Costs and Coverage of Medicaid in Massachusetts

How much does Medicaid cost in Massachusetts? With one of the most extensive Medicaid coverage programs of any U.S. state, the Massachusetts Department of Health and Human Services offers several types of Medicaid insurance plans to its qualified residents. Medicaid cost estimates depend on what is covered by Medicaid and what is not, and differs between each state-sponsored health care plan offered. How much is Medicaid if services are not covered?

Learn more about Massachusetts Medicaid coverage and costs via the following topics:

  • Types of Medicaid Insurance in Massachusetts

  • What services are covered by Medicaid in Massachusetts?

  • What does Medicaid not cover in Massachusetts?

Types of Medicaid Insurance in Massachusetts

Under MassHealth Medicaid coverage, there are various types of Medicaid insurance plans offered to qualified beneficiaries. Each MA Medicaid coverage plan services different patient groups. It is important to review the types of Medicaid insurance in order to select the proper policy when accepted into the MassHealth program. Medicaid types of insurance in MA include the following:

MassHealth Standard – This Medicaid coverage plan offers full-scale Medicaid services. There are many beneficiaries who can elect for MassHealth Standard, including: pregnant women, young adults 19 or 20 years of age, patients younger than 19, parents and relative caretakers, disabled individuals, former foster care children under 26, patients with breast cancer or cervical cancer and HIV-positive patients.

MassHealth CommonHealth – Medicaid services through MassHealth CommonHealth are meant for disabled children and adults who need government-sponsored medical assistance. The following beneficiaries can choose to join this type of Medicaid plan: disabled children under 19, disabled young adults between 19 and 20 years old and disabled adults under 65 who work 40 hours monthly or more.

MassHealth CarePlus – This Medicaid insurance plans is limited to adults. The MassHealth CarePlus plan services adults 21 to 64 years of age and those who cannot qualify into MassHealth Standard.

MassHealth Family Assistance – This MA Medicaid coverage plan is for children younger than 19, young adults ages 19 and 20, adults, HIV-positive patients, disabled adults and adults eligible for Emergency Aid to the Elderly, Disabled and Children (EAEDC). The above parties can elect for MassHealth Family Assistance if they do not qualify for MassHealth Standard.

MassHealth Small Business Employee Premium Assistance – Uninsured adults who meet all Medicaid coverage requirements and work for small businesses can select this health coverage plan. Note that beneficiaries of this policy must be exempt from tax credits through the private marketplace in order to join this health policy through the state.

MassHealth Limited – This emergency-based Medicaid coverage in Massachusetts supplies assistance to immigrants who do not qualify for standard Medicaid in MA, and thus need additional Medicaid services. Children’s Medical Security Plan (CSMP) – This MA Medicaid coverage plan provides primary and preventive care for children and teenagers who do not otherwise have medical insurance. Those who can enroll in CSMP must be uninsured patients under 19 years old who are not eligible for any other MassHealth plan. However, those that are eligible for MassHealth Limited can still receive medical assistance through CSMP.

What services are covered by Medicaid in Massachusetts?

What is covered by Medicaid in Massachusetts may not be covered by a government-sponsored health care in, say, Vermont. Although Massachusetts Medicaid coverage offers several different medical assistance plans, many of the Medicaid services covered overlap from policy to policy.

To better visualize the Medicaid services offered by the majority of MassHealth policies, review the below list:

  • Inpatient hospital services

  • Outpatient services

  • Labs and X-rays

  • Medical supplies and equipment

  • Behavior health and mental health (including substance use disorder) services

  • Well-child screenings

  • Long-term care services

  • Transportation and ambulance services

  • Services to aid with quitting smoking

  • Dental services

Since MassHealth Limited is only meant for medical emergencies, the Medicaid services covered vary considerably from all other MassHealth benefits. Those covered under MassHealth include: inpatient hospital emergencies (including labor and delivery), outpatient hospital emergency services as well as emergency room visits, limited services provided by clinics and doctors outside of a hospital setting, emergency pharmacy services and ambulance transportation for medical emergencies.

In addition, Children’s Medical Security plan coverage only allows for limited Medicaid services. This Medicaid plan for younger patients includes: eye exam and hearing tests, outpatient services (including preventive and sick care), outpatient surgeries and anesthesia deemed medically necessary to treat hernias and ear tubes, outpatient mental health services along with substance use disorder treatments totaling no more than 20 visits annually and prescription drug expenses totaling no more than $200 per year, durable medical equipment no more than $200 a year and dental services up to $750 annually.

What does Medicaid not cover in Massachusetts?

What is not covered by Medicaid, and how much is Medicaid under those circumstances? Even though MA Medicaid coverage offers comprehensive medical services, there is still a list of services noted as what is not covered by Medicaid. The Medicaid cost estimates vary depending on the service, in terms of cost to the patient.

The following medical services are not covered under MassHealth:

  • Long-term nursing facility services

  • Private duty nursing services

  • Day habilitation services

  • Personal care services

How much does Medicaid cost when services are not fully covered? Depending on the types of Medicaid insurance offered, there may be limited coverage for certain Medicaid services. Under these circumstances patients may be responsible for partial payments in the forms of co-pays for services. If a service is entirely uncovered by MassHealth, beneficiaries should prepare to pay from out of their own pockets. Review all Medicaid types of insurance to see if the beneficiary is responsible for any monthly premiums, as well as partial payments once a limit is reached. For example, if a patient is allotted up to a certain expense in medical supplies or medication and goes over the limit, he or she should prepare accordingly to pay the excess costs. Note that the costs vary depending on each patient’s own medical and financial situations.



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