It is important to know the difference between MassHealth Standard and MassHealth CommonHealth because the eligibility requirements and benefits of each program are different. MassHealth Standard primarily serves low-income individuals who may not be able to afford private health insurance, while MassHealth CommonHealth serves individuals with disabilities or medical conditions who may have higher income or assets and may not qualify for other MassHealth programs.
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What is MassHealth Standard?
Masshealth Standard is the Medicaid for residents in Massachusetts.
MassHealth Standard is a state-run health insurance program in Massachusetts that provides free or low-cost healthcare coverage to eligible low-income residents of the state. The program is intended to provide comprehensive coverage for medical services, including doctor visits, hospital care, prescription drugs, and mental health services, among others.
To be eligible for MassHealth Standard, you must be a resident of the state of Massachusetts and meet certain income and asset limitations. Eligibility is based on family size and income, and varies depending on individual circumstances. You can apply for MassHealth coverage online, by mail, or in person at a local MassHealth enrollment center.
Once enrolled in MassHealth Standard, you will be assigned a primary care provider (PCP) or you can choose your own PCP. You will also receive a MassHealth card that you can use to access medical services covered by the program. MassHealth Standard offers no-cost coverage for eligible individuals, while others may have to pay a small premium based on their income level.
MassHealth Standard does have some limitations, including restrictions on certain services and providers, and prior authorization requirements for some medical services. However, the program aims to provide comprehensive healthcare coverage to eligible residents of Massachusetts who may not be able to afford private health insurance.
If you are a resident of Massachusetts and believe you may be eligible for MassHealth Standard, it’s recommended to contact MassHealth or a licensed insurance agent for guidance on how to enroll and determine your eligibility.
Masshealth Commonhealth
Masshealth Commonhealth is a last resort payer.
Who is it for?
MassHealth CommonHealth is a state-run program in Massachusetts that provides healthcare coverage for eligible individuals with disabilities who may not qualify for other MassHealth programs due to higher income or assets. CommonHealth is intended to provide comprehensive health coverage that includes doctor visits, hospital care, prescription drugs, and mental health services, among others.
Eligibility for CommonHealth is based on meeting specific income and asset limitations and having a qualifying disability or medical condition. The program serves individuals who have disabilities or medical conditions, such as epilepsy, HIV or AIDS, chronic mental illness, physical disabilities, among others. Eligible individuals may be enrolled in CommonHealth for free or may be required to pay a premium based on their income level.
How does the plan work?
Once enrolled in CommonHealth, members will be assigned a primary care provider (PCP) and will receive a CommonHealth card that can be used to access covered medical services.
CommonHealth provides coverage for services not covered by other MassHealth programs, such as long-term care services and durable medical equipment.
CommonHealth does have certain limitations, including restrictions on certain medical services, payment requirements for some services, and potentially lengthy wait times for some services.
If you are a Massachusetts resident with a disability or medical condition and believe you may be eligible for CommonHealth, it’s recommended to contact MassHealth or a licensed insurance agent for guidance on how to enroll and determine your eligibility.
MassHealth CommonHealth is a MassHealth program available to individuals with disabilities who
are not eligible for MassHealth Standard.Unlike MassHealth Standard, MassHealth CommonHealth participants are not subject to income or asset limitations.
MassHealth CommonHealth is an option for people with disabilities who have income that exceeds 133% of the federal poverty level (FPL). It allows individuals with disabilities to purchase health coverage
through a sliding-scale monthly premium that is based on total household income. – https://abh.memberclicks.net/assets/docs/BHCA/FactSheets/08-06MassHealth-CommonHealth%20copy%202.pdf
For people who have private insurance coverage through their employer, MassHealth CommonHealth will pay for any medically necessary Medicaid-covered services that the employer health plan does not cover, including co-pays, co-insurance and deductibles, as long as the provider accepts MassHealth.
Eligibility for Seniors
This letter is from the Director of Eligibility Policy. It states that seniors who are enrolled in this plan, may choose to state if they have been on the plan for at least ten years.
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