A premium is the amount that a person may need to pay each month for their health coverage.
You may have a premium if you are receiving MassHealth Standard, CommonHealth, Family Assistance, and have income above 150% of the federal poverty level (FPL), or are a member of the Children’s Medical Security Plan (CMSP) and have income at or above 200% of the FPL. If you need to pay a premium, MassHealth will tell you the amount and send you a bill every month.
Premiums are based on family size, monthly income, and whether you have other health insurance. Your premium will not be more than 3% of your monthly household income. This limit does not apply to CommonHealth members. For more information on premium amounts, please see the MassHealth Premium Schedule for Members webpage.
If you have to pay a premium each month, MassHealth will send you a letter with the premium amount. You will also get a bill every month.
If there are other members in your family who have to pay a premium, MassHealth will review your accounts and send one bill for the whole family. MassHealth refers to this as your premium family billing group (PFBG). This means that the amount on your eligibility notice may not be the same amount as your premium bill. You are responsible for paying the amount listed on your premium bill. If you do not pay your premium payments on time, your benefits may end.
Members Who Don’t have to Pay a Premium
You won’t have to pay a premium if:
- You are American Indian or Alaska Native and are currently receiving or have ever received services at the Indian Health Service (IHS), an Indian tribe, a tribal organization, or an urban Indian organization,
- You have a MassHealth MAGI household income or MassHealth Disabled Adult household income that is at or below 150% of the federal poverty level (FPL)
- You are pregnant or have recently given birth (are in a postpartum period)
- You are a child younger than age one getting MassHealth Standard
- You are a child whose parent or guardian in the PBFG is eligible for a Qualified Health Plan (QHP) with Advance Premium Tax Credits (APTC) who has enrolled in and has begun paying for a QHP
- You are a child for whom child welfare services are made available under Part B of Title IV of the Social Security Act on the basis of being a child in foster care OR are an individual of any age receiving benefits under Part E of that title
- You are receiving hospice care
- You are a former foster care child younger than 26 years old
- You have reached your 3% premium cap in a given month and do not have to pay any more MassHealth premiums for that month.
Premium Hardship Waiver
If you have trouble paying the premium, MassHealth may be able to help. If you’re facing an undue financial hardship, we may be able to reduce your premium payment or waive it completely. Undue financial hardship means that when your premium was due or when you were trying to restart your benefits, that:
- You were homeless, owed more than 30 days in rent or mortgage payments, or you had received a current eviction or foreclosure notice
- You had a current shut-off notice, or were shut off, or had a current refusal to deliver essential utilities, like gas, electric, oil, water, or telephone
- You had medical or dental expenses totaling more than 7.5% of the family group’s gross annual income, that were not subject to payment by the Health Safety Net, and were not paid by a third-party insurance, including MassHealth. In this case “medical or dental expenses” means:
- Any outstanding medical or dental services debt that is currently owed by the family group, or
New as of July 1, 2021:
- Any medical or dental expenses paid by the family group within the twelve months before the date of application for a waiver, regardless of the date of service
- You experienced a significant, unavoidable increase in essential expenses within the last six months
New as of July 1, 2021:
- You were a CommonHealth member who accessed available third-party insurance or had no third-party insurance and…
- The total monthly premium charged for CommonHealth would cause extreme financial hardship for your family, such that the paying of premiums could make it hard to pay for housing, food, utilities, transportation, other essential expenses, or would otherwise materially interfere with MassHealth’s goal of providing affordable health insurance to a low-income person
New as of July 1, 2021
- You suffered undue financial hardship because of a state or federally declared disaster or public health emergency within the six months before you applied for a waiver or are likely to suffer in the six months after you applied for a waiver.
If you have questions about the premium hardship waiver, or would like to apply, please call the MassHealth Customer Service Center. See contact information below.
If you have questions about any letter you receive, or if you have questions about your premiums, call us at (800) 841-2900, Monday through Friday between 8:00 a.m. and 5:00 p.m. For TTY, call (800) 497-4648 during the same hours.