Public Insurance Programs
MassHealth and Medicare provide free or low-cost health insurance coverage to eligible individuals and families. The guide below provides information on the public insurance programs that are available in Massachusetts, how to determine if you are eligible, and how to apply for coverage.
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If you would like to speak with someone who can help you assess your options and walk you through the process, these organizations are ready to help!
Health Care For All
The Health Care For All Helpline offers free multi-lingual statewide assistance with enrolling in health insurance coverage. Call (800) 272-4232 or visit their website to learn more.
Navigators and Certified Application Counselors
Navigators and Certified Application Counselors (CACs) are trained individuals that can help you apply for coverage, shop for plans, and answer questions about your eligibility and payments. Help from an Enrollment Assister is free. Call 1-800-841- 2900 (TTY: 1-800-497-4648).
Serving the Health Insurance Needs of Everyone (SHINE)
SHINE offers free health insurance information and counseling to all MA residents with Medicare or who are about to become eligible for Medicare. To schedule an appointment, call MassOptions at 1-800-243-4636, or TTY/ASCll (800) 439-2370.
MassHealth offers free or low-cost coverage to eligible residents for doctor visits, prescription drugs, hospital stays, and many other important services. Eligibility for MassHealth is based on multiple factors including age, household income, and disability status.
To find out if you qualify for MassHealth, you should fill out the application linked below that matches your age group.
For individuals under age 65
and not in need of long-term care:
For individuals ages 65 and over
and/or in need of long-term care:
Once you complete an application and are approved as a MassHealth member, the next step will depend on your age and the type of MassHealth plan you have.
If you are under 65 and MassHealth is your primary coverage (you do not have another type of health insurance), you will need to select the insurance plan in which you would like to enroll. On the MassHealth website, you can compare plans and enroll in the one that best matches your needs. You can call the MassHealth Customer Service Center at 1-800-841-2900 (TTY: 1-800-497-4648) if you have questions or need help choosing a plan.
If you are an adult with a disability between the ages of 21 and 64 and have both Medicare and MassHealth, you may be eligible for One Care. With One Care, you have one plan, one card, and one person to coordinate your care. For more details on how to enroll, please visit the One Care website.
If you are an older adult, you may be eligible for Senior Care Options (SCO) and Program of All-Inclusive Care for the Elderly (PACE).
Senior Care Options (SCO) is a comprehensive health plan that offers health care services that are coordinated with social support services. Enrollment is open to MassHealth members who are 65 or older and meet specific eligibility requirements. To enroll in SCO, you must select a Senior Care Organization for your health plan. Please contact the individual Senior Care Organizations or MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648) to learn more.
The Program of All-Inclusive Care for the Elderly (PACE) is administered by MassHealth and Medicare to provide a wide range of medical, social, recreational, and wellness services to eligible individuals. The goal of PACE is to allow people to live safely in their homes instead of in a nursing home. To enroll in PACE, contact the PACE organization that serves the area where you live.
Accessing Behavioral Health Care
Once you are MassHealth member and have selected your plan, you will be able to use your plan to access behavioral health services. The INTERFACE Referral Service has a guide for families and individuals seeking mental health services. It can help you understand various aspects of mental health insurance coverage and offers ideas about how to get started, questions to ask an insurance company, and a glossary of insurance terms.
If you are a member under age 65 with MassHealth as your primary coverage, behavioral health services are covered by the Massachusetts Behavioral Health Partnership (MBHP). You can find a behavioral health provider through MBHP’s Behavioral Health Provider locator.
If you are a member enrolled in an MCO or Accountable Care Partnership Plan, the behavioral health care providers you have access to will depend on your plan. It is best to contact your plan directly for information about which behavioral health providers participate in your network. You can visit the MassHealth website and enter your zip code to find contact information of the health plans near you.
If you are a member enrolled in One Care or Senior Care Options (SCO), the behavioral health care provider network you have access to will depend on the plan you have selected. It is best to contact your plan directly for information about which behavioral health providers participate in your network. For contact information and tools to help you locate in-network providers, please click on the links below.
If you are a member enrolled in Program of All-Inclusive Care for the Elderly (PACE), you can be connected to behavioral health care through your PACE organization.
If you are not sure what type of coverage you have through MassHealth, please call MassHealth Customer service at 1-800-841-2900 (TTY: 1-800-497-4648) for guidance on how to locate the behavioral health services available to you.
Massachusetts Health Connector
The Health Connector offers health and dental coverage from the state’s leading insurers and provides tools for Massachusetts residents to determine which plans and cost savings you and your family may be eligible for.
Applications for health insurance through the Health Connector are open during a specific time during the year called the “open enrollment period.” During open enrollment people can buy a new insurance plan or change their current plan.
There are some situations, however, where you can apply for health insurance outside of the open enrollment period. If you have a qualifying life event—such as a change in your household size (like getting married, divorced, or having a child) or a change in income—you may meet the criteria for a Special Enrollment Period (SEP). A Special Enrollment Period is a time outside of the open enrollment period where you and your family have a right to sign up for health coverage through the Health Connector. Please visit the Special Enrollment Period page for more information about qualifying life events.
You can also apply for coverage at any time of the year if:
To apply or learn more about your options, visit the Getting Started Guide or contact the Massachusetts Health Connector for assistance. You can also contact Enrollment Assisters for free support in understanding the coverage options available to you. Enrollment Assisters are trained and certified to help you from application through enrollment into new health insurance plans. Click here to search for an enrollment assister near you.
Medicare is the federal health insurance program for people who are 65 or older. Certain people younger than age 65 can qualify for Medicare too, including those with disabilities and those who have End-Stage Renal Disease (permanent kidney failure requiring dialysis or kidney transplant).
The different parts of Medicare help cover specific services.
- Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility, nursing home care, hospice care, and some home health care. Most people do not pay a monthly fee (referred to as a monthly premium) for Part A if they or their spouse paid Medicare taxes for a certain amount of time while working. Visit the Medicare website for more information about Part A costs.
- Medicare Part B (Medical Insurance) covers certain doctors' services, outpatient care, medical supplies, and preventive services. Everyone pays a monthly premium for Part B, which is based on income level. Visit the Medicare website for more information about Part B costs.
- Medicare Part D (prescription drug coverage) helps cover the cost of prescription drugs. Medicare drug coverage is optional, and you must join an approved plan to receive it. Each plan varies in cost and the specific drugs that are covered. Please visit the Medicare website for more information on getting Medicare prescription drug coverage.
When you first enroll in Medicare and during certain times of the year, you can choose how to get your Medicare coverage. There are two main ways to get your Medicare coverage—Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people need to get additional coverage, like Medicare drug coverage or Medicare Supplement Insurance (Medigap). Medicare has an online tool that can help you compare your coverage options.
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). You can join a separate Medicare drug plan (Part D) if you need drug coverage. With Original Medicare, you can use any doctor or hospital in the United States that takes Medicare. Please visit the Medicare website for more information on how Original Medicare works.
Medicare Advantage (also known as Part C) is an alternative to Original Medicare that includes Part A, Part B, and usually Part D (prescription drug coverage). Most plans also offer extra benefits that Original Medicare does not cover. These plans may have lower out-of-pocket costs than Original Medicare as long as you use doctors and other providers who are in your plan’s network and service area for the lowest costs. Please visit the Medicare website to learn more about how Medicare Advantage Plans work.
Applying and Enrolling
The process for getting started with Medicare depends on your unique situation, so the best first step is to visit the Medicare website to learn about your options. If you would prefer to speak with someone to help you navigate the process, you can schedule a free appointment with a health insurance counselor through the SHINE Program at 1-800-243-4636 (TTY/ASCll: (800) 439- 2370).