Can You Get More Medicare Benefits in Massachusetts?
If you have Medicare in Massachusetts, you may be able to get more help than you realize. You may qualify for programs that help pay Medicare costs, lower prescription drug costs, and add benefits such as dental, vision, hearing, transportation, care coordination, and support services based on certain eligibility criteria.
The challenge is knowing which program applies to you. Some programs provide broader MassHealth benefits, while others mainly help with Medicare premiums, deductibles, copays, coinsurance, or prescription drug costs.
This guide walks you through a few simple questions that include your age, household size, monthly income, and, for some programs, countable assets. Based on your answers, you can identify which benefit options you may be eligible for.
This guide is for people who already have Medicare. If you are turning 65 soon or not yet enrolled, start by learning when to enroll in Medicare and whether you need Part A, Part B, and drug coverage.
NEW TO MEDICARE?
Start with this guideYour age and household size determine which income limits and benefit options apply to you.
If you are under 65, this guide assumes you already have Medicare because of disability. Different rules may apply if you have Medicare under 65 for another reason, such as ESRD or ALS.
Income Limits
Your monthly income is one of the important factors that determines whether you may qualify for additional Medicare benefits in Massachusetts.
For this screening, income means your estimated current monthly household income before deductions, including gross Social Security, pensions, wages, retirement withdrawals, and other regular income you receive.
For Social Security, use the gross monthly benefit amount shown on your current Social Security benefit letter, not the amount deposited into your bank account after Medicare Part B or other deductions.
Following are some common income sources:
- Social Security benefits
- SSI benefits
- Railroad Retirement benefits
- Veterans or VA benefits
- Pension or retirement income (employer pension, union pension, government pension, military pension, or annuity payments)
- Rental income (rent received after allowable property expenses)
- Retirement account withdrawals
- Wages from work (gross pay before taxes and deductions)
- Self-employment income (income after ordinary business expenses, based on current records)
- Unemployment, workers’ compensation, or disability payments
- Interest, dividends, trust payments, royalties, or other regular income
MassHealth uses countable income, not always gross income. Certain deductions may apply, so someone slightly over the monthly number should still check eligibility.
Asset Limits
MassHealth counts assets you own and can use to pay for your needs. It does not count basic personal items and certain protected assets.
| Assets That Count | Assets That Do Not Count |
|---|---|
| Cash | Primary residence |
| Checking and savings accounts, CDs | One vehicle for personal use |
| Stocks, bonds, and mutual funds | Personal belongings and household goods |
| IRAs and accessible retirement funds | Term life insurance with no cash value |
| Cash value of life insurance policies | Certain prepaid burial arrangements |
| Additional real estate | Burial plots |
For people 65 and older, regular MassHealth Standard has a countable asset limit.
What If Your Assets Are Over the Limit?
If your countable assets are over the limit, you must reduce them before MassHealth Standard eligibility starts. This is often called an asset spend-down.
Common examples include paying medical bills, buying needed personal items, paying down debt, or setting aside allowed burial funds.
Do not give away money or property without guidance, because transfer rules can delay eligibility.
Income Limits
Your monthly income is one of the important factors that determines whether you may qualify for additional Medicare benefits in Massachusetts, including help for people under 65 who have Medicare because of disability.
For this screening, income means your estimated current monthly household income before deductions, including gross Social Security, pensions, wages, retirement withdrawals, and other regular income you receive.
Following are some common income sources:
- Social Security benefits, including Social Security Disability Insurance (SSDI), retirement, survivor, or spousal benefits
- SSI benefits
- Railroad Retirement benefits
- Veterans or VA benefits
- Pension or retirement income (employer pension, union pension, government pension, military pension, or annuity payments)
- Rental income (rent received after allowable property expenses)
- Retirement account withdrawals
- Wages from work (gross pay before taxes and deductions)
- Self-employment income (income after ordinary business expenses, based on current records)
- Unemployment, workers’ compensation, or disability payments
- Interest, dividends, trust payments, royalties, or other regular income
For Social Security, use the gross monthly benefit amount shown on your current Social Security benefit letter, not the amount deposited into your bank account after Medicare Part B or other deductions.
MassHealth Standard — Under 65
Based on your answers, you may qualify for additional Medicare benefits from MassHealth that:
- Pay your Medicare Part B premium
- Pay your Medicare deductibles, copays, and coinsurance
- Automatically qualify you for Extra Help with Medicare Part D prescription drug costs
- Cover dental care, including exams, cleanings, fillings, extractions, and dentures
- Cover vision and hearing services, including eyeglasses and hearing aids when approved
- Provide non-emergency transportation to eligible medical appointments
- Cover certain home and community-based services, personal care, adult day health, and nursing facility care when program rules are met
- Give you access to One Care, an integrated Medicare and MassHealth plan for eligible adults ages 21 to 64, if One Care rules are met
These benefits are available through MassHealth Standard, Massachusetts’ full Medicaid coverage type. For eligible adults under 65 who have Medicare because of disability, MassHealth Standard works with Medicare to reduce costs and add covered services that Medicare does not fully provide.
CommonHealth-QMB — Under 65
Based on your answers, you may qualify for additional Medicare benefits from MassHealth that:
- Pay your Medicare Part B premium
- Pay your Medicare deductibles, copays, and coinsurance
- Automatically qualify you for Extra Help with Medicare Part D prescription drug costs
- Cover dental care, including exams, cleanings, fillings, extractions, and dentures
- Cover vision and hearing services, including eyeglasses and hearing aids when approved
- Provide non-emergency transportation to eligible medical appointments
- Cover certain home and community-based services, personal care, adult day health, and nursing facility care when program rules are met
- Give you access to One Care, an integrated Medicare and MassHealth plan for eligible adults ages 21 to 64, if One Care rules are met
These benefits are available through MassHealth CommonHealth, a MassHealth coverage type for certain people with disabilities whose income is too high for MassHealth Standard, and a Medicare Savings Program called QMB, administered by MassHealth in Massachusetts.
Within this income range, a monthly CommonHealth premium applies only if your income is above 150% FPL.
CommonHealth-SLMB/QI — Under 65
Based on your answers, you may qualify for additional Medicare benefits from MassHealth that:
- Pay your Medicare Part B premium
- Automatically qualify you for Extra Help with Medicare Part D prescription drug costs
- Cover dental care, including exams, cleanings, fillings, extractions, and dentures
- Cover vision and hearing services, including eyeglasses and hearing aids when approved
- Provide non-emergency transportation to eligible medical appointments
- Cover certain home and community-based services, personal care, adult day health, and nursing facility care when program rules are met
- Give you access to One Care, an integrated Medicare and MassHealth plan for eligible adults ages 21 to 64, if One Care rules are met
These benefits are available through MassHealth CommonHealth, a MassHealth coverage type for certain people with disabilities, and a Medicare Savings Program called SLMB/QI, administered by MassHealth in Massachusetts.
A monthly CommonHealth premium applies because your income is above 150% FPL.
CommonHealth-Over 225% FPL — Under 65
Based on your answers, you may qualify for additional Medicare benefits from MassHealth that:
- Cover dental care, including exams, cleanings, fillings, extractions, and dentures
- Cover vision and hearing services, including eyeglasses and hearing aids when approved
- Provide non-emergency transportation to eligible medical appointments
- Cover certain home and community-based services, personal care, adult day health, and nursing facility care when program rules are met
- Give you access to One Care, an integrated Medicare and MassHealth plan for eligible adults ages 21 to 64, if One Care rules are met
These benefits are available through MassHealth CommonHealth, a MassHealth coverage type for certain people with disabilities.
A monthly CommonHealth premium applies because your income is above 150% FPL.
MassHealth Standard — Age 65+
Based on your answers, you may qualify for additional Medicare benefits from MassHealth that:
- Pay your Medicare Part B premium
- Pay your Medicare deductibles, copays, and coinsurance
- Automatically qualify you for Extra Help with Medicare Part D prescription drug costs
- Cover dental care, including exams, cleanings, fillings, extractions, and dentures
- Cover vision and hearing services, including eyeglasses and hearing aids when approved
- Provide non-emergency transportation to eligible medical appointments
- Cover certain home and community-based services, personal care, adult day health, and nursing facility care when program rules are met
- Give you access to Senior Care Options (SCO), an integrated Medicare and MassHealth plan for eligible adults age 65 and over, if SCO rules are met
These benefits are available through MassHealth Standard, Massachusetts’ full Medicaid coverage type. For eligible adults age 65 and over who have Medicare and limited income, MassHealth Standard works with Medicare to reduce costs and add covered services that Medicare does not fully provide.
MSP-QMB
Based on your answers, you may qualify for additional Medicare benefits that:
- Pay your Medicare Part B premium
- Pay your Medicare deductibles, copays, and coinsurance
- Automatically qualify you for Extra Help with Medicare Part D prescription drug costs. Extra Help provides $0 Part D plan premium and $0 Part D deductible when the person is enrolled in a qualifying Medicare drug plan. It also lowers your prescription drug costs.
- Reduce your covered Part D drug costs to $0 for the rest of the year once your total drug costs reach the annual Part D out-of-pocket limit.
- Protect you from being billed for most Medicare-covered cost-sharing amounts.
These benefits are available through a Medicare Savings Program called QMB (formerly called MassHealth Senior Buy-In), which is administered by MassHealth in Massachusetts.
QMB stands for Qualified Medicare Beneficiary. It is designed for Medicare members with limited income and can be one of the most valuable forms of help because it may reduce both your monthly Medicare costs and your out-of-pocket costs when you receive Medicare-covered care.
MSP-SLMB/QI
Based on your answers, you may qualify for additional Medicare benefits that:
- Pay your Medicare Part B premium
- Automatically qualify you for Extra Help with Medicare Part D prescription drug costs. Extra Help provides $0 Part D plan premium and $0 Part D deductible when enrolled in a qualifying Medicare drug plan. It also lowers your prescription drug costs.
- Reduce your covered Part D drug costs to $0 for the rest of the year once your total drug costs reach the annual Part D out-of-pocket limit.
These benefits are available through Medicare Savings Programs called SLMB/QI (formerly called MassHealth Buy-In) administered by MassHealth in Massachusetts. SLMB/QI stands for Specified Low-Income Medicare Beneficiary/Qualifying Individual.
No Benefits-Over 225% FPL — Age 65+
Based on your answers, you are not likely to qualify for the extra Medicare benefits covered in this guide. This does not mean there are no options available. It means your income appears to be above the regular screening range for these specific programs.
How to Apply for MassHealth Standard
To apply for MassHealth Standard, start with the Massachusetts application for health and dental coverage for people under 65.
Apply online through MA Login, the secure online account used for MassHealth and Health Connector applications. The online application is available at mahealthconnector.org.
For help applying, call MassHealth Customer Service at 1-800-841-2900, TDD/TTY: 711. MassHealth can provide help with the application, interpreter services, and application materials in other languages.
For people under 65, applying online is the fastest way to apply.
Before You Apply, Gather:
- Social Security number, if you have one.
- Proof of Massachusetts residency, such as a lease, rent receipt, utility bill, mortgage statement, deed, etc. showing your Massachusetts address.
- Proof of income, such as pay stubs, a Social Security benefit letter, pension statement, unemployment statement, workers’ compensation statement, VA benefit letter, tax return, W-2, 1099, rental income records, or self-employment records.
- Medicare and health insurance information, such as your red, white, and blue Medicare card, Medicare Advantage or Part D card, employer coverage card, or other insurance card.
- Proof of citizenship, national status, or immigration status, such as a U.S. passport, birth certificate, naturalization certificate, permanent resident card, employment authorization card, or other immigration document, if requested.
- Disability information, such as a Social Security disability award letter, Medicare award letter, medical records, provider information, or an Adult Disability Supplement if MassHealth needs to make a disability decision.
MassHealth may not ask for every document from every applicant, but these are the types of documents commonly used to verify eligibility.
Application Submission
Submit the MassHealth/Health Connector application in one of these ways:
| Method | Where to Submit |
|---|---|
| Online | mahealthconnector.org |
| Health Insurance Processing Center, P.O. Box 4405, Taunton, MA 02780 | |
| Fax | 857-323-8300 |
| Phone | 1-877-MA-ENROLL (1-877-623-6765), TTY: 711 |
How to Apply for CommonHealth
To apply for MassHealth CommonHealth, start with the Massachusetts application for health and dental coverage for people under 65.
Apply online through MA Login, the secure online account used for MassHealth and Health Connector applications. The online application is available at mahealthconnector.org.
For help applying, call MassHealth Customer Service at 1-800-841-2900, TDD/TTY: 711. MassHealth can provide help with the application, interpreter services, and application materials in other languages.
Before You Apply, Gather:
- Social Security number, if you have one.
- Proof of Massachusetts residency, such as a lease, rent receipt, utility bill, mortgage statement, deed, etc. showing your Massachusetts address.
- Proof of income, such as pay stubs, a Social Security benefit letter, pension statement, unemployment statement, workers’ compensation statement, VA benefit letter, tax return, W-2, 1099, rental income records, or self-employment records.
- Medicare and health insurance information, such as your red, white, and blue Medicare card, Medicare Advantage or Part D card, employer coverage card, or other insurance card.
- Proof of citizenship, national status, or immigration status, such as a U.S. passport, birth certificate, naturalization certificate, permanent resident card, employment authorization card, or other immigration document, if requested.
- Disability information, such as a Social Security disability award letter, Medicare award letter, medical records, provider information, or an Adult Disability Supplement if MassHealth needs to make a disability decision.
MassHealth may not ask for every document from every applicant, but these are the types of documents commonly used to verify eligibility.
If MassHealth needs to confirm disability, you may also need to submit the Adult Disability Supplement.
Application Submission
Submit the MassHealth/Health Connector application in one of these ways:
| Method | Where to Submit |
|---|---|
| Online | mahealthconnector.org |
| Health Insurance Processing Center, P.O. Box 4405, Taunton, MA 02780 | |
| Fax | 857-323-8300 |
| Phone | 1-877-MA-ENROLL (1-877-623-6765), TTY: 711 |
How to Apply for MassHealth Standard
To apply for MassHealth Standard, use the Application for Health Coverage for Seniors and People Needing Long-Term-Care Services, also called SACA-2.
You can submit the completed SACA-2 application by mail, fax, or in person.
Before applying or asking for help, gather the documents that show your Medicare status, income, assets when relevant, residency, and current coverage. Having these ready can reduce delays.
| Category | What to Have Ready |
|---|---|
| Medicare | Medicare card showing Part A and Part B effective dates. |
| Current coverage | Cards or letters for Medigap, employer coverage, retiree coverage, VA coverage, or other insurance. |
| Income | Social Security benefit letter, pension statement, pay stubs, annuity statement, VA benefit letter, unemployment statement, rental income record, or recent tax return. |
| Bank accounts | Recent checking, savings, money market, and certificate of deposit statements when assets are relevant. |
| Retirement and investments | Recent IRA, 401(k), 403(b), pension, brokerage, stock, bond, mutual fund, and annuity statements when assets are relevant. |
| Life insurance | Policy pages or statements showing owner, insured person, face amount, and cash value when assets are relevant. |
| Massachusetts residency | Lease, mortgage statement, utility bill, property tax bill, facility letter, or other proof of Massachusetts residence. |
| Citizenship or legal status | U.S. passport, birth certificate, naturalization certificate, Permanent Resident Card, employment authorization card, or other immigration documents. |
| Authorized representative | Power of attorney, guardianship document, health care proxy, or authorized representative form if someone is helping with the application. |
Application Submission
Submit the SACA-2 application in one of these ways:
| Method | Where to Submit |
|---|---|
| MassHealth Enrollment Center, P.O. Box 290794, Charlestown, MA 02129-0214 | |
| Fax | 617-887-8799 |
| Phone help | MassHealth Customer Service: 800-841-2900, TTY: 711 |
How to Apply for a Medicare Savings Program
To apply for a Medicare Savings Program, use the Medicare Savings Programs Application from MassHealth.
Before You Apply, Gather:
- Medicare card
- Social Security number
- Proof of Massachusetts residency (Lease, mortgage statement, utility bill, property tax bill, facility letter, or other proof of Massachusetts residence)
- Proof of income, such as Social Security benefit letter, pension statement, VA benefit letter, pay stubs, or tax documents
Application Submission
Submit the Medicare Savings Program application in one of these ways:
| Method | Where to Submit |
|---|---|
| MassHealth Enrollment Center, P.O. Box 4405, Taunton, MA 02780 | |
| Fax | 857-323-8300 |
| Phone help | MassHealth Customer Service: 1-800-841-2900, TDD/TTY: 711 |
Need Help Applying?
Hesteon Solutions can help you complete and submit the Medicare Savings Program application to MassHealth. We can review the information needed, help gather the right documents, and submit the application on your behalf with your permission.
Common Mistakes
Assuming all MassHealth coverage types are the same
MassHealth Standard, CommonHealth, Medicare Savings Programs, and Extra Help do not provide the same benefits or plan options. Always confirm the exact coverage type.
Choosing a plan without checking doctors, prescriptions, and pharmacies
Before enrolling in SCO or One Care, confirm that your doctors, specialists, hospital, medications, and pharmacy work with the plan.
Confusing MSP with full MassHealth Standard
A Medicare Savings Program can help with Medicare costs, but it is not the same as full MassHealth Standard coverage.
Forgetting that the stand-alone option needs Part D
If you keep Original Medicare and MassHealth Standard separate, you still need a Part D plan for prescription drug coverage.
Ignoring letters from MassHealth, Medicare, Social Security, or your plan
These letters can include renewal requests, eligibility changes, plan changes, deadlines, or enrollment notices.
Assuming long-term care uses the same rules
Nursing-facility care, home care, waiver programs, and other long-term-care situations may follow different MassHealth eligibility and application rules than this regular screening guide.
How Hesteon Solutions Can Help You
At Hesteon Solutions, we help Medicare beneficiaries make informed decisions about their coverage. Our licensed agents work with you to review your current benefits, assess your healthcare and prescription needs, and explain the plan options available in your area.
We provide clear, straightforward guidance so you can feel confident your Medicare coverage fits your needs and budget. Whether you are new to Medicare or considering a change, we are here to make the process easier.
Call us today to schedule your free consultation.
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