The Difference Between MassHealth & Commonwealth Care

According to Massachusetts law, all residents must have health insurance coverage or be subject to fines. As of 2010, 98 percent of residents have some sort of health-care coverage Many residents receive help purchasing insurance from either MassHealth or Commonwealth Care, government-funded programs designed to assist low- and middle-incomes residents get the health care they need.

MassHealth is Massachusetts' Medicaid program and provides free or low-cost health care to low- or middle-income Massachusetts residents. MassHealth also manages the Insurance Partnership, which helps small businesses provide low-cost health insurance to their employees; the Children's Medical Security Plan, which provides access to health-care services for all uninsured children in Massachusetts, regardless of family income; the Healthy Start program to provide prenatal care for low-income women; and the Special Kids/Special Care program for children in foster care who have special needs. MassHealth also has a program for HIV-positive residents.

MassHealth is available to households that fall below the federal poverty guidelines and meet certain other criteria. In general, you are eligible to receive MassHealth benefits if you are low-income and disabled, under age 65 and have breast or cervical cancer, HIV-positive or pregnant. Low-income families with children under age 19 living in the home, or those under age 19 living on their own, are also eligible. Certain residents who have been unemployed for more than a year may also qualify for MassHealth.

Low and middle-income Massachusetts adults who do not meet the qualifications for MassHealth benefits, but do not have health insurance, can purchase coverage through Commonwealth Care. Five managed-care insurance companies participate in the Commonwealth Care plan, and residents receive free or low-cost care through these plans that are subsidized by the government. There are three types of plans available, based on income, as of 2010. Plan 1, for households with an income equal to or less than 100 percent of the federal poverty level, does not require premiums or co-pays. Plan 2, for households with incomes between 150 and 200 percent of federal poverty level, are plans that charge monthly premiums and co-payments based on income. There are some Plan 2 options that are free. Plan 3 is for households with incomes between 200 and 300 percent of the federal poverty guidelines, and charge premiums and co-payments according to income and household size. Plans vary throughout the state.

To be eligible for Commonwealth Care, you must be over age 19, a U.S. citizen or eligible noncitizen, and a resident of Massachusetts. You must be uninsured or paying full premium costs through COBRA or in a waiting period for coverage, and your employer must not have offered subsidized group health insurance within the past six months. Your household income must be below 300 percent of the federal poverty guidelines for your family size; a family of four, as of 2010, must earn less than $66,156 per year to qualify.