Massachusetts Medicaid, or MassHealth, is a health insurance program that assists its citizens in obtaining free or affordable health insurance.
As of 2025, the income ceiling will be pegged to the new Federal Poverty Level (FPL), and children and pregnant women will have wider access.
There are also other pathways to elders and people with disabilities that are based on different income and asset requirements.
Key Takeaways
- Growing adults are eligible up to 138% FPL.
- Higher thresholds are set for pregnant women and children.
- Elderly citizens and individuals with disabilities can receive income and asset tests.
- There is an application made via the Massachusetts Health Connector.
MassHealth in Context
Massachusetts has been a health reformer long before. The state already had close to universal coverage by the previous reforms before the Affordable Care Act.
MassHealth is one of the most extensive Medicaid systems in the country nowadays serving over 2 million citizens.
MassHealth has a major characteristic of being integrated with a marketplace, the Health Connector, which is run by the state.
Citizens submit a single application, and the system will identify them as either eligible to receive MassHealth, ConnectorCare coverage subsidies (ConnectorCare), or full-priced coverage.
This will make continuous coverage easier for the families experiencing varying incomes.
The other characteristic of MassHealth is the long-term services and supports (LTSS). Palliative and disabled citizens may be eligible to receive a program to assist them in covering the cost of nursing homes, home-based services, or community-based services.
These tracks do not only look at income but also take into account assets that further complicate the eligibility levels, but make sure that those who require the support are given the chance.
Household Income (2025) Limits
| Household Size | 100% FPL (Annual) | 138% FPL (Adults) | 200%+ (Kids/Pregnancy) |
| 1 person | $15,650 | $21,597 | ~$31,300+ |
| 2 people | $21,150 | $29,187 | ~$42,300+ |
| 3 people | $26,650 | $36,777 | ~$53,300+ |
| 4 people | $32,150 | $44,367 | ~$64,300+ |
Source: MassHealth 2025 Income Standards
Explanation: One grown-up can qualify with a low income of less than $21,600. Four-member family may be eligible in case their income is less than $44,400. Children and pregnant women are usually eligible at much higher levels, thus ensuring coverage of the mother and child.
Who is Eligible to receive MassHealth?
- Adults 19-64: Under Medicaid expansion covered to 138% FPL (KFF Expansion Map).
- Children: Included at higher levels, usually 200% FPL or higher. Massachusetts has almost universal pediatric coverage.
- Pregnant Women: Greater income limits are in place, and 12 months of postpartum care are covered.
- Elderly and Disabled People: There are income and asset requirements to access long-term services and support.
If you want to know how to apply to MassHealth in 2025.
- Go to the Massachusetts Health Connector.
- Check your eligibility online.
- Submit documents:
- Documentation of earnings (pay stubs, tax return, or W-2)
- Evidence of Massachusetts residence (state ID, lease, or bill)
- Social security numbers of the entire family.
- Immigration papers, where suitable.
- Choose a scheme or be allocated on the basis of eligibility.
- Rebate coverage every year with updated information on incomes and households.
Otherwise, You Do Not Qualify.
Alternatives if You Don’t Qualify
- CHIP (Children’s Health Insurance Program): This is an affordable coverage offered to children who are beyond Medicaid.
- ConnectorCare Plans: Marketplace coverage of individuals and families who are not covered by the Medicaid limits, but are subsidized.
- Community Health Centers: Provide care on the sliding scale at a low cost.
- Medically Needy Pathways: Gives the residents with high medical bills to get a temporary qualification by subsidizing income.
FAQs
Q1: What will be the income cap of adults under MassHealth in 2025?
Adults are eligible for 138 percent FPL, or approximately 21,600 a year on one adult.
Q2: Are there higher levels of eligibility for pregnant women?
Yes. Expectant mothers are eligible at increased levels, which in most cases are 200% FPL, and are provided with 12 months postpartum cover.
Q3: Do we have any long-term care services in MassHealth?
Yes. The elderly or disabled people can be eligible for nursing home or home and community-based services.
Q4: Does it matter that the parents are not eligible?
Yes. There is a high pediatric coverage rate, as children are covered at very high income levels.
Q5: What are the eligibility criteria for seniors to MassHealth?
They have to satisfy income and asset requirements and affordances on the part of spouses when one of them requires attention.
Q6: What do I do to apply to MassHealth?
Use the Massachusetts Health Connector, and you are directed to the appropriate program depending on your household income.
Conclusion
MassHealth leads the way in health coverage in Massachusetts. The adults are eligible to reach the 138% FPL, whereas children and pregnant women are eligible for higher amounts. Special programs with income and asset requirements are also available to seniors and disabled residents.
You can apply through the Massachusetts Health Connector in case you feel that you qualify. Even so, the ConnectorCare plans and CHIP are good substitutes to make coverage affordable.
