Is the MassHealth standard considered Medicaid?

MassHealth Standard provides full, comprehensive health benefits, while MassHealth Family Assistance provides coverage for specific groups who do not qualify for Standard, often focusing on children or certain immigrant populations with a wider range of rules regarding premiums and other insurance.

MassHealth Standard

• Coverage Level: Offers the most complete, full healthcare benefits available.
• Included Services: Covers inpatient and outpatient care, medical and pharmacy services, mental health care, long-term care, and non-emergency transportation.
• Audience: Available to qualifying low-income children, parents, pregnant individuals, disabled adults, and seniors who meet specific federal and state criteria.
• Costs: Generally has little to no cost or premiums for those who qualify under standard income thresholds.

MassHealth Family Assistance

• Coverage Level: Offers essential health benefits for eligible Massachusetts residents who do not qualify for MassHealth Standard.
• Included Services: Helps pay for doctor visits, hospital stays, prescriptions, and some dental/vision care, but historically has more restrictions on long-term services and supports compared to Standard.
• Audience: Often serves specific children, young adults, or certain immigrants (such as lawfully present or PRUCOL individuals) who do not meet federal Medicaid rules.
• Costs: May require copayments for visits or prescriptions, and higher-income households might have to pay a monthly premium or enroll in employer-sponsored insurance with MassHealth helping pay the premium (Premium Assistance).

You can find your specific MassHealth plan by logging into your account on the MyServices Portal or by calling MassHealth Customer Service at (800) 841-2900.

How to Check Your Plan

• Online: Log in to your MyServices account to view your active coverage type, health plan, and primary care provider.
• By Phone: Call MassHealth Customer Service at (800) 841-2900 (TTY: 711) available Monday through Friday from 8:00 AM to 5:00 PM.
• Check Your Mail: Look at your most recent approval notice, renewal paperwork, or your MassHealth member ID card, which often lists your coverage type (such as Standard, CommonHealth, or Care Plus) and managed care plan.

An income above 138% of the federal poverty level—roughly $20,783 per year for a single adult or $42,831 for a family of four—is typically too high for standard expansion Medicaid, though exact limits vary significantly by state.

General Income Limits

• Expansion Adults: In states that expanded Medicaid, the general limit is 138% of the Federal Poverty Level (FPL) (including a 5% disregard). For an individual, this is about $20,783 a year ($1,732 a month); for a family of three, it is around $37,682 a year.
• Non-Expansion States: Limits for adults without children or specific qualifying conditions are much lower, often well under 100% of the FPL.
• Long-Term Care: For nursing homes or in-home care programs, the 2026 cap in many states is $2,982 per month ($35,784 per year) for an individual, though excess income can sometimes be funneled into a special trust.

Key Factors That Change the Limit

• Your state: Every state sets its own rules and operational guidelines.
• Household size: More family members raise the allowable income ceiling.
• Category: Pregnant women, children, seniors (65+), and individuals with disabilities often qualify at much higher income percentages than nondisabled working adults.

If your income is slightly over the limit, you may still qualify through programs like a medical "spend-down" or by checking options on the HealthCare.gov Marketplace for tax credits.

To check what kind of Medicaid you have, log into your state's online Medicaid client portal or call your state's Medicaid agency. Because Medicaid is run by individual states, your specific plan details, coverage type (such as managed care vs. fee-for-service), and program name are tied to your state's records.

Ways to Check Your Medicaid Type

• Check Your Insurance Cards: Look at your physical or digital insurance cards. You will usually have a state-issued Medicaid ID card, and if you are enrolled in a managed care program, you will also have a separate card from your specific health plan (such as Molina, Anthem, UnitedHealthcare, etc.) listing your exact program.
• Use Your State’s Online Portal: Go to your state's official health or human services website (find your state via Medicaid.gov State Resources). Log into your member account to view your active benefits, program name, and assigned managed care plan.
• Review Approval Letters: Check the most recent eligibility or placement letters sent to you by mail or electronic inbox from your state's Department of Health or Social Services.
• Call Customer Service: Call the toll-free member helpline listed on the back of your Medicaid card or found on your state's official Medicaid website.
• Ask Your Doctor: A healthcare provider or pharmacist can look up your active coverage and specific managed care program using your Medicaid ID number.

Having both Medicare and Medicaid is called being dual eligible.

How Dual Eligibility Works

• Dual-eligible beneficiaries qualify for both federal Medicare and joint state-federal Medicaid.
• Medicare acts as the primary payer for most health care services.
• Medicaid acts as the secondary payer. It covers costs that Medicare does not pay, such as premiums, deductibles, copays, and long-term care.
• Dual Eligible Special Needs Plans (D-SNPs) are specific Medicare Advantage plans that combine both types of coverage into one single plan. You can learn more about these options directly from the official Medicare Special Needs Plans Guide.