MassHealth and Medicare

Help for MassHealth members who are eligible for Medicare to understand the requirement to enroll in and use Medicare.

Overview

Medicare is the federal health insurance program for people 65 and older and younger people with disabilities. MassHealth members can have MassHealth and Medicare at the same time. If you have Medicare and MassHealth, Medicare is considered a liable third party or TPL. This means Medicare is billed as the primary insurer and MassHealth is the secondary coverage.

Medicare pays for many hospital and doctor services, medical supplies, and prescription drugs. You might also be able to see a broader network of health care providers when you have both Medicare and MassHealth. Depending on your income, MassHealth may also pay for your premiums and cost-sharing through the Medicare Savings Program (MSP). MassHealth members who are eligible for help paying for their Medicare premiums through the MSP are required to apply for Medicare.

If you are a MassHealth member and you have Medicare

• Having Medicare will not cause you to lose your MassHealth as long as you remain eligible for MassHealth.
• Your Medicare will be the primary insurer and pay first for your health care.
• MassHealth will pay for MassHealth-covered services if your Medicare doesn’t. MassHealth will also pay any Medicare copays or deductibles for MassHealth-covered services.
• You will never have to pay more than you did when you were on just MassHealth.
• 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 Medicare. 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 Medicare at no additional cost

You are required to do the following.

• Apply for Medicare if it is available to you at no extra cost. If you are a Qualified Medicare Beneficiary (QMB), MassHealth will pay for your Medicare premiums and cost-sharing through the Medicare Savings Program (MSP) and require you to apply for Medicare. If you receive an outreach letter in a yellow envelope, you can call the Medicare Enrollment Support Project at [phone], TDD/TTY: 711 for help setting up your Medicare application appointment with your local Social Security office;
• Let MassHealth know if you are denied Medicare coverage. You can call the Medicare Enrollment Support Project at [phone], TDD/TTY: 711 for help dealing with a Medicare denial; and
• Maintain Medicare coverage that is available to you at no extra cost.

You could lose your MassHealth benefits if you do not apply for Medicare when you are required to do so by MassHealth. If you do lose your MassHealth benefits, you can reapply for MassHealth once you have applied for Medicare.

Sample letters mailed to members

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/TTY: 711 for help enrolling in Medicare. If you don’t take action to enroll in Medicare, you could lose your MassHealth benefits.  If you applied for Medicare and were denied, you must call the Medicare Enrollment Support project and provide a copy of your denial letter.

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 at [phone], TDD/TTY: 711 and apply for Medicare, you may qualify for MassHealth again. If you applied and were denied Medicare coverage, call the Medicare Enrollment Project for assistance.  You will need to provide a copy of your Medicare denial letter via fax, email, or mail.

Contact the Medicare Enrollment Support Project

If you received an outreach letter in a yellow envelope requiring you to enroll in Medicare, contact the Medicare Enrollment Support Project. If you are QMB eligible but did not receive an outreach letter in a yellow envelope, call the Social Security Administration to apply for Medicare.

Note: the Medicare Enrollment and Support Project can only help members who have received an outreach letter in a yellow envelope. They can’t help with Medicare enrollment for members who did not receive an outreach letter in a yellow envelope. non-MSP eligible members.

Monday through Friday from 9:00 am to 5:00 pm

• By phone: [phone], TDD/TTY: 711

Date published:	July 23, 2025