Members who do NOT have pharmacy copays

Some members do not have to pay a copay at all. You do not have to pay a MassHealth copay for any service covered by MassHealth if:

  • Your income is at or below 50% of the federal poverty level (FPL)
  • You are eligible for MassHealth because you are receiving certain public assistance benefits such as Supplemental Security Income (SSI), Transitional Aid to Families with Dependent Children (TAFDC), or services through the Emergency Aid to the Elderly, Disabled and Children (EAEDC) Program. See regulations at 130 CMR 506.015 and 130 CMR 520.037
  • You are under 21 years old
  • You are pregnant or you have recently given birth (you are in the postpartum period)
  • You are receiving benefits under MassHealth Limited (Emergency Medicaid)
  • You are a member who has MassHealth Senior Buy-In or MassHealth Standard, and you are receiving a drug that is covered under Medicare Parts A and B only, when provided by a Medicare-certified provider,
  • You are in a long-term care facility such as:
    • A nursing facility
    • Chronic-disease or rehabilitation hospital, or
    • Intermediate-care facility for individuals with intellectual disabilities or
    • You have been admitted to a hospital from such a facility or hospital
  • You are receiving hospice services
  • You were a foster care child and you are eligible for MassHealth Standard, until age 21 or 26 as described in regulations at 130 CMR 505.002(H),
  • You are American Indian or an Alaska Native and you are currently receiving or have ever received services at the Indian Health Service (IHS), an Indian tribe, a tribal organization, or an urban Indian organization, or
  • You are in another exempt category (see regulations at 130 CMR 506.015 or 130 CMR 520.037).