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Boston Health Safety Net 2026–27: Who Qualifies Up to 300% FPL, How the Deductible Works, Secondary Coverage and the 30-Day Review

Writer: FSR Editorial Team
FSR Editorial Team
11 minutes ago
5 min read

Massachusetts doesn't leave hospital charity care entirely to each hospital. It runs a statewide pool, the Health Safety Net (HSN), that pays Massachusetts acute care hospitals and community health centers for care given to low-income uninsured and underinsured residents.

For Boston patients, that means one application covers HSN at Boston's hospitals and health centers. The rules are the same everywhere. But there are a few traps: HSN isn't insurance, it doesn't cover most separately billed doctors, and you may have to track your own deductible.



What HSN Is, and Isn't

According to Mass.gov:

  • HSN pays for some health services at acute care hospitals and community health centers for certain low-income, uninsured and underinsured patients.

  • It is not insurance, and it can't be used at tax time to show you had coverage.

  • There's no member card. Keep the eligibility letters you receive. They usually include an ID number that providers can use.



Who Qualifies

Mass.gov lists the required steps:

  1. Complete the application for financial assistance. This is the same Massachusetts application used for MassHealth and Health Connector programs (the ACA-1 booklet).

  2. Have a Modified Adjusted Gross Income (MAGI) at or below 300% of the federal poverty level.

  3. Be a Massachusetts resident.

  4. Provide proof of identity.

Income bands:

Household income (% of FPL)

HSN status

Deductible?

0% to 150%

HSN

No deductible

Above 150% to 300%

HSN Partial

Annual deductible

Approximate dollar levels, using the 2026 HHS poverty guidelines (MassHealth applies its own income standards, so treat these as estimates):

Household size

150% FPL

300% FPL

1

$23,940

$47,880

2

$32,460

$64,920

3

$40,980

$81,960

4

$49,500

$99,000

Income verification is mandatory under 101 CMR 613.04. MassHealth may verify income through electronic data matches with federal and state sources. If the match doesn't confirm your income, you'll be asked for paper proof.

Affordable insurance rule: if insurance is considered affordable for you under the state's individual mandate rules, you aren't eligible for HSN Primary, the version for the uninsured. If your employer offers coverage, you can get HSN Primary only during the employer's waiting period.



HSN as a Secondary Payer (If You Have Insurance)

HSN can act as a secondary payer if you're enrolled in private insurance, student health insurance, Medicare, certain MassHealth programs, a Qualified Health Plan, or ConnectorCare (for the first 90 days).

With private insurance (including high deductibles):

  1. Your provider first bills your insurance.

  2. Then it bills you for any HSN deductible.

  3. After that, it may bill HSN for your private plan's deductible and coinsurance.

HSN doesn't pay copayments required by private plans.

With Medicare: HSN pays after Medicare, Medicare Advantage and any supplemental plan. It may help with deductibles, coinsurance and copayments.

With ConnectorCare: once you're found eligible for ConnectorCare, you have 90 days of HSN medical eligibility, starting on your application date, to enroll in a plan. If you don't enroll, HSN medical eligibility ends. If you stop paying ConnectorCare premiums, you lose HSN medical services, though some dental services at health centers may still be available. The Health Connector may arrange a payment plan: call 1-877-MA-ENROLL.

With MassHealth: HSN generally covers the same services as MassHealth Standard, but only at Massachusetts acute hospitals or community health centers. It also pays for certain adult dental services that MassHealth no longer covers.



How the HSN Partial Deductible Works

Under 101 CMR 613.04 and HSN's 2026 notice, the annual deductible is the greater of:

  • (a) the lowest-cost premium for the Health Connector's premium assistance program, adjusted for family size. For 2026, that's $636 for a family of one; or

  • (b) 40% of the difference between your household income and 200% of FPL.

Rough examples for a single adult, using 2026 HHS guidelines:

  • About 160% FPL (roughly $25,500 a year): income is below 200%, so (b) is zero. The deductible is $636.

  • About 250% FPL (roughly $39,900 a year): $39,900 minus $31,920 (200% FPL) is $7,980. 40% of that is about $3,192, which is more than $636.

Your eligibility notice shows your actual deductible.

Other deductible rules:

  • No deductible for anyone in your family group if any member has income at or below 150% FPL.

  • There's one deductible per family group per approval period.

  • The deductible doesn't apply to pharmacy services.

  • At hospitals, you must incur expenses above the deductible before the hospital can bill HSN for the rest.

Track it yourself. Mass.gov says HSN does not track your deductible. The regulations say that if you use more than one provider, or more than one family member qualifies, you must track the deductible and show proof when you reach it. Keep every receipt.



What HSN Pays For, and the Doctor Bill Trap

HSN pays hospital facility charges, such as room and bed, nurses, technicians and equipment. Mass.gov warns that at many hospitals, doctors bill separately and their charges are not covered. You may also get bills for labs or X-rays from private companies.

What to do: when you get a bill, call the sender and ask whether it can bill HSN or whether it's a private doctor or lab. If it's private, ask about its own financial assistance.

Prescriptions: HSN has a limited pharmacy network of health center and hospital outpatient pharmacies, and the prescription usually has to come from a clinician at that facility. Mass.gov states HSN patients don't have copayments for prescription drugs.



A Step-by-Step Plan for Boston Patients

  1. At registration, tell the hospital or health center you're uninsured or underinsured and ask to apply for MassHealth and the Health Safety Net. A single application screens you for both.

  2. Gather proof of identity and income. Income is verified electronically when possible. Have pay stubs ready in case it isn't.

  3. Keep your determination notice. It shows your HSN status (Primary, Secondary or Partial), your ID number and any deductible.

  4. If you have a deductible, keep a folder of every receipt from every HSN provider, for every family member.

  5. For each bill, confirm whether it came from the hospital, which HSN covers, or from a private doctor, lab or radiology group, which HSN usually doesn't.

  6. Mark your renewal date, and answer MassHealth mail promptly.

  7. If you disagree with a decision, send a written grievance to the HSN Office within 30 days.



Keeping HSN

  • Renew every year, and answer any request for more information quickly. Requests may come before the year is over.

  • Report changes right away to MassHealth at (800) 841-2900: address, phone, health insurance or income. Mass.gov warns that not reporting changes may cost you coverage or HSN.



If You're Denied: The HSN Grievance Process

Under 101 CMR 613.04(5), you can ask the Health Safety Net Office to review:

  • a determination of your Low Income Patient status. Send a written request with supporting documents within 30 days of the official notice.

  • a Medical Hardship eligibility decision, if circumstances outside your control affected it. You have six months from the notice.

  • a provider's compliance with HSN rules.

If the office asks you for more information, you must send it within 30 days. The office gives an initial response within 30 days of receiving your grievance, then a written decision with reasons. Mass.gov has a page on how to file a grievance with HSN.



More Help



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Sources

This guide gives general information, not legal advice. Confirm your HSN status and deductible with MassHealth or your provider.

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