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
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Monday and Tuesday from 8:00 am to 7:00 pm
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Wednesday, Thursday, and Friday from 8:00 am to 5:00 pm
Contact Information
- Phone: (800) 862-4840
- Fax: (617) 451-1332
- TTY: (617) 886-8102
- Mailing Address:
519 Somerville Ave, #372 Somerville, MA 02143 - Email: MassPremAssistance@accenture.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
Member communications
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Premium Assistance (PA) Application |
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Summary of Benefits Example |
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Premium Assistance Confirmed Access Letter |
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Premium Assistance (PA) Qualifying Event Letter |
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MassHealth Termination Notice |
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Premium Assistance (PA) Approval Notice |
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Electronic Funds Transfer (EFT) |
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Premium Assistance (PA) Termination Notice |
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Premium Assistance (PA) Review Form |
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