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MassHealth CommonHealth Premium and Deductible

There is no income limit for CommonHealth eligibility, but if the gross countable monthly income (after any excluded income but before taxes and deductions are subtracted) for every person in the MassHealth family group is above a certain amount, you may have to pay monthly premiums. You may also have to pay a one-time only deductible.

NOTE: See below for a list of those for whom the deductible is not required.

If you enter information about your MassHealth family group income, WorkWORLD will calculate the premium and one-time deductible amounts for you (if you are otherwise eligible for MassHealth CommonHealth).

Premium Amounts

NOTE: On November 1st, 2003, the Massachusetts Department of Medical Assistance (DMA) began charging premiums to some MassHealth Standard beneficiaries. Those who are eligible because of having a disability must pay a premium of $12 per month if their family income is greater than 114% of the Federal Poverty Level (FPL). Those who are eligible because they are children (less than 19 years old) must pay a premium of $12 ($15 if there are two or more children) if their family income is greater than 133% of FPL. Those who are eligible because they are pregnant or under 6 years old do not have to pay premiums. For detailed information see M506.011 of the DMA Medicaid Manual, available online in PDF format (requires Adobe Acrobat Reader) at:
http://www.mass.gov/Eeohhs2/docs/masshealth/regs_member/regs_memb_506.pdf

The amount of the premium is based on:

·      Your monthly countable income;

·      Your family size; and

·      Whether you have other health insurance.

If you must pay a premium, the Division of Medical Assistance will tell you the amount and send you a bill every month.

One-Time Only Deductible

Certain adults with disabilities who have income too high to get MassHealth Standard must meet a one-time only deductible before getting MassHealth CommonHealth. The deductible is the amount that the countable income of a person's MassHealth family group is higher than the Division's deductible income standard for a six-month period.

NOTE: See below for a list of those for whom the deductible is not required.

Example

This example shows how the one time only deductible is computed (using 2003 Standards, believed valid through March 31, 2006).

If a family of two had a monthly income of $1400, subtract $670 and get $730. Multiply $730 by 6 months and this gives $4,380 as the deductible amount. In this example, the deductible is met when the family has medical bills that are not covered by any other health insurance that total $4,380.

Medical bills that may be used to meet a deductible include:

·      The cost of health-insurance premiums for your family over the six-month period;

·      Unpaid bills received before or during the deductible period; and

·      Bills that were paid during the deductible period.

No Deductibles are Required for:

·     Children under 19 years of age; and

·     Adults who are HIV positive and have family countable income that does not exceed 200% of the Federal Poverty Guidelines (see MassHealth Income Limits); and

·     Working adults who work at least 40 hours per month, or who have worked at least 240 hours in the previous six months.

·     Additional family members: Only one deductible is required per family.

Additional Information

A more detailed description of the MassHealth eligibility requirements, including premium schedules, can be found in the Division’s regulations at 130 CMR 501.000 through 508.000. More details about the one-time only deductible can be found at 130 CMR 506.009. The deductible regulations are available in PDF format (requires Adobe Acrobat Reader) at
http://www.mass.gov/Eeohhs2/docs/masshealth/regs_member/regs_memb_506.pdf

See Also:

MassHealth CommonHealth

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