Individuals and Families Applications for Coverage and Help Paying Costs
Download Applications for Health and Dental Coverage
Important: Use this two-page Health Coverage Mail/Fax Cover Sheet when sending your application.
Massachusetts Application for Health and Dental Coverage and Help Paying Costs (English Large Print) (PDF)
Solicitud de cobertura de servicios de salud y dental de Massachusetts y ayuda para pagar los costos (PDF)
Massachusetts Application for Health and Dental Coverage and Help Paying Costs—Additional Persons (PDF)
You can also find these forms plus additional applications and member information on the MassHealth website →