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Applications to become a MassHealth member

Get the applications you need to become a new MassHealth member, including applications for seniors and long-term-care.

Find out more about applying to MassHealth, the Health Safety Net, or the Children's Medical Security Plan and for seniors or those who need long-term-care. If you need help applying for MassHealth, you can find assistance in your area. 

If you are already a MassHealth member, or are looking to renew or report changes in your information, you do not need use these applications. 

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Massachusetts Application for Health and Dental Coverage and Help Paying Costs [ACA-3 (08/23)]

Open PDF file, 1.2 MB,  Massachusetts Application for Health and Dental Coverage and Help Paying Costs (English, PDF 1.2 MB)
Open DOCX file, 103.73 KB,  Massachusetts Application for Health and Dental Coverage and Help Paying Costs (English, DOCX 103.73 KB)
Open PDF file, 813.71 KB,  Massachusetts Application for Health and Dental Coverage and Help Paying Costs (English Large Print) (English, PDF 813.71 KB)

Massachusetts Application for Health and Dental Coverage and Help Paying Costs—Additional Persons [ACA-3-AP (08/23)]

Open PDF file, 246.38 KB,  Massachusetts Application for Health and Dental Coverage and Help Paying Costs—Additional Persons (English, PDF 246.38 KB)
Open DOCX file, 33.62 KB,  Massachusetts Application for Health and Dental Coverage and Help Paying Costs—Additional Persons (English, DOCX 33.62 KB)
Open PDF file, 114 KB,  Massachusetts Application for Health and Dental Coverage and Help Paying Costs—Additional Persons (Large Print) (English, PDF 114 KB)

Application for Health Coverage for Seniors and People Needing Long-Term-Care Services [SACA-2 (08/23)]

Open PDF file, 1.86 MB,  Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (English, PDF 1.86 MB)
Open DOCX file, 123.15 KB,  Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (English, DOCX 123.15 KB)
Open PDF file, 607.81 KB,  Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (Large Print) (English, PDF 607.81 KB)
Open PDF file, 1.58 MB,  Renewal Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (English, PDF 1.58 MB)
Open DOCX file, 120.29 KB,  Renewal Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (English, DOCX 120.29 KB)

Medicare Savings Programs Application

Open PDF file, 324.77 KB,  Medicare Savings Programs Application (English, PDF 324.77 KB)
Open DOCX file, 62.77 KB,  Medicare Savings Programs Application (English, DOCX 62.77 KB)
Open PDF file, 218.4 KB,  Medicare Savings Programs Application (Large Print) (English, PDF 218.4 KB)
Open PDF file, 341.57 KB,  Medicare Savings Programs Renewal Application (English, PDF 341.57 KB)
Open DOCX file, 60.22 KB,  Medicare Savings Programs Renewal Application (English, DOCX 60.22 KB)
Open PDF file, 186.49 KB,  Medicare Savings Programs Renewal Application (Large Print) (English, PDF 186.49 KB)

Application for Waiver or Reduction of MassHealth Premium [HW (Rev. 06/22)]

Open PDF file, 170.99 KB,  Application for Waiver or Reduction of MassHealth Premium – English/Spanish (English, PDF 170.99 KB)
Open DOCX file, 23.81 KB,  Application for Waiver or Reduction of MassHealth Premium – English/Spanish (English, DOCX 23.81 KB)

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