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Learn About Medicaid Costs and Coverage in Massachusetts

You may be wondering, “How much is Medicaid in Massachusetts?” when evaluating your health insurance options. Medicaid cost estimates will depend greatly on your ability to stay within the covered benefits that are available with your MassHealth insurance plan. Each of the five types of Medicaid insurance will provide different benefits and services as well as different premium and copayment expectations. The question “How much does Medicaid cost through MassHealth?” is often a determining factor for many families seeking affordable health care options. Therefore, it is important to understand the Medicaid coverage and cost that each type of insurance provides before beginning the application process. In order to be better prepared for your Medicaid benefits, it is recommended that you also familiarize yourself with the medical services that are not covered as well as when coverage begins. This will ensure that you avoid any unexpected out of pocket costs. For more information on what services are covered by Medicaid, the types of insurances that are available for Medicaid and the potential costs associated with plans, you can review the sections provided below.

Learn About the Types of Medicaid Insurance in Massachusetts

Massachusetts Medicaid cost estimates will depend on what eligibility requirements you meet for each type of Medicaid insurance offered by MassHealth. In many cases, you may be eligible for Medicaid coverage from more than one MassHealth plan, so it is important to familiarize yourself with the options that are available to you and select a plan within a timely manner. These plans can affect not only your coverage and benefits, but the doctors, specialists and hospitals that you can receive medical services from and your expected premiums and copayment amounts. If you do not choose your own type of Medicaid insurance, a health plan will be chosen for you by the state of Massachusetts. The five different coverage types that are available through MassHealth and the Massachusetts Health Connector include:

  • MassHealth Standard
  • MassHealth CommonHealth
  • MassHealth CarePlus
  • MassHealth Family Assistance
  • MassHealth Limited

What services are covered by Medicaid in Massachusetts?

The types of Medicaid insurance available in Massachusetts will determine the level of Medicaid benefits and coverage that you can receive if you meet basic Medicaid eligibility requirements. Medicaid coverage for MassHealth Standard will include inpatient hospital services, family planning services, visits with a physician, laboratory and X-ray services, prescription drug coverage, behavioral health services, preventative services, long-term care and transportation services. These Medicaid coverage benefits are available to all MassHealth Standard members, but it is important to know that children who are under the age of 21 will receive additional coverage benefits such as Early and Periodic Screening, Diagnosis and Treatment (ESPDT) services. For MassHealth CommonHealth, the services covered by Medicaid include inpatient hospital services, family planning, doctors, limited dental services, limited vision care, pharmacy services and prescriptions, behavioral health care, well-child screening, transportation services, quit smoking services and long-term care services. The type of Medicaid coverage offered by CommonHealth is for adults and/or children with disabilities who may not be eligible for MassHealth Standard plans.

MassHealth CarePlus has similar Medicaid coverage, but it only available to individuals who are between the ages of 21 and 64 and not eligible to receive MassHealth Standard. Individuals who receive coverage from Medicaid through the MassHealth CarePlus may be eligible for additional benefits if considered “medically frail.” You may be considered medically frail if you have a condition that limits your ability to work, have an addiction, need assistance with daily activities or if you are terminally ill. MassHealth Family Assistance provides coverage for Medicaid for anyone who is not qualified for MassHealth Standard options. This type of Medicaid coverage provides slightly less services than the Standard plan.

Lastly, MassHealth Limited has limited services covered by Medicaid and will only include emergency services such as inpatient hospital emergency services, visits to the emergency room, pharmacy services when used to treat an emergency medical condition and ambulance transportation services in the case of an emergency. The services provided by Medicaid with the MassHealth Limited plan is only for immigrants with a citizenship status that currently disqualifies them from other plans.

It is crucial that you select the type of Medicaid insurance that is right for you based on the Medicaid coverage that you require and the costs that you are expecting to pay. As mentioned previously, the state of Massachusetts will chose your health plan if you do not. A health plan can only be selected or changed in the initial days of approval to MassHealth or during your Medicaid renewal process. To learn more about Medicaid coverage, download our national Medicaid guide today.

When does Medicaid coverage begin in Massachusetts?

Since Massachusetts Medicaid cost estimates depend on the coverage benefits that you receive, it is important to also know when your health insurance will likely begin. Generally, you will receive Medicaid coverage during the same month that you were approved for Medicaid benefits, generally 10 days before your application was received. In some cases, you may be eligible to receive certain Medicaid benefits up to three months prior to the completion of the application process, so long as you were eligible for coverage during that time period.

What does Medicaid not cover in Massachusetts?

In order to fully understand how much Medicaid costs in Massachusetts, it is recommended that you familiarize yourself with the medical services and procedures that are not covered by Medicaid in Massachusetts. Medicaid coverage may not extended to:

  • Cosmetic surgeries and procedures
  • Personal care services
  • Day habilitation services
  • Private duty nursing services
  • Long-term nursing facility services

Depending on the type of Medicaid insurance plan you get, coverage can vary. Additionally, some medical procedures may require that your physician seek prior authorization before performing a procedure, unless in the case of a medical emergency. It is recommended that you wait for this authorization as failing to do so could result in out of pocket costs. This would only serve to raise the Medicaid cost estimates that you can expect to see.

How much does Medicaid cost in Massachusetts?

When considering, “How much is Medicaid in Massachusetts?” it is important to know that you may need to pay a copayment for some medical services. Medicaid cost estimates will depend upon the type of Medicaid insurance that you receive as some of these health plans will include monthly premiums. Copayment expectations will fluctuate from one type of health plan to the next. Additionally, some types of Medicaid insurance, such as MassHealth CommonHealth, include a onetime deductible that must be met before Medicaid will provide coverage and benefits. Many Medicaid costs depend on your household income, so costs are not standard. For more information concerning Medicaid cost estimates and the services covered by Medicaid, consider downloading our free guide.