prescription(s) and has to pay an expense (including co-insurance, copays, and deductibles) up front in compliance with their insurance policy.

To request reimbursement for out-of-pocket mail order pharmacy expenses, please complete the Pharmacy Mail Order Expense Reimbursement Form. Instructions explaining the documentation that you’ll need, and how to submit your request, are included on the form.

Last updated:	July 23, 2025