MassHealth requires members to enroll in health insurance they have access to that’s at no cost to them, including Medicare. This is because MassHealth is the payer of last resort and pays for health care and related services only when no other source of payment is available, except when required by federal law.
Qualified Medicare Beneficiaries (QMB) are eligible for Medicare at no cost to them. To ensure that MassHealth is the payor of last resort, MassHealth will require QMB-eligible members age 65 and older to take action to apply for Medicare. If, after 60 days, a member does not take action to apply for Medicare, they may lose their MassHealth benefits. Members who are not eligible for Medicare and provide proof of Medicare denial will not lose their MassHealth.
Medicare is a federal health insurance program for those age 65 and older, as well as those under age 65 with certain disabilities or health conditions. People may be automatically enrolled in Medicare if they already receive Social Security or Railroad Retirement benefits before age 65. Others must apply through the Social Security Administration (SSA).
Persons age 65 and older qualifies for Medicare, if they:
Receive or qualifies for Social Security retirement benefits or Railroad Retirement benefits, or
Currently lives in the United States and are either a U.S. citizen or permanent resident who has lived in the U.S. continuously for 5 years before applying.
MassHealth will begin to outreach Qualified Medicare Beneficiary (QMB) members starting in July. MassHealth members will receive a notice in a yellow envelope from the UMass Medicare Outreach and Enrollment Project team, explaining that they may be eligible for Medicare and that they are required to make an appointment to apply for Medicare within 60 days. The UMass team will offer to call SSA on behalf of the member to set up an appointment and answer any questions they may have about the letter. Members who have received a letter in a yellow envelope and need more information can call the team at 877-935-1280, TTD/TTY 711.
Note, the UMass team can only help members who have received an outreach letter in a yellow envelope. They can’t help with Medicare enrollment for members who did not receive an outreach letter in a yellow envelope. Members who did not receive an outreach letter in a yellow envelope should call the Social Security Administration to apply for Medicare.
Members who are eligible for Medicare, but who fail to apply for Medicare within 60 days of receiving a letter in a yellow envelope from the Medicare Outreach and Enrollment Project team may risk losing their MassHealth. However, the member may be able to regain their MassHealth benefit without a new application if they call the Medicare Outreach and Enrollment team and schedule an appointment with the SSA to apply for Medicare
You can read more about Enrolling Qualified Medicare Beneficiary (QMB) Members in Medicare at MassHealth’s Eligibility Operations Memo 25-10.