Health Insurance in Massachusetts: Frequently Asked Questions
Health Insurance is complicated. The answers on this tip sheet will help youget started understanding the best coverage for your child/youth with special health care needs.
Are Massachusetts residents required to have health insurance?
Yes. Massachusetts Law requires that most residents over 18 who can afford health insurance have
coverage or pay a penalty through their tax returns.
Information about the MA health insurance mandate:
https://www.mahealthconnector.org/wp-content/uploads/Individual-Mandate-Consumer-Guide.pdf
Where do Massachusetts residents get health insurance?
Most Massachusetts residents (individuals and their families) get their health insurance through: an
employer, a government program (Mass Health), or the Massachusetts marketplace (Health Connector,
https://www.mahealthconnector.org/).
Does health insurance in Massachusetts need to meet certain requirements?
Yes. Mass residents must be enrolled in health insurance plans that meet Minimum Creditable Coverage
(MCC) requirements. Information about minimal credible coverage:
https://www.mass.gov/info-details/health-care-reform-for-individuals#minimum-creditable-coverage-
(mcc)-
How do I know what services my employer health insurance covers for my child with special health
needs?
Contact your health plan if you have questions about your child’s coverage.
Will my employer health insurance cover behavioral health services for my child?
Behavioral Health Services may be covered by your employer insurance. Check with your plan for
confirmation. For more information about coverage of these services:
https://www.childrensmentalhealthcampaign.org/direct-services/
What if I cannot afford the deductible or copays for healthcare services my child needs or those services are not covered by my employer/private insurance?
MassHealth CommonHealth is a supplemental insurance from MassHealth available to children with
qualifying disabilities. CommonHealth will pay for copays and deductibles that are not covered by your
private insurance. CommonHealth will pay for services that are not covered by your private policy such as
behavioral health services. CommonHealth has a sliding scale premium.
What if I cannot afford CommonHealth Premiums?
The MassHealth Premium Assistance program reimburses eligible MassHealth members for some or all
their insurance premium cost. Children on CommonHealth may be eligible for Premium Assistance. For
information about Premium Assistance:
https://www.mass.gov/info-details/masshealth-premium-assistance-pa
Where do I go to apply for Mass Health?
Here is the website to apply for Mass Health: https://www.mass.gov/how-to/apply-for-masshealth-thehealth-safety-net-or-the-childrens-medical-security-plan
Will I need to choose a specific plan with Mass Health Standard?
Yes. You will need to the choose the best plan in Mass Health Standard for your child and family. For more information: https://www.mass.gov/masshealth-plans-and-enrollment-guide
What if my family does not qualify for MassHealth Standard and we do not have employer/private
insurance?
An individual or household can apply for insurance through the Health Connector. The Massachusetts
Health Connector is the state’s marketplace for health and dental insurance. For information on the health
connector: https://www.mahealthconnector.org/ .
For additional questions with Health Insurance and Mass Health, please contact:
The Federation for Children with Special Needs
Phone: (617) 236-7210, (800) 331-0688 (in MA)
Email: fcsninfo@fcsn.org
Online Intake form: https://fcsn.org/fcsn-intake-form/
Funding provided by the U.S. Department of Health & Human Services, Health Resources & Services Administration, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Grant #H84MC08005 to Massachusetts Family Voices @ the Federation for Children with Special Needs.