Access to Health Insurance and Benefits

Health insurance provides coverage for medical and other health care services. MassHealth is a public health insurance option available to eligible individuals. MassHealth covers medical services as well as long-term services and support.

MassHealth

Massachusetts Medicaid (MassHealth) pays for health care for certain low and medium income people living in Massachusetts.  MassHealth offers health-care benefits directly or by paying part or all of your health-insurance premiums.  MassHealth is available to Massachusetts residents that meet eligibility requirements based on income, disability, or health condition status. MassHealth provides access to integrated care services that promote health, well-being, independence, and quality of life.  Please see MassHealth website to apply today.

There are six MassHealth coverage types offered to eligible individuals, families, and people with disabilities: Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, and Limited.  Learn more about MassHealth Coverage Types.

Eligibility requirements for MassHealth Standard are expanded by offering coverage to children through the age of 18 and increasing the financial eligibility standards for pregnant women and newborns to 200% FPL and for children, aged one through 18, to 150% FPL, and parents and disabled adults to 133%FPL.  Financial guidelines are updated on a yearly basis.

My Ombudsman 

My Ombudsman is an independent program for MassHealth members who are enrolled in MassHealth managed and integrated care plans. My Ombudsman can help enrolled members understand the benefits and services offered through their MassHealth health plan; answer member questions or address concerns; help to mediate or otherwise find resolutions for members who are having difficulty accessing their benefits; and help explain member rights, including the right to appeal or file a grievance. Many My Ombudsman staff also have lived experience with disability and personal experience being enrolled in a MassHealth health plan. You can contact My Ombudsman directly via phone at 855.781.9898; Videophone (VP) at 339-224-6831; email at: info@myombudsman.org; or visit their website at for more information at: https://myombudsman.org/

Medicare

Medicare is a federal program that provides health insurance coverage for adults 65 or older, younger people with a disabilities and  people with end stage renal disease. Medicare.gov is a US Government website that can provide you with more information about Medicare. It tells you how to enroll, choose a health plan, and manage your benefits.

Prescription Advantage

Prescription Advantage provides prescription drug coverage for Massachusetts residents age 65 and older, as well as younger people with disabilities who meet income and employment guidelines.

<SHINE (Serving the Health Insurance Needs of Everyone)

SHINE (Serving the Health Insurance Needs of Everyone) is a program that provides free insurance counseling to Massachusetts Medicare beneficiaries and caregivers. More information on the program is available at the SHINE website. 

Other Insurance

The Massachusetts Health Connector

The Massachusetts Health Connector is the state’s health insurance marketplace. You can shop for health insurance online and apply for insurance subsidies on the Massachusetts Health Connector website.

1-877-MA-ENROLL (1-877-623-6765), or TTY 1-877-623-7773 for persons with a hearing or speech disability.

ICO Plan

Integrated Care Options (ICO) is a comprehensive health plan that covers services normally paid for through Medicare and MassHealth.  It is also referred to as One Care.  It combines health services with social support services by coordinating care and specialized support services.  There are no copays for enrolled members enrolled.

PACE

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 participants. The goal of PACE is to allow participants to live safely in their homes instead of in nursing homes.

SCO Plan

Senior Care Options (SCO) is a comprehensive health plan that covers all of the services normally paid for through Medicare and MassHealth. This plan provides services to members through a senior care organization and its network of providers. It combines health services with social support services by coordinating care and specialized geriatric support services, along with respite care for families and caregivers. SCO offers an important advantage for eligible members over traditional fee-for-service care. There are no copays for enrolled members enrolled.