How to Get MassHealth: A Step‑by‑Step Guide to Applying and Getting Covered

If you live in Massachusetts and need health insurance, MassHealth (the state’s Medicaid program and Children’s Health Insurance Program) may be an option. Many people qualify based on income, household size, age, disability status, or other factors—even if they’re working.

This guide walks you through how to get MassHealth, from checking eligibility to submitting your application and understanding what happens next.

What Is MassHealth?

MassHealth is Massachusetts’ public health coverage program. It helps eligible residents pay for a wide range of health services, such as:

• Doctor and clinic visits
• Hospital care and surgery
• Prescription drugs
• Behavioral health services
• Lab tests and X‑rays
• Some long‑term services and supports (for those who qualify)

It is run by the state and funded by both state and federal dollars. Different MassHealth coverage types exist, and the benefits you receive depend on your category and eligibility.

Step 1: Check If You Might Qualify

Before you apply, it helps to know whether you’re likely to be eligible. MassHealth generally looks at four main areas:

1. Income

MassHealth is primarily income-based, though rules vary by group.

Common groups include:

• Children and teens
• Pregnant people
• Parents and caretakers
• Adults without children
• People with disabilities
• Older adults (65+)

Your income is compared to federal poverty guidelines, adjusted by household size and category. Many people with low or moderate incomes qualify, including workers, part‑time employees, and people between jobs.

2. Household Size

Your household usually includes:

• Yourself
• Your spouse, if you’re married and living together
• Your children who live with you and (in some cases) other dependents

Household size is important because income limits change depending on how many people are in your household.

3. Residency and Immigration Status

To get MassHealth, you typically must:

• Live in Massachusetts and intend to stay
• Meet certain citizenship or immigration requirements

Some noncitizens may qualify for limited or emergency coverage. Eligibility rules in this area can be complex, so many people find it helpful to talk to an enrollment assister if they’re unsure.

4. Age, Disability, and Special Circumstances

Certain groups have additional pathways to coverage, including:

• People who are 65 and older
• People who meet the state’s disability standards
• People in long‑term care settings
• Children and adults with specific medical or support needs
• People experiencing homelessness

If you fall into any of these groups, you may be evaluated under slightly different rules or may qualify for additional benefits.

Step 2: Decide How You Want to Apply

You can apply for MassHealth in several ways. The best option depends on your situation and comfort with paperwork or online forms.

Option 1: Apply Online

Many individuals and families under 65 apply using an online application portal the state provides. This is often the fastest way to:

• Submit your information
• Upload documents
• Check your application status

Online applications can be especially convenient if your household has straightforward income and no special long‑term care needs.

Option 2: Apply by Mail or In Person

If you prefer paper:

• You can request or download a paper application
• Fill it out by hand
• Mail it to the designated MassHealth office
• Or drop it off in person at certain locations

This route is often used by:

• People more comfortable with paper forms
• Those applying with help from a community organization
• People 65 or older or applying based on disability or long‑term care needs (who often use a different application form)

Option 3: Get Help from an Enrollment Assister

Many residents get support from navigators, certified application counselors, or other enrollment assisters. These professionals can:

• Explain which application you should use
• Help you fill it out correctly
• Assist with gathering and submitting documents
• Support you if you need to file an appeal

Their help is typically free. If your situation is complex—such as mixed immigration status in your household, self‑employment income, or disability-related questions—this support can be valuable.

Step 3: Gather the Information You’ll Need

Being prepared makes the application process smoother. While exact requirements can vary, you’ll usually need information about:

Personal and Household Details

• Full names, dates of birth, and addresses for everyone applying
• Social Security numbers, if available
• Immigration documents or numbers, if relevant
• Relationship to other people in the household

Income and Employment

You may be asked for:

• Recent pay stubs or a letter from your employer
• Information on self-employment income
• Details on unemployment, Social Security, pensions, or other benefits
• Information about income you receive from other sources (such as rental income)

Other Coverage and Special Situations

You may also be asked about:

• Whether anyone has employer-sponsored insurance available
• Any private health plans or COBRA coverage
• Recent loss of coverage (for example, losing a job or aging off a parent’s plan)
• Long‑term care or nursing facility stays (if applicable)

If you don’t have every document exactly right, you can still typically submit an application. MassHealth may contact you for more information or ask you to verify certain details.

Step 4: Complete and Submit Your MassHealth Application

Once you’ve chosen how to apply and gathered your information, it’s time to fill out the application.

Tips for Filling Out the Application

• Answer every required question as accurately as you can
• Be clear about who is in your household and who is applying
• List all sources of income, even if they’re small or occasional
• Indicate whether you or anyone in your household has other health coverage

If you’re not sure how to answer something, you can:

• Leave a note in the comments section (if available)
• Contact the MassHealth customer service line
• Ask an enrollment assister for guidance

Submitting and Keeping Records

After submitting your application:

• Save copies of your forms, documents, and any confirmation numbers
• Note the date you submitted everything
• Keep an eye on mail, email, or your online account for follow-up requests

MassHealth may reach out if they need additional information to complete your eligibility review.

Step 5: What Happens After You Apply?

After you submit your application, MassHealth reviews your information to determine:

• Whether you are eligible
• What type of coverage you qualify for
• Whether any premium payments or copayments apply in your case

Possible Outcomes

Here are common outcomes and what they mean in simple terms:

You’ll generally receive a written notice explaining the decision, your coverage type, and next steps. If your coverage is approved, the notice typically includes:

• The date your coverage starts
• Which MassHealth coverage type you have
• Any member ID or information you need to share with providers

Step 6: Choosing a Health Plan (If Required)

Depending on your coverage type, you may be asked to choose a managed care plan or a specific Accountable Care Organization (ACO) network.

In that case, you’ll typically:

1. Receive an information packet listing available plans in your area
2. Compare options such as provider networks and certain plan features
3. Select a plan by phone, mail, or online within the given timeframe

If you do not choose a plan by the deadline, you may be assigned to one. You can usually request changes later during specific periods or if you have a qualifying situation.

Step 7: Using Your MassHealth Coverage

Once your MassHealth coverage is active:

• You should receive a MassHealth ID card by mail
• Present your card or member information when you see a doctor, pharmacy, or hospital
• Ask providers if they accept MassHealth or your specific MassHealth health plan

MassHealth coverage often includes:

• Primary and specialty care
• Preventive services like checkups and screenings
• Mental health and substance use services
• Some vision, dental, and transportation services (depending on your coverage type)

If you are not sure whether a service is covered, you can ask:

• Your doctor’s office
• Your plan’s member services
• The MassHealth customer service line

What If You’re Denied or Disagree with the Decision?

Sometimes people receive a notice stating they are not eligible or are only eligible for limited benefits. If you believe the decision is incorrect or do not understand it, you generally have options.

Steps You Can Take

• Read the notice carefully to understand the reason
• Check whether any information was missing or incorrect on your application
• Respond promptly if MassHealth requested additional documents
• Consider asking an enrollment assister or legal aid organization to help review your case

Many people in this situation can file an appeal within a set timeframe if they disagree. The process is outlined in the decision notice and may include instructions for requesting a hearing.

Renewing Your MassHealth Coverage

Coverage under MassHealth is not always permanent. The program usually requires redeterminations or renewals to confirm you still qualify.

When and How Renewals Happen

• You may receive a renewal form or notice by mail or through your online account
• You’ll be asked to update your information, such as income, address, or household
• You may need to provide current verification documents

To avoid gaps in coverage:

• Watch for mail with MassHealth or state health program logos
• Respond to renewal requests by the deadline
• Update your contact information if you move or change phone numbers

If your income or situation changes during the year, it is usually recommended to report it, as it may affect your eligibility or coverage type.

Special Situations: Common Questions About Getting MassHealth

Can I Have MassHealth and Other Insurance?

Some people have MassHealth as secondary coverage while they also have:

• Employer-sponsored insurance
• Medicare
• Other private plans

In these cases, MassHealth may help with certain costs not fully covered by the other plan, depending on your eligibility and coverage type.

What If I Just Lost My Job or Health Insurance?

Losing a job or other coverage is often considered a qualifying change, and many people in this situation apply for MassHealth immediately. You may need to provide:

• The date your coverage ended or will end
• Any final pay stubs or unemployment information

Applying promptly can help minimize time without coverage.

What If I’m Self‑Employed or Have Irregular Income?

Self‑employed individuals and people with gig or contract work can still qualify for MassHealth. You may be asked for:

• A reasonable estimate of your current income
• Records of business income and expenses
• Any recent tax information, if available

Because these situations can be more complex, many people find it helpful to get help from an enrollment assister.

Quick Checklist: How to Get MassHealth ✅

1. Confirm you live in Massachusetts and may qualify based on:

• Income
• Household size
• Age, disability, or special circumstances
• Citizenship or immigration status

2. Choose how you’ll apply:

• Online
• By mail or in person
• With help from an enrollment assister

3. Gather key information:

• Names, dates of birth, and Social Security numbers (if available)
• Income details and pay information
• Any current health insurance information

4. Submit your application and keep copies.

5. Watch for notices:

• Requests for more information
• Eligibility decision and coverage type
• Instructions about choosing a health plan, if required

6. Use your coverage once active, and respond to renewal notices on time.

By following these steps—checking eligibility, choosing the right application method, providing accurate information, and responding to notices—you can move through the process of getting MassHealth more confidently and with fewer surprises.