Massachusetts Health & Medicare Information

Massachusetts Health, better known as MassHealth, is the state of Massachusetts' Medicaid program. Medicaid is a federal and state funded program that provides health insurance to low-income individuals. Medicare is the federally administered health insurance program designed to give coverage to the elderly and disabled. Some elderly and disabled individuals qualify for both.

MassHealth Eligibility

• Beneficiaries must meet strict income eligibility guidelines. Under the aged, blind and disabled category, applicants must make less than 133 percent of the federal poverty guidelines. There are different federal poverty levels for those who are single and married, and these levels change annually. In 2010, those who were single could not bring in more than $1,201 monthly, and couples could not bring in more than $1,616 monthly. The first $20 of earned income each month is not counted. Income includes Social Security checks, any income from a job, alimony, child support or any money that is brought in regularly.

  MassHealth has asset limits for some populations. Assets are things like bank accounts, bonds, stocks and property. Those 65 and over may not have more then $2,000 in assets if single or $3,000 in assets if married. If under 65 and disabled, there are no asset limits.

Medicare Eligibility

• There are four ways to qualify for Medicare. First, those 65 and older are eligible. Second, those with disabilities are also eligible. Their coverage begins once they receive SSDI payments for 24 months. End-stage renal disease (ESRD) is another class that is covered under Medicare, and ESRD patients become eligible as soon as they begin receiving dialysis or once they have a kidney transplant. Finally, those diagnosed with amytrophic lateral sclerosis (ALS) are eligible as soon as they begin receiving SSDI payments.

Coverage

• Basic Medicare offers three components: Part A, Part B and Part D. Part A is inpatient, hospital coverage. Part B is outpatient, doctor coverage. Part D is a prescription drug benefit. If beneficiaries opt for traditional Medicare, they are not confined to a network.

  MassHealth, on the other hand, is limited to a network. MassHealth offers many benefits that Medicare does not, including long-term care, transportation, preventive care, dental and vision care. MassHealth will also cover prescriptions that Medicare is excluded from covering by law. These drugs include benzodiazepines, barbiturates, cold and cough drugs, drugs to treat anorexia and weight gain, vitamins and minerals and over-the-counter drugs.

Coordination

• When a beneficiary has both MassHealth and Medicare, they are known as a "dual eligible." Dual eligibles are covered primarily by Medicare. That means Medicare is billed first by doctors and hospitals, and then MassHealth picks up any extraneous charges such as co-insurances, deductibles and premiums.

Extra Help

• MassHealth enrollees are automatically qualified for Extra Help, a government program that helps out with Medicare's Part D costs. As an Extra Help enrollee, a beneficiary will never pay more than $1.10 for a generic drug or $3.30 for a brand name drug (though even this cost will typically be picked up by MassHealth if it is covered by MassHealth) and will pay no deductible or premium.