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MassHealth Premium Assistance (PA)

This is a program for MassHealth members who have access to employer-sponsored health insurance (ESI).

The MassHealth Premium Assistance program is for MassHealth members who have access to employer-sponsored health insurance (ESI) from a job or from another source, such as members of your household.

The MassHealth Premium Assistance program reimburses eligible MassHealth members for some or all the premium cost of eligible private insurance.

Table of Contents

What is MassHealth Premium Assistance (PA)?

The MassHealth Premium Assistance (PA) program is for MassHealth members who have access to employer-sponsored health insurance (ESI) from a job or from another source, such as members of your household. If you have MassHealth and have access to ESI, you may be able to get help paying for your share of the health insurance premium if you qualify for the PA program. MassHealth may also assist with other out-of-pocket costs such as copayments, deductibles, and coinsurance, so that having ESI should not cost you more than when you only had MassHealth.

In addition to helping you pay for ESI, the PA program can help you in the following ways:

  • You may have more benefits by getting insurance both through your job and through MassHealth than just through MassHealth alone. For example, your employer’s health plan may provide access to more healthcare providers, additional paid services, and even wellness programs.
  • Family members who are not eligible for MassHealth may be able to get ESI at little to no cost when other family members have MassHealth.
  • If you have MassHealth CommonHealth with a high premium, PA can reduce or eliminate the cost of your CommonHealth premium if you get private health insurance through your job or family.
  • If you lose your MassHealth eligibility, you can keep your ESI so you will not go without health insurance. Please note that if you lose your MassHealth coverage, your PA benefits will also end, so you will be responsible for any ESI premiums after the end of your MassHealth coverage.

You may qualify for the MassHealth Premium Assistance (PA) program

  • If you have access to employer-sponsored insurance (ESI) coverage that meets certain requirements called the Basic Benefit Level;
  • If MassHealth determines that it is cost effective for the member to enroll in the PA program;
  • If at least one person covered by the ESI is eligible for MassHealth Premium Assistance; and
  • If the ESI policyholder lives with the eligible MassHealth member, or the eligible MassHealth member is the ESI policyholder.

Certain MassHealth members with access to ESI are required to enroll in and maintain available ESI, as long as MassHealth determines that the appropriate rules are met. For more information please see MassHealth Member Eligibility Regulations.

What you need to do

You must provide MassHealth with information about any private employer-sponsored insurance (ESI) that you or a family member already has or may have access to at application, at annual renewal, and any time there is a change in your ESI or access to ESI (i.e. a change of job).

We will use this information to decide:

  • Whether the services covered under your ESI meet MassHealth’s standards
  • Whether you are eligible for the Premium Assistance (PA) program
  • What we may pay toward the cost of your ESI premium
  • Whether you may be required to enroll in ESI as a condition of remaining eligible for MassHealth

We may ask you or your employer for more information about your access to health insurance from a job. We may also ask for proof you or your family members have enrolled in health insurance. You must give us the information we ask for. If you do not, your MassHealth benefits may end.

How to Apply for MassHealth Premium Assistance

Who's ​eligible for MassHealth Premium Assistance (PA)?

MassHealth members on Standard, CommonHealth, Family Assistance, and CarePlus who have access to private employer-sponsored insurance (ESI) from a job may be able to get help paying for part of their premium.

 

Ready to apply? Complete the MassHealth Premium Assistance (PA) application

Download  and complete the Additional Information about Your Access to Employer Sponsored Health Insurance (ESI) coverage form. Or Call the MassHealth PA Unit at (800) 862-4840 (TTY: (617) 886-8102 for people who are deaf, hard of hearing, or speech disabled) to request an application.

  • Part 1 (Member Information) must be completed by you.
  • Part 2 (Employer Sponsored Insurance Information) must be completed by your employer.

 

Mail or fax your completed MassHealth Premium Assistance (PA) application

Mail or fax your completed MassHealth Premium Assistance (PA) application and Summary of Benefits.

MassHealth members should return the completed application to the Premium Assistance Unit, along with the Summary of Benefits from your employer.

You can fax the completed application to: (617) 451-1332

Or you can mail the completed application to:

MassHealth Premium Assistance Program
519 Somerville Ave #372
Somerville, MA 02143

Note: It may take up to 45-60 days for the application to be processed. While your application is processing, you will retain your MassHealth benefits if your MassHealth eligibility does not change.

Additional Resources

Maintaining your Employer-Sponsored Insurance (ESI)

To keep your MassHealth benefits, including PA payments for your ESI, you must report any changes in your ESI policy information to the Premium Assistance Unit at (800) 862-4840 as soon as possible, but no later than 10 days from the date of the change. This includes changes to your health insurance coverage, health insurance premiums, or changes in your employer.

Annual Premium Assistance (PA) policy and rate review

Annually, the Premium Assistance Unit reviews member’s policy information and rates. Review Forms are sent both to you and to your employer’s Human Resources department during the health insurance open enrollment period. This is the time of year when your employer offers changes in health insurance coverage for the following year. Failure to respond to annual policy review may result in termination of your PA payments.

Health Insurance Responsibility Disclosure (HIRD) for employers

The HIRD form is a new employer reporting requirement in Massachusetts in 2018. The HIRD form collects employer-level information about private employer-sponsored insurance (ESI), in order to assist MassHealth in identifying members with access to qualifying ESI who may be eligible for the PA Program.

If you are an employer looking for more information about HIRD reporting or the PA program, please reference the following publications below.

Additional Resources

Premium Assistance (PA) FAQs

Additional Resources

Premium Assistance contact information

Premium Assistance Unit

Use the contact information below to report access to private health insurance coverage, changes or updates to your PA case.

Hours of Operation

  • Monday, Tuesday, and Friday: 8:00 am – 5:00 pm
  • Wednesday and Thursday: 8:00 am – 7:00 pm

Contact Information

  • Phone: (800) 862-4840
  • Fax: (617) 451-1332
  • TTY: (617) 886-8102
  • Mailing Address:
    519 Somerville Ave, #372 Somerville, MA 02142
  • Email: MassPA@hms.com

Premium Assistance Customer Service for Payment Related Inquiries

Hours of Operation

  • Monday – Friday 8:00 am – 5:00 pm

Contact Information

  • Phone: (800) 462-1120
    Option 1, Option 1
  • Fax: (617) 886-8440
  • TTY: (617) 886-8102
  • Mailing Address:
    PO Box 120068 Boston, MA 02112
  • Email: PremiumAssistance@umassmed.edu

Board of Hearings

Member communications

Premium Assistance (PA) Application

  • You may receive this in the mail if you reported to MassHealth that you are working at least 138 hours per month; you indicated on your MassHealth application that your employer may offer your health insurance benefits; and/or MassHealth has information indicated that your employer may offer you health insurance benefits. Form 1 needs to be completed by you and Form 2 needs to be completed by your employer’s Human Resources representative.  You must provide the information MassHealth requests by the deadline provided or your MassHealth benefits may end.

Summary of Benefits Example

  • Summary of Benefits. Easy to read summary detailing the plan(s) covered services.   You can obtain a plan Summary of Benefits from your employer or in some cases from the insurance carrier.

Premium Assistance Confirmed Access Letter

  • You will receive this letter if MassHealth has determined that you have health insurance available through a job in your family, and that the insurance meets MassHealth rules for PA. The people listed in the letter must enroll in the insurance by deadline provided or their MassHealth benefits may end.

Premium Assistance (PA) Qualifying Event Letter

  • You will receive this letter after you receive the Confirmed Access letter. The letter details which Employer Sponsored Health Insurance plan(s) available to you through a job meets PA qualifications.

MassHealth Termination Notice

  • You will receive this letter if you do not enroll in the private health insurance available through a job or you have not notified PA that you have enrolled before the deadline provided.

Premium Assistance (PA) Approval Notice

  • You will receive this letter when you have been approved for MassHealth PA benefits. The letter will let you know when your benefit begins and how much Premium Assistance will pay towards your private insurance monthly premium.

Electronic Funds Transfer (EFT)

  • PA members are eligible to get their payments directly deposited into a savings or checking account through the EFT process.

Premium Assistance (PA) Termination Notice

  • You will receive this letter if   you are no longer eligible for PA and MassHealth has stopped your PA Payments.

Premium Assistance (PA) Review Form

  • When you are enrolled in PA, you may receive this form in the mail during your employers open enrollment period to verify your insurance information.

Additional Resources

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