How do I apply for MassHealth Premium Assistance?

By Cathy Hickey, Project Coordinator – Mass Family Voices (FCSN)

It seems like a simple question but for many Massachusetts families it is quite complex. Mass Family Voices hopes to help you get started!

What is Premium Assistance?
Premium Assistance is when MassHealth pays part of your private health insurance premium. This could mean a reduced MassHealth premium, no MassHealth premium, or a monthly payment from the state to help defray the cost of your primary insurance. Your result depends on the amount of your MassHealth premium. Premium Assistance payments are available to those eligible for coverage types including MassHealth’s Standard, CommonHealth CarePlus coverage plans, and Kaileigh Mulligan.

Premium Assistance is also available to some adults with private health insurance through their employers. Families with children younger than 19 whose household Modified Adjusted Gross Income is between 150% and 300% of the Federal Poverty Level are eligible through either the Family Assistance program or the MassHealth Small Business Employee Premium Assistance Program.

MassHealth may provide a Premium Assistance payment to an eligible member meeting the following criteria:

• The health insurance coverage meets the Basic Benefit Level (BBL)
• The health insurance policy holder lives with a person eligible for Premium Assistance benefit
• At least one person covered by the health insurance is eligible for MassHealth benefits and the health-insurance policy meets the criteria of MassHealth coverage for Premium Assistance benefits

Eligibility is determined by the coverage type and the type of private health insurance the person has or has access to. There are two types of health insurance that are eligible for Premium Assistance: Employer-Sponsored Insurance 50% Plans and Other Group Insurance Plans.
For Other Group Insurance Plans where the employer contributes less than 50% of the monthly premium, COBRA, and other group health insurance, MassHealth will provide Premium Assistance to enroll in plans purchased directly for children under 21. All plans must meet a Basic Benefit Level. In addition, MassHealth may provide Premium Assistance for individuals with unsubsidized insurance.

It cannot be stressed enough that after submitting quote/insurance information to Premium Assistance, it is a good idea to follow-up with a phone call to confirm that it was received and that they have everything they need.

When you find out you are eligible, MassHealth Premium Assistance will then submit payments directly to the HealthConnector or to the applicant’s insurance company.

MassHealth Premium Assistance contacts are:
Lekecia Powell-Watkins at 617-886-8263/ or
Samantha Laskey at 617-886-8058/
Faxes can be sent to their attention at 617-886-8400.

It is very important to note that while Health Connector Plans are available for children under 21, families who are in Standard or CommonHealth and are seeking coverage for services not covered by MassHealth, such as ABA services, are not eligible.

MassHealth will not pay premium assistance for a Health Connector Plan if the child has access to the needed services through an Employer Sponsored Insurance, even if outside the open enrollment period for that plan.

Any questions about the process for enrolling children in a Health Connector Plan can be answered by calling 1-877-MA-ENROLL (877-623-6765). Be sure to let the customer service representative know that you are only interested in purchasing an unsubsidized Connector Plan for your child.