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Other health insurance and MassHealth Premium Assistance

This program may help you pay for other health insurance if you qualify.

If you’re a MassHealth member who has access to other health insurance, such as through your job, you must cooperate with MassHealth to determine if you must obtain and maintain that insurance. The MassHealth Premium Assistance Program may be able to help you pay for the other health insurance, provided certain rules are met.

MassHealth and other health insurance

To get and keep your MassHealth benefits, you must cooperate with MassHealth to determine if you must obtain and maintain other insurance available to you.

You may be required to:

  • Maintain any health insurance that is available to you at no cost (including Medicare)
  • Enroll in insurance through your job, unless MassHealth determines it is not cost-effective to do so.

MassHealth Premium Assistance Program

The MassHealth Premium Assistance program is for MassHealth members who have employer-sponsored health insurance (ESI) from a job or who have access to other health insurance. If you have MassHealth and other insurance, you may be able to get help paying for your premium—the amount you pay every month. 

How can premium assistance help me?

MassHealth members with qualified ESI may be able to get help paying for the monthly premiums deducted from their pay check by their employer. MassHealth may also assist with other out-of-pocket costs such as copayments, deductibles, and coinsurance. 

  • You may have more benefits by getting insurance both through your job and through MassHealth, than just through MassHealth alone. 
  • 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 lose your MassHealth coverage, you can keep your ESI so you won’t go without health insurance. 
  • If you have MassHealth CommonHealth with a high premium, premium assistance can reduce or eliminate the cost of your CommonHealth premium if you get private insurance through your job or family.

You may qualify for premium assistance if

  • Your private health insurance coverage meets certain requirements called the Basic Benefit Level. 
  • The person who has the health insurance policy lives with the eligible MassHealth member; and 
  • At least one person covered by the health insurance is eligible for premium assistance. This is based on the eligibility of the MassHealth member.

Additional Resources

What you need to do

You must give us information about any health insurance that you or a family member already has or can get. We will use this information to decide:

  • If the services covered under your health insurance meet MassHealth’s standards
  • What we may pay toward the cost of your health insurance premium.

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 available health insurance. You must give us information we ask for. If you do not, your MassHealth benefits may end.

Additional Resources

Questions about the Premium Assistance Program?

To learn more or to apply, call the MassHealth Premium Assistance Unit at

  • (800) 862-4840
  • (TTY: 1-617-886-8102 for people who are deaf, hard of hearing, or speech disabled)

Additional Resources

Ready to apply?

Download and complete the Additional Information about Your Access to Employer Sponsored Health Insurance Coverage form and send to the Premium Assistance Unit.

MassHealth
Attn: ESI
P.O. Box 7
Quincy, MA 02171

Student Health Insurance

If you are a college student in Massachusetts and you have MassHealth, you may enroll in your school’s Student Health Insurance Plan (SHIP) through the Premium Assistance program. 

For Student Health Insurance, you must apply through your college’s online waiver and enrollment process. For questions, call Student Health Insurance Premium Assistance at 1-855-273-5903.

Additional Resources

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