Premium Schedule
Premium Billing Family Groups (PBFG)
Premium formula calculations for MassHealth and Children's Medical Security Plan (CMSP) premiums are based on the Premium Billing Family Group (PBFG). A premium billing family group consists of
- an individual,
- a couple—two people who are married to each other under Massachusetts law,
OR
- a family—a family is defined as people who live together and includes:
- a child or children younger than 19 years old, any of their children, and their parents;
- siblings younger than 19 years old and any of their children who live together even if no adult parent or caretaker relative is living in the home; or
- a child or children younger than 19 years of age, any of their children, and their caretaker relative when no parent is living in the home.
A child who is absent from the home to attend school is considered as living in the home. A parent may be a natural, step, or adoptive parent. Two parents are members of the same premium billing family group if they are both mutually responsible for one or more children who live with them.
Calculating Premiums
Children younger than 19 years old with household income at or below 300% of the Federal Poverty Level (FPL) will have their MassHealth premium amount set using the lowest percentage of the FPL of all the children in the Premium Billing Family Group (PBFG). If any child in the PBFG has a percentage of the FPL at or below 150% of the FPL, premiums for all children younger than 19 years old in the PBFG will be waived.
MassHealth and Children's Medical Security Plan (CMSP) premiums for children younger than 19 with household income greater than 300% of the FPL, and all premiums for young adults and adults, are calculated using the individual’s FPL.
When the PBFG contains members responsible for a premium in more than one coverage type or program, including CMSP, the PBFG is only responsible for the higher premium amount.
When the PBFG includes a parent or caretaker relative who is paying a premium and getting a ConnectorCare plan and Advance Premium Tax Credits, the premiums for children in the PBFG will be waived once the parent or caretaker relative has enrolled in and begun paying for the ConnectorCare plan.
Premium Formulas
To determine the monthly premium, MassHealth uses age, income, and if the member has other health insurance.
The full premium is charged to members who have no private health insurance, or to members who have health insurance where MassHealth pays a portion of their health insurance premium through the premium assistance program.
A lower supplemental premium is charged to members who do have private health insurance but are not eligible for or do not apply for premium assistance.
Learn more about why you may need to pay a premium for your MassHealth coverage.
Premium Formula for MassHealth Standard Members with Breast and Cervical Cancer
Premium Formula for MassHealth Standard Members who have Breast and Cervical Cancer
| % of Federal Poverty Level (FPL) | Monthly Premium Cost |
|---|---|
| Above 150% to 160% | $16.50 |
| Above 160% to 170% | $22 |
| Above 170% to 180% | $27.50 |
| Above 180% to 190% | $33 |
| Above 190% to 200% | $38.50 |
| Above 200% to 210% | $44 |
| Above 210% to 220% | $52.80 |
| Above 220% to 230% | $61.60 |
| Above 230% to 240% | $70.40 |
| Above 240% to 250% | $79.20 |
MassHealth CommonHealth Premium Formulas
CommonHealth members who are eligible for a premium assistance payment that is less than the full CommonHealth premium will have their monthly premium bill lowered by the amount of their premium assistance payment and will be responsible for the difference.
CommonHealth Full Premium Formula Children between 150% and 300%
| % of Federal Poverty Level (FPL) | Monthly Premium Cost |
|---|---|
| Above 150% to 200% | $13.20 per child ($39.60 PBFG maximum) |
| Above 200% to 250% | $22 per child ($66 PBFG maximum) |
| Above 250% to 300% | $30.80 per child ($92.40 PBFG maximum) |
CommonHealth Full Premium Formula Young Adults and Adults
Above 150% of the FPL and Children above 300% of the FPL
| Base Premium | Additional Premium Cost | Range of Monthly Premium Cost |
|---|---|---|
| Above 150% FPL– start $16.50 | Add $5.50 for each additional 10% FPL until 200% FPL | $16.50 - $38.50 |
| Above 200% FPL – start $44 | Add $8.80 for each additional 10% FPL until 300% FPL | $44 - $123.20 |
| Above 300% - start at $132.00 | Add $8.80 for each additional 10% FPL until 400% FPL | $132.00 to $211.20 |
| Above 400% FPL – start at $220 | Add $11 for each additional 10% FPL until 600% | $220-$429 |
| Above 600% FPL – start at $440 | Add $13.20 for each additional 10% FPL until 800% FPL | $440 - $690.80 |
| Above 800% FPL – start at $704 | Add $15.40 for each additional 10% FPL until 1,000% FPL | $704-$996.60 |
| 1,000% FPL – start at $1012 | Add $17.60 for each additional 10% FPL | $1012 + greater |
CommonHealth Supplemental Premium Formula
A lower supplemental premium is charged to members who do have private health insurance but are not eligible for or do not apply for premium assistance.
| % of Federal Poverty Level (FPL) | Monthly Premium Cost |
|---|---|
| Above 150% to 200% | 60% of full premium |
| Above 200% to 400% | 65% of full premium |
| Above 400% to 600% | 70% of full premium |
| Above 600% to 800% | 75% of full premium |
| Above 800% to 1,000% | 80% of full premium |
| Above 1,000% | 85% of full premium |
MassHealth Family Assistance Premium Formulas
Family Assistance for Children Premium Formula
| % of Federal Poverty Level (FPL) | Monthly Premium Cost |
|---|---|
| Above 150% to 200% | $13.20 per child ($39.60 PBFG maximum) |
| Above 250% to 300% | $22.00 per child ($66 PBFG maximum) |
| Above 250% to 300% | $30.80 per child ($92.40 PBFG maximum) |
Premium Formula for Family Assistance Adult members age 21-64 who are HIV+
| % of Federal Poverty Level (FPL) | Monthly Premium Cost |
|---|---|
| Above 150% to 160% | $16.50 |
| Above 160% to 170% | $22 |
| Above 170% to 180% | $27.50 |
| Above 180% to 190% | $33 |
| Above 190% to 200% | $38.50 |
Family Assistance for HIV+ Adults Premium Formula Supplemental Premium Formula
A lower supplemental premium is charged to members who do have private health insurance but are not eligible for or do not apply for premium assistance.
| % of Federal Poverty Level (FPL) | Monthly Premium Cost |
|---|---|
| Above 150% to 200% | 60% of full premium |
Premium Formula for Family Assistance Adult Members 21-64 who are Nonqualified PRUCOL (NQP)
| % of Federal Poverty Level (FPL) | Monthly Premium Cost |
|---|---|
| Above 150% to 200% | $44 |
| Above 200% to 250% | $85.80 |
| Above 250% to 300% | $129.80 |
Children’s Medical Security Plan (CMSP) Premium Formula
CMSP Premium Schedule
| % of Federal Poverty Level (FPL) | Monthly Premium Cost |
|---|---|
| Above 300% to 400% | $36.45 per PBFG per month |
| Above 400% | $70.40 per child per month |
| Last updated: | December 9, 2025 |
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