Masshealth premium 2026

1. Click ‘Get Form’ to open the MassHealth Premium Waiver application in the editor.
2. Begin by entering your Customer Account Number and the Date Received at the top of the form.
3. Fill in your personal information, including your last name, first name, middle initial, daytime phone number, street address, city, state, and zip code.
4. In the Details of Hardship section, check all applicable boxes that describe your financial hardship. Ensure you have proof ready to upload for each selected hardship.
5. If necessary, provide additional comments regarding your situation in the Comments section. You can attach a separate sheet if more space is needed.
6. Finally, sign and date the application. If an eligibility representative is filling it out for you, ensure they also sign and date it.

Start using our platform today to easily complete your MassHealth Premium Waiver application online for free!