| Program Type | MassHealth is a state-funded Medicaid program that provides free or low-cost healthcare coverage to eligible low-income individuals and families. | The Health Connector is Massachusetts' state-based health insurance marketplace, facilitating the purchase of private health insurance plans for individuals and families, as well as the distribution of federal subsidies. |
| Eligibility | Eligibility for MassHealth is primarily based on income, household size, and other factors, and it serves a wide range of low-income individuals, including children, adults, pregnant women, and individuals with disabilities. | The Health Connector offers private health insurance plans for individuals and families who do not qualify for MassHealth and are not offered employer-sponsored insurance. Eligibility criteria may vary based on plan types and income levels. |
| Coverage Options | MassHealth provides comprehensive coverage, including doctor visits, hospital stays, prescription drugs, preventive care, and other essential healthcare services. | The Health Connector offers a variety of private health insurance plans with varying coverage levels, including different tiers (Bronze, Silver, Gold, Platinum), and plan types (HMOs, PPOs, etc.), allowing individuals to choose plans that best suit their needs. |
| Application Process | Eligible individuals apply directly to MassHealth through the state's online application portal, in-person assistance, or by phone. | Eligible individuals apply for private health insurance plans offered through the Health Connector using the online marketplace, in-person assistance, or by phone. |
| Subsidies and Financial Assistance | MassHealth provides free or heavily subsidized coverage to eligible individuals and families based on income and other factors. | The Health Connector administers federal premium subsidies (Advanced Premium Tax Credits) and cost-sharing reductions (if eligible) to make private health insurance plans more affordable for those who qualify. |
| Provider Networks | MassHealth has a network of healthcare providers that accept Medicaid patients, including doctors, hospitals, clinics, and specialists. | Private health insurance plans offered through the Health Connector have their own networks of healthcare providers, and individuals can choose plans with networks that align with their preferred providers. |
| Medicaid Expansion | MassHealth expanded its eligibility criteria under the Affordable Care Act (ACA) to cover more low-income individuals and families, including those with income above traditional Medicaid limits. | The Health Connector facilitates the enrollment of eligible individuals in private plans, including those who may have gained eligibility through Medicaid expansion. |
| Plan Selection and Enrollment | Individuals who qualify for MassHealth are automatically enrolled in the program or can select from available MassHealth plans. | Individuals shopping for private insurance plans through the Health Connector can compare and choose plans based on their preferences, needs, and financial situation. |
| State Regulation | MassHealth is administered by the Massachusetts Executive Office of Health and Human Services (EOHHS) and is subject to state regulations and guidelines. | The Health Connector is a state agency established under Massachusetts law to implement and oversee the state's health insurance marketplace, aligning with federal regulations under the ACA. |
| Cost-Sharing and Premiums | MassHealth typically has minimal or no premiums, and cost-sharing (such as copayments) is generally very low for eligible individuals. | Costs for private insurance plans through the Health Connector vary based on plan selection, income, and subsidies. Premiums, deductibles, and cost-sharing can be higher than MassHealth but are offset by subsidies for eligible individuals. |
