Can I have MassHealth and other health insurance?

On Behalf of | May 17, 2024 | MassHealth

MassHealth is a valuable program that provides low-income Massachusetts residents with health care or long-term care needs. MassHealth acts as a combination of Medicaid and the Children’s Health Insurance Program (CHIP).

Elderly Massachusetts residents can benefit from MassHealth because it provides coverage for long-term care and nursing home services. You can qualify for MassHealth even if you have other private insurance available.

When you have private insurance and MassHealth, your private insurance is called a liable third party. Your private health insurance provider is your primary provider, while MassHealth is a secondary provider.

This is the same no matter where your private health insurance comes from. It may come from an employer if you are still working, or another family member.

How primary and secondary coverage works

Being your primary provider means that your private health insurance provider pays first. MassHealth typically covers the cost of what your private health insurance provider does not pay, such as any uncovered deductibles or co-pays.

However, to make sure this happens properly, you must follow the rules and regulations of your private health insurance.

This usually requires seeing a physician or medical provider who is in your private insurance plan’s health network and accepts MassHealth. Before making any appointments with any medical providers, be sure to ask if they accept both.

If you applied for and received MassHealth before you had the option of private health insurance, obtaining the private health insurance does not mean you lose your MassHealth coverage. The cost you pay for MassHealth should not increase due to your private health insurance.

You must tell MassHealth about your private insurance

When you become eligible for private health insurance, you must report this information to MassHealth. Depending on your circumstances, MassHealth may require you to enroll in and maintain private health insurance, even if you were not planning to.

However, there are benefits to having two insurance plans. You have a more complete overall health insurance plan while keeping the same MassHealth out-of-pocket costs. When your private health insurance plan does not cover certain co-pays or deductibles, MassHealth usually covers those costs for you.

It is important to note that although you will still have MassHealth coverage, you might be disenrolled from certain plans if you obtain private health insurance. This includes plans such as a managed care organization (MCO) plan, a primary care clinician (PCC) plan or an accountable care organization (ACO) plan.

When this happens, you will receive a disenrollment notice in the mail. This can be confusing because it may appear as though you were disenrolled in MassHealth. You should not be. The only change should be how you receive your MassHealth benefits.

Although there are advantages to having MassHealth and private insurance, it can sometimes be complicated figuring out how coverage works for a specific situation. Insurance company problems are not what most people want to deal with when handling a sensitive or serious medical situation. Knowing where to turn for guidance is helpful.