Third-Party Liability
MassHealth is the payer of last resort and is therefore secondary or tertiary coverage for members with third-party liability (TPL). Note: Casualty payers are not considered health insurance; however, casualty payers (accident and/or workers’ compensation) must be billed before MassHealth when applicable.
Commercial Insurance
MassHealth members can have both MassHealth and private health insurance at the same time. Private health insurance could be from employment, a family member, or a parent with or without custody. The non-MassHealth insurance is the primary insurance. This is sometimes referred to as commercial insurance or employer-sponsored insurance.
Medicare as Primary Insurance
Some MassHealth members have MassHealth and Medicare at the same time. MassHealth considers Medicare the primary insurance. This means Medicare is billed as the primary insurer and MassHealth is the secondary coverage. Note: This does not apply to members who have Medicare/MassHealth and participate in integrated care plans such as One Care and Senior Care Options.
Updating a Member’s Third-Party Insurance Information
When a provider has evidence that a MassHealth member’s TPL health insurance information differs from what appears in the Eligibility Verification System record, the provider must tell the MassHealth TPL Unit about the changes. To ensure that the member’s file is updated to reflect current information, providers should submit the TPL Indicator Form with acceptable documentation to the TPL Unit.
| Date published: | August 21, 2026 |
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