MassHealth Enrollment Guide Your Choices Starting JANUARY 2019

LEARN about health plans

COMPARE health plans

ENROLL in a health plan

COMMONWEALTH OF MASSACHUSETTS | Executive Office of Health and Human Services We are here to help

We speak your language If you need an interpreter or translation help, please call the MassHealth Customer Service Center.

Questions? www.mass.gov/masshealth MassHealth Customer Service Center (800) 841-2900 TTY: (800) 497-4648 for people who are deaf, hard of hearing, or speech disabled. Monday–Friday 8:00 a.m.–5:00 p.m. Hello and welcome

MassHealth is the Medicaid program in Massachusetts. We now have more health plans to choose from so you can get the health care you need. Please read this guide to learn about the new plans so you can choose the one that’s best for you.

This guide will help you...

Learn Learn about the health plans available in your area and how to choose a provider.

Compare Compare health plans in your area and choose the one that’s right for you.

Enroll Enroll in a health plan or change to a different health plan.

Let’s enroll in a health plan.

i Is this guide for you?

Certain members in the MassHealth program will need to enroll in a health plan. Use this guide if you ■ Are under 65 ■ Do not have other insurance (including Medicare) ■ Live in the community (for example, not in a nursing facility), and ■ Are in MassHealth Standard, CommonHealth, CarePlus, or Family Assistance. For information about MassHealth coverage, visit www.mass.gov/masshealth.

Members described below are not eligible for the health plan options described in this guide. For information about MassHealth coverage, visit www.mass.gov/masshealth.

Do not use this guide if you ■ Are over 65 ■ Have other insurance (including Medicare) ■ Do not reside in the community (for example, members who reside in a nursing facility) ■ Are enrolled in Senior Care Options (SCO), Program of All-Inclusive Care for the Elderly (PACE), or One Care ■ Are a member who is eligible solely for » MassHealth Limited » Children’s Medical Security Plan (CMSP) or » Health Safety Net (HSN)

ii Contents

Learn About Health Plan Options 2–5 Introducing Accountable Care Organizations (ACOs) 2 Accountable Care Partnership Plans 2 Primary Care ACOs 3 Managed Care Organizations (MCOs) 3 Primary Care Clinician (PCC) Plan 4 Community Partners 4 Choosing a Primary Care Provider 4 Which Providers Can You See? 5

Compare Health Plans 6–29 Compare Available Health Plans 6 Accountable Care Partnership Plans 7 Primary Care ACO Plans 24 Managed Care Organizations 27 Primary Care Clinician Plan 29

Enroll in or Change a Health Plan 30–33 Enrolling in a Health Plan 30 Changing Your Health Plan 31 Using Your Member ID Cards 33

More Information 34–42 Rights and Responsibilities 34 Understanding Your Costs 35 Grievances, Appeals, and Fair Hearings 35 My Ombudsman 35 Service Areas 36

1 Learn About Health Plan Options

Introducing Accountable Care Accountable Care Partnership Plans Organizations (ACOs) In this type of ACO, a group of PCPs work with just one managed care organization ACOs are groups of doctors, hospitals and to create a full network that includes PCPs, other health care providers who come specialists, behavioral health providers, and together to give coordinated, high-quality hospitals. PCPs plan and coordinate care to care to MassHealth members. This way, meet your health care needs. MassHealth members get the right care at the right time. When an ACO succeeds In this kind of health plan, you in both delivering high-quality care and ■ Must live in the service areas covered spending health care dollars wisely, by the ACO MassHealth will reward the ACO. ■ Must use the plan’s network of providers There are two types of ACOs you can enroll ■ May get the services of a behavioral in: Accountable Care Partnership Plans or health or long-term services and supports Primary Care ACOs. In both, ACOs are led (LTSS) Community Partner (see page 4) by providers of care, not just administrators. ■ Choose a PCP in the ACO, or one will be Primary Care Providers (PCPs) are at the assigned to you center of the care network. Providers work ■ Can change your PCP at any time within with you directly and know your needs, and the ACO they will have a much bigger part in working ■ Will have a Plan Selection Period and a with you to make decisions about care in an Fixed Enrollment Period every year ACO than in other types of health plans. On the following pages, we describe the two different types of ACOs as well as managed care organizations (MCOs) and the Primary Care Clinician (PCC) Plan. You can choose any of the options available in your service area. Key Term

Primary Care Provider (PCP) A health care provider you choose to give you routine care and refer you to a specialist when necessary. (See page 4 for more information.)

2 MassHealth Enrollment Guide | LEARN Primary Care ACOs Managed Care

In this type of ACO, a group of PCPs have Organizations (MCOs) LEARN joined together into an ACO to be responsible for your care. The ACO contracts directly MCOs are health plans run by insurance with MassHealth to provide primary care companies that provide care through their and coordinate the full range of services for own provider network that includes PCPs, its enrollees. Primary Care ACOs work with specialists, behavioral health providers, and the MassHealth network of specialists and hospitals. Care coordinators are employed by hospitals and may have certain providers the MCO. in their “referral circle.” This circle gives Please note: PCPs who are part of an ACO you direct access to other providers. The will not be available as PCPs in MCO plans. Massachusetts Behavioral Health Partnership (MBHP) provides behavioral health services. In this kind of plan, you ■ Must live in the service areas covered COMPARE In this kind of plan, you by the MCO ■ May get the services of a behavioral ■ Must use the MCO network of providers health or long-term services and supports (LTSS) Community Partner (see page 4) ■ May get the services of a behavioral health or long-term services and supports ■ Choose a PCP in the ACO, or one will be (LTSS) Community Partner (see page 4) assigned to you ■ Choose a PCP in the MCO, or one will be ■ Can change your PCP at any time within assigned to you the ACO ■ Can change your PCP at any time within ■ Will have a Plan Selection Period and a the MCO Fixed Enrollment Period every year ■ Will have a Plan Selection Period and a Fixed Enrollment Period every year ENROLL

Key Terms

Network Plan Selection Period A group of doctors, hospitals, and other The time of year when you CAN change health care providers that a health plan your health plan. contracts with to provide medical (See page 31 for more information.) care to you. MORE INFORMATION Fixed Enrollment Period Community Partners The time of year when you CANNOT Community Partners are community- change your health plan, except for based experts that can work with you certain reasons. and your health plan to get and arrange (See page 31 for more information.) behavioral health and LTSS services. (See page 4 for more information.)

3 Primary Care Clinician Choosing a (PCC) Plan Primary Care In the PCC Plan, primary care providers are Provider called primary care clinicians (PCCs). The MassHealth network of PCCs, specialists, It is important to choose a primary care and hospitals delivers services. The provider (PCP) for you or your family. Massachusetts Behavioral Health Partnership (MBHP) provides behavioral health services. Your PCP helps you get the care you need. Please note: PCPs who are part of an ACO PCPs provide a wide range of health care will not be available as PCCs in the PCC Plan. services, such as In the PCC Plan, you ■ Yearly checkups ■ Choose a PCC from the MassHealth list, or ■ Vaccinations one will be assigned to you ■ Sick visits ■ Can change your PCC at any time ■ Health screenings ■ Can change from the PCC Plan to an ACO or MCO at any time Getting to Know Your PCP Please note that Community Partners are not Your PCP gets to know you and your health generally available in the PCC Plan, and care history, habits, and goals. Your PCP may not be as coordinated as it is in the ACO ■ Provides treatment or MCO plans. ■ Helps you manage health issues like asthma, obesity, diabetes, and high blood pressure Community Partners ■ Refers you to a specialist when needed If you have a high need for behavioral health or long-term services and supports (LTSS), Changing Your PCP ACOs and MCOs are now able to help You can change from one PCP to another more by providing you with support from a within your health plan at any time and for Community Partner. Community Partners are any reason. community-based experts who can work with you and your health plan to get and arrange ACOs and MCOs behavioral health and LTSS services. To change your PCP, call your health plan’s customer service department. Their phone number is on the back of your health plan’s member ID card.

PCC Plan If you are a PCC Plan member and you would like to change your PCP, call us at (800) 841-2900 (TTY: (800) 497-4648).

4 MassHealth Enrollment Guide | LEARN Which Providers Can You See?

Your choice of PCP and the network of providers you can see depends on LEARN which health plan you choose. Below is a description of the providers you can see based on your health plan choices. PCPs that are in the networks of ACOs (Accountable Care Partnership Plans and Primary Care ACOs) are generally not available in MCOs or in the PCC Plan. These PCPs are generally only available in their ACOs.

Accountable Care Partnership Plans Managed Care Organizations

PCPs PCPs COMPARE You have to choose a PCP within the You have to choose a PCP within the Accountable Care Partnership Plan’s MCO’s network. network.

Medical Services and Medical Services and Behavioral Health Services Behavioral Health Services You will receive medical AND You will receive medical AND behavioral health services from behavioral health services from providers in the Accountable providers in the MCO’s network. Care Partnership Plan’s network.

There are 13 ACO Partnership Plans. See pages 7-23. There are 2 MCO Plans. See pages 27-28. ENROLL

Primary Care ACOs Primary Care Clinician Plan

PCPs PCPs You have to choose a PCP within the You have to choose a PCP within the Primary Care ACO’s network. PCC Plan network.

Medical Services Medical Services You will receive medical services from You will receive medical services from providers in the MassHealth network. providers in the MassHealth network. MORE INFORMATION Behavioral Health Services Behavioral Health Services You will receive your behavioral health You will receive your behavioral health services from the Massachusetts services from the Massachusetts Behavioral Health Partnership Behavioral Health Partnership (MBHP) network. (MBHP) network.

There are 3 Primary Care ACO Plans. See pages 24-26. There is 1 Primary Care Clinician Plan. See page 29.

5 Compare Health Plans

Compare Available Compare Online Health Plans Choosing a plan and a primary care provider is simple when you use our online tool. There are many health plan options to www.MassHealthChoices.com allows you choose from. Each health plan has a different to search a complete list of primary care list of doctors, behavioral health providers, providers and compare health plans side by and hospitals. The following pages provide side based on what is important to you or a summary of each of the health plans your family. available to help you choose the one that is At www.MassHealthChoices.com you can use right for you. the Learn, Compare, and Enroll tabs to Go online to www.MassHealthChoices.com to use our tool to search for providers and to Learn about important MassHealth compare plans. information. Finding a Health Plan in Your Service Area Compare ■ Health plan options in your area Each of the health plans covers a set of ■ Primary care providers that service areas. You may choose a health plan participate in your health only if it is available in your service area. plan options Service areas are regional groups of cities and towns where a health plan accepts Enroll in the plan that best members. When you select a plan in your meets your needs service area, you will use providers within your plan’s network. Visit www.MassHealthChoices.com today!

Find your service area...Find your health plan. To find your service area, go to page 36. Find the town you live in and use its service area to find the health plans available to you on the following pages.

Remember, you can only choose a health plan in your service area.

If the health plan that you need is not available in your area, you may be able to submit a request for a Service Area Exception. For more information, please visit www.masshealthchoices.com/learn/changing-your-health-plan on the MassHealth Choices website or call MassHealth Customer Service at (800) 841-2900.

6 MassHealth Enrollment Guide | COMPARE Accountable Care Partnership Plans

My Care Family LEARN

Merrimack Valley ACO in partnership with Allways Health Partners Accountable Care Partnership Plan

My Care Family

SERVICE AREAS

Behavioral Health Services Haverhill COMPARE Lawrence Members can get a full range of Lowell mental health and substance use Find your town and its services. For more information, call service area on page 36. (844) 451-3519.

My Care Family surrounds you with a family of culturally sensitive, high-quality community providers you know and trust. Conveniently located, Greater Lawrence Family Health Center and Lawrence General Hospital have partnered ENROLL with Allways Health Partners and local social and health service organizations to offer a new MassHealth plan to better meet all your health care and well-being needs. Special Programs and Extra Benefits

■ Online supports ■ Over-the-counter ■ Childbirth & drug coverage parenting programs ■ Fitness membership reimbursement ■ Child care & safety products ■ Tobacco cessation program ■ Pharmacy discounts ■ Access 90 MORE INFORMATION prescriptions Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.mycarefamily.org Customer Service: (800) 462-5449 Behavioral Health: (844) 451-3519

7 Accountable Care Partnership Plans

Hospitals Hospital Name City Allways Health Partner’s Lawrence Memorial Hospital Medford Accountable Care Partnership Plan of Medford includes the following hospitals in Lowell General Hospital Lowell its network: Main Campus Lowell General Hospital Lowell Saints Campus My Care Family Martha’s Vineyard Hospital Oak Bluffs (Partners HealthCare)

Hospital Name City Mass. Eye and Ear Infirmary Boston Mass. General Hospital Boston Addison Gilbert Hospital Gloucester (Partners HealthCare) (Lahey Health) MelroseWakefield Hospital Melrose Anna Jaques Hospital Newburyport (Hallmark) Beverly Hospital (Lahey Health) Beverly Morton Hospital (Steward) Taunton BI Deaconess Medical Center Boston Nantucket Cottage Hospital Nantucket BI Deaconess-Milton Milton (Partners HealthCare) BI Deaconess-Needham Needham Nashoba Valley Medical Center Ayer (Steward) BI Deaconess-Plymouth Plymouth New England Baptist Roxbury Crossing *Boston Children’s Hospital Boston Newton-Wellesley Hospital Newton Boston Medical Center Boston (Partners HealthCare) Brigham and Women’s Faulkner Jamaica Plain Norwood Hospital (Steward) Norwood Hospital (Partners HealthCare) Salem Hospital Salem Brigham and Women’s Hospital Boston (NSMC/Partners HealthCare) (Partners HealthCare) Somerville Hospital (CHA) Somerville Cambridge Hospital (CHA) Cambridge Saint Anne’s Hospital (Steward) Fall River Carney Hospital (Steward) Dorchester St. Elizabeth’s Medical Center Brighton *Dana-Farber Cancer Institute Boston (Steward) Emerson Hospital Concord Tufts Medical Center Boston Everett Hospital (CHA) Everett Union Hospital Lynn Good Samaritan Medical Center Brockton (NSMC/Partners HealthCare) (Steward) Winchester Hospital Winchester Holy Family Hospital (Steward) Haverhill (Lahey Health) Holy Family Hospital Methuen Methuen (Steward) The hospital list is subject to change, and the hospitals may have service limits. Please check Lahey Hospital and Burlington Medical Center with the plan for specific questions about network hospitals. Lahey Medical Center-Peabody Peabody Lawrence General Hospital Lawrence *Please call the health plan about availability.

8 MassHealth Enrollment Guide | COMPARE Accountable Care Partnership Plans

BMC HealthNet Plan Community Alliance LEARN

Boston Accountable Care Organization in partnership with BMC HealthNet Plan Accountable Care Partnership Plans

BMC HealthNet Plan Community Alliance (page 9) BMC HealthNet Plan Mercy Alliance (page 10) SERVICE AREAS

Attleboro Plymouth COMPARE BMC HealthNet Plan Signature Boston Quincy Alliance (page 10) Brockton Revere BMC HealthNet Plan Southcoast Fall River Somerville Falmouth Springfield Alliance (page 11) Greenfield Taunton Holyoke Waltham Lynn Wareham Malden Westfield New Bedford Woburn Behavioral Health Services Northampton Members can get a full range of Find your town and its service area on page 36. mental health and substance use services. For more information, call We make it our mission to know you because for (888) 217-3501. us, it’s personal. We gather a complete picture

of your health—your goals, daily life, and the ENROLL community where you live—to provide the right care at the right time. Because working together is smarter. Special Programs and Extra Benefits

■ Healthy cooking & ■ Free kids’ bike nutrition classes helmets

■ Fruit and vegetable ■ Free dental kits vouchers ■ Mobile ID card ■ Free car seats & ■ Fitness booster seats reimbursements MORE INFORMATION

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.bmchp.org/community Customer Service: (888) 566-0010 Behavioral Health: (888) 217-3501

9 Accountable Care Partnership Plans

BMC HealthNet Plan BMC HealthNet Plan Mercy Alliance Signature Alliance

Mercy Medical Center in partnership with Signature Healthcare in partnership with BMC HealthNet Plan BMC HealthNet Plan

SERVICE AREAS SERVICE AREAS

Holyoke Brockton Northampton Plymouth Springfield Quincy Westfield Taunton

Find your town and its Find your town and its service area on page 36. service area on page 36.

BMC HealthNet Plan is teaming up with Mercy BMC HealthNet Plan is partnering with Medical Center to help make Springfield Signature Healthcare to help make our healthier. We do this by talking more, planning community healthier. We do this through regular better, and including you in the conversation. communication, smarter planning, and including When it comes to your health, we work together you in the conversation. Because working for a reason. together benefits you, our patient.

Special Programs and Extra Benefits Special Programs and Extra Benefits

■ Weight ■ Free car seats & ■ Parenting & family ■ Free car seats & management booster seats classes booster seats programs ■ Free kids’ bike ■ Free Zumba & yoga ■ Fitness

■ Mobile health helmets classes reimbursements screening van ■ Mobile ID card ■ Nutrition education ■ Free kids’ bike ■ Fruit & vegetable ■ Fitness & fresh produce helmets vouchers reimbursements vouchers ■ Free dental kits

Contact the plan for a full list of special programs and Contact the plan for a full list of special programs and extra benefits. Certain rules may apply. extra benefits. Certain rules may apply.

www.bmchp.org/mercy www.bmchp.org/signature Customer Service: (888) 566-0010 Customer Service: (888) 566-0010 Behavioral Health: (888) 217-3501 Behavioral Health: (888) 217-3501

10 MassHealth Enrollment Guide | COMPARE Accountable Care Partnership Plans

BMC HealthNet Plan Southcoast Alliance Hospitals LEARN All BMC HealthNet Plan’s Southcoast Health in partnership with Accountable Care Partnership BMC HealthNet Plan Plans and the BMC HealthNet Plan include the following hospitals in their network:

BMC HealthNet Plans (All Plans)

SERVICE AREAS

Attleboro Hospital Name City COMPARE Fall River Addison Gilbert Hospital Gloucester Falmouth (Lahey Health) New Bedford Plymouth Anna Jaques Hospital Newburyport Taunton Athol Hospital Athol Wareham (Heywood Healthcare) Find your town and its Baystate Medical Center Springfield service area on page 36. Baystate Wing Hospital Palmer Berkshire Medical Center Pittsfield In our fresh approach to health care, you take center stage. BMC HealthNet Plan helps you get Beverly Hospital Beverly the right care at the right time—we listen more, (Lahey Health) plan better, and include you every step of the BI Deaconess Boston

way. Because working together for your health Medical Center ENROLL just makes sense. BI Deaconess-Milton Milton Special Programs and Extra Benefits BI Deaconess-Needham Needham

■ Access to our ■ Fruit & vegetable BI Deaconess-Plymouth Plymouth Baby Café vouchers Boston Children’s Hospital Boston (Not available in BMC Mercy or ■ Mobile health ■ Free car seats & BMC Signature Plans) screening van booster seats Boston Medical Center Boston ■ Walking programs ■ Fitness & yoga classes reimbursements **Brigham and Women’s Jamaica Plain Hospital (Partners HealthCare) ■ Nutrition education **Brigham and Women’s Boston Hospital (Partners HealthCare) MORE INFORMATION Brockton Hospital Brockton Contact the plan for a full list of special programs and (Signature Healthcare) extra benefits. Certain rules may apply. Cambridge Hospital (CHA) Cambridge Cape Cod Hospital Hyannis www.bmchp.org/southcoast Customer Service: (888) 566-0010 Behavioral Health: (888) 217-3501

11 Accountable Care Partnership Plans

Hospital Name City Hospital Name City Carney Hospital (Steward) Dorchester Leonard Morse Hospital Natick (MetroWest Medical Center) Charlton Hospital (Southcoast) Fall River Lowell General Hospital Lowell Clinton Hospital Clinton Main Campus (UMassMemorial HealthAlliance) Lowell General Hospital Lowell Cooley Dickinson Health Care Northampton Saints Campus (Partners HealthCare) Marlborough Hospital Marlboro *Dana-Farber Cancer Institute Boston **Martha’s Vineyard Hospital Oak Bluffs Emerson Hospital Concord (Partners HealthCare) Everett Hospital (CHA) Everett Mass. Eye and Ear Infirmary Boston Fairview Hospital Great Barrington **Mass. General Hospital Boston (Berkshire Health Systems) (Partners HealthCare) Falmouth Hospital Falmouth MelroseWakefield Hospital Melrose (Cape Cod Healthcare) (Hallmark) Framingham Union Hospital Framingham Mercy Medical Center Springfield (Metrowest Medical Center) Milford-Whitinsville Hospital Milford Franklin Medical Center Greenfield (Baystate Health) Miriam Hospital Providence, RI Good Samaritan Medical Center Brockton Morton Hospital (Steward) Taunton (Steward) Mt. Auburn Hospital Cambridge Harrington Hospital Southbridge **Nantucket Cottage Hospital Nantucket (Southbridge) (Partners HealthCare) Health Alliance Hospital Leominster Nashoba Valley Medical Center Ayer (UMassMemorial) (Steward) Heywood Hospital Gardner **Newton-Wellesley Hospital Newton Holy Family Hospital (Steward) Haverhill (Partners HealthCare) Holy Family Hospital Methuen Methuen Noble Hospital (Baystate) Westfield (Steward) Norwood Hospital (Steward) Norwood Holyoke Medical Center Holyoke Rhode Island Hospital Providence, RI Lahey Hospital and Burlington Salem Hospital Salem Medical Center (NSMC/Partners HealthCare) Lahey Medical Peabody Shriners Hospital for Boston Center-Peabody Children-Boston Lawrence General Hospital Lawrence Shriners Hospital for Springfield Lawrence Memorial Hospital Medford Children-Springfield of Medford Somerville Hospital (CHA) Somerville South Shore Hospital South Weymouth

12 MassHealth Enrollment Guide | COMPARE Accountable Care Partnership Plans

Hospital Name City LEARN Southern NH Nashua, NH Medical Center Saint Anne’s Hospital (Steward) Fall River St. Elizabeth’s Medical Center Brighton (Steward) St. Luke’s Hospital New Bedford (Southcoast) Saint Vincent Hospital Worcester Sturdy Memorial Hospital Attleboro

Tobey Hospital (Southcoast) Wareham COMPARE Tufts Medical Center Boston UMass Memorial Medical Center Worcester Memorial Campus UMass Memorial Medical Center Worcester University Campus **Union Hospital Lynn (NSMC/Partners HealthCare) Winchester Hospital Winchester (Lahey Health)

The hospital list is subject to change, and the hospitals may have service limits. Please check

with the plan for specific questions about ENROLL network hospitals.

*Please call the health plan about availability.

**Please call BMC Mercy Alliance, BMC Signature Alliance, and BMC Southcoast Alliance about availability. MORE INFORMATION

13 Accountable Care Partnership Plans

Berkshire Fallon Health Collaborative

Health Collaborative of the Berkshires in partnership with Fallon Health Accountable Care Partnership Plans

Berkshire Fallon Health Collaborative (page 14) Fallon 365 Care (page 15) SERVICE AREAS Wellforce Care Plan (page 15) Adams Pittsfield Find your town and its service area on page 36. Behavioral Health Services Members can get a full range of mental health and substance use services. For more information, call • (888) 877-7184 (Berkshire Fallon Health Collaborative) The Berkshire Fallon Health Collaborative • (888) 877-7182 (BFHC) is a partnership between Fallon Health, (Fallon 365 Care) Berkshire Health Systems and Community Health Programs. BFHC is committed to • (888) 877-7183 providing our members with the right care at (Wellforce Care Plan) the right time, in the right place. Special Programs and Extra Benefits

■ Quit to Win—quit smoking program ■ Oh Baby—baby wellness ■ Pharmacy discount ■ Healthwise Knowledgebase—health encyclopedia ■ Mobile ID card app

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.fallonhealth.org/Berkshires Customer Service: (855) 203-4660 Behavioral Health: (888) 877-7184

14 MassHealth Enrollment Guide | COMPARE Accountable Care Partnership Plans

Fallon 365 Care Wellforce Care Plan LEARN

Reliant Medical Group Wellforce in partnership with Fallon Health in partnership with Fallon Health

SERVICE AREAS SERVICE AREAS Attleboro Malden Barnstable Orleans Gardner-Fitchburg Beverly Plymouth COMPARE Framingham Boston Quincy Southbridge Brockton Revere Worcester Falmouth Salem Find your town and its Framingham Somerville service area on page 36. Haverhill Waltham Lawrence Wareham Lowell Woburn Lynn Find your town and its service area on page 36.

With a goal of delivering high-quality care Wellforce Care Plan works to improve your and a history of innovation, Fallon 365 health and provide a positive experience. We

Care is committed to improving the lives of have high-quality providers, including primary ENROLL the members and patients we serve in our care doctors, specialists, community and community. academic hospitals, a hospital for children, and a large community health center. Special Programs and Extra Benefits Special Programs and Extra Benefits ■ Quit to Win—quit smoking program ■ Oh Baby—baby wellness ■ Quit to Win—quit smoking program ■ Pharmacy discount ■ Oh Baby—baby wellness ■ Healthwise Knowledgebase—health ■ Pharmacy discount encyclopedia ■ Healthwise Knowledgebase—health ■ Mobile ID card app encyclopedia

■ Mobile ID card app MORE INFORMATION

Contact the plan for a full list of special programs and Contact the plan for a full list of special programs and extra benefits. Certain rules may apply. extra benefits. Certain rules may apply.

www.fallonhealth.org/365care www.fallonhealth.org/wellforce Customer Service: (855) 508-3390 Customer Service: (855) 508-4715 Behavioral Health: (888) 877-7182 Behavioral Health: (888) 877-7183

15 Accountable Care Partnership Plans

Hospitals Wellforce Care Plan Fallon Health’s Accountable Care Partnership Plans include the Hospital Name City following hospitals in their network: BI Deaconess-Milton Milton BI Deaconess-Plymouth Plymouth Brockton Hospital Berkshire Fallon Health Collaborative Brockton (Signature Healthcare) Cape Cod Hospital Hyannis Hospital Name City Falmouth Hospital Falmouth Baystate Medical Center Springfield (Cape Cod Healthcare) Berkshire Medical Center Pittsfield Lawrence General Hospital Lawrence Fairview Hospital Great Barrington Lawrence Memorial Hospital Medford (Berkshire Health Systems) of Medford Mass. Eye and Ear Infirmary Boston Lowell General Hospital Lowell Main Campus Tufts Medical Center Boston Lowell General Hospital Lowell Saints Campus

Fallon 365 Care Mass. Eye and Ear Infirmary Boston MelroseWakefield Hospital Melrose (Hallmark) Hospital Name City Milford-Whitinsville Hospital Milford Framingham Union Hospital Framingham South Shore Hospital South Weymouth (MetroWest Medical Center) Tufts Medical Center Boston Harrington Hospital (Southbridge) Southbridge Heywood Hospital Gardner The hospital list is subject to change, and the Leonard Morse Hospital Natick hospitals may have service limits. Please check (MetroWest Medical Center) with the plan for specific questions about Milford-Whitinsville Hospital Milford network hospitals. Saint Vincent Hospital Worcester Tufts Medical Center Boston

16 MassHealth Enrollment Guide | COMPARE Accountable Care Partnership Plans

Be Healthy Partnership LEARN

Baystate Health Care Alliance in partnership with Health New England Accountable Care Partnership Plan

Be Healthy Partnership

SERVICE AREAS

Behavioral Health Services Holyoke COMPARE Northampton Members can get a full range of Springfield mental health and substance use Westfield services. For more information, call Find your town and its (800) 495-0086. service area on page 36.

In the Be Healthy Partnership Plan you get the support of caring professionals who live and work in your community. Our goal is to be your health care partner and our focus is on you and your family’s overall well-being, making sure that

you receive high-quality medical and behavioral ENROLL health care. The Partnership’s Community Health Centers are Caring Health Center, Mason Square Health Center, Brightwood Health Center, High Street Adult Health Center, and High Street Pediatric Health Center. Special Programs and Extra Benefits

■ Bee Healthy Babies ■ Free kids’ bike Program helmets ■ Wellness & healthy ■ Free booster or cooking programs car seats

■ Free dental kit ■ Money back for MORE INFORMATION wellness

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.behealthypartnership.org Customer Service: (800) 786-9999 Behavioral Health: (800) 495-0086

17 Accountable Care Partnership Plans

Hospitals Hospital Name City Health New England’s Accountable Southwestern Vermont Bennington, VT Care Partnership Plan includes the Medical Center following hospitals in its network: *UMass Memorial Medical Center Worcester Memorial Campus *UMass Memorial Medical Center Worcester Be Healthy Partnership University Campus

The hospital list is subject to change, and the Hospital Name City hospitals may have service limits. Please check Athol Hospital Athol with the plan for specific questions about (Heywood Healthcare) network hospitals. Baystate Medical Center Springfield *Please call the health plan about availability. Baystate Wing Hospital Palmer Berkshire Medical Center Pittsfield *Clinton Hospital Clinton (UMassMemorial HealthAlliance) Fairview Hospital Great Barrington (Berkshire Health Systems) Franklin Medical Center Greenfield (Baystate Health) *Health Alliance Hospital Leominster (UMassMemorial) Holyoke Medical Center Holyoke *Marlborough Hospital Marlboro Mercy Medical Center Springfield Noble Hospital (Baystate) Westfield *Shriners Hospital for Boston Children-Boston Shriners Hospital for Springfield Children-Springfield

18 MassHealth Enrollment Guide | COMPARE Accountable Care Partnership Plans

Tufts Health Together with Atrius Health LEARN

Atrius Health in partnership with Tufts Health Plan (THP) Accountable Care Partnership Plans

Tufts Health Together with Atrius Health (page 19)

Tufts Health Together with SERVICE AREAS BIDCO (page 20) Attleboro Lynn COMPARE Tufts Health Together with Beverly Malden Boston Children’s ACO (page 20) Boston Plymouth Brockton Quincy Tufts Health Together with CHA Falmouth Revere (page 21) Framingham Salem Gardner- Somerville Fitchburg Waltham Lawrence Wareham Lowell Woburn Behavioral Health Services Find your town and its service area on page 36. Members can get a full range of mental health and substance use services. For more information, call The vision of the Tufts Health Together with Atrius Health plan is to improve the health (888) 257-1985

and wellness of our MassHealth members. We ENROLL are committed to providing high-quality care with kindness and compassion, and we value diversity in our employees and our members. Special Programs and Extra Benefits

■ Health coaching ■ Fitness ■ Pregnancy programs reimbursements ■ Specialized care ■ Gift card toward coordination car seats & booster programs seats ■ Pharmacy discount ■ Yearly checkup rewards MORE INFORMATION

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.TuftsHealthTogether.com/AtriusHealth Customer Service: (888) 257-1985 Behavioral Health: (888) 257-1985

19 Accountable Care Partnership Plans

Tufts Health Together Tufts Health Together with BIDCO with Boston Children’s ACO

Beth Israel Deaconess Care Organization (BIDCO) Boston Children’s ACO in partnership in partnership with Tufts Health Plan (THP) with Tufts Health Plan (THP)

SERVICE AREAS SERVICE AREAS Attleboro Lynn Attleboro Malden Barnstable Malden Barnstable Orleans Beverly New Bedford Beverly Plymouth Boston Northampton Boston Quincy Brockton Orleans Brockton Revere Fall River Plymouth Falmouth Salem Falmouth Quincy Framingham Somerville Framingham Revere Haverhill Waltham Haverhill Salem Lowell Wareham Holyoke Somerville Taunton Westfield Lynn Woburn Lawrence Southbridge Waltham Woburn Find your town and its Lowell Springfield Wareham Worcester service area on page 36. Find your town and its service area on page 36.

Tufts Health Plan and BIDCO work together to Tufts Health Plan and Boston Children’s ACO provide the best care possible to all members. share the mission of improving children’s health We offer person-centered and culturally and well-being. Our inclusive approach focuses sensitive services to improve members’ on the preventive care and treatments that health while promoting healthy lifestyles and have long-term health benefits for our pediatric behavioral changes. members. Special Programs and Extra Benefits Special Programs and Extra Benefits

■ Health coaching ■ Pharmacy discount ■ Health coaching ■ Gift card toward ■ Pregnancy programs ■ Fitness ■ Community-based car seats & booster seats ■ Nutrition counseling reimbursements asthma program program ■ Gift card toward ■ Yearly checkup ■ Pharmacy discount rewards ■ Group support car seats & booster seats ■ Fitness programs reimbursements ■ Yearly checkup ■ Stress management rewards

Contact the plan for a full list of special programs and Contact the plan for a full list of special programs and extra benefits. Certain rules may apply. extra benefits. Certain rules may apply.

www.TuftsHealthTogether.com/BIDCO www.TuftsHealthTogether.com/BCACO Customer Service: (888) 257-1985 Customer Service: (888) 257-1985 Behavioral Health: (888) 257-1985 Behavioral Health: (888) 257-1985

20 MassHealth Enrollment Guide | COMPARE Accountable Care Partnership Plans

Tufts Health Together with CHA Hospitals LEARN All Tufts Health Plan’s Accountable Cambridge Health Alliance (CHA) Care Partnership Plans and Tufts in partnership with Tufts Health Plan (THP) Health Together include the following hospitals in their network:

Tufts Health Together with Atrius Health

Hospital Name City SERVICE AREAS Beverly Hospital Beverly Boston COMPARE (Lahey Health) Lynn Malden BI Deaconess Medical Center Boston Revere BI Deaconess-Milton Milton Somerville Waltham BI Deaconess-Needham Needham Woburn BI Deaconess-Plymouth Plymouth Find your town and its Boston Children’s Hospital Boston service area on page 36. Emerson Hospital Concord Lahey Hospital & Medical Center Burlington Lowell General Hospital Lowell Main Campus Tufts Health Together with CHA provides person-centered, coordinated health care to Lowell General Hospital Lowell Saints Campus

help you feel your best. We embrace diversity, ENROLL speak many languages, respect culture, and Mass. Eye and Ear Infirmary Boston believe everyone deserves to be treated with Mt. Auburn Hospital Cambridge dignity. New England Baptist Roxbury Crossing Special Programs and Extra Benefits *Newton-Wellesley Hospital Newton ■ Health coaching ■ Gift card toward (Partners HealthCare) ■ Pregnancy car seats & booster South Shore Hospital South Weymouth seats programs Winchester Hospital Winchester ■ Team-based care ■ Yearly checkup (Lahey Health) rewards ■ Pharmacy discount *Please call the health plan about availability.

■ Fitness MORE INFORMATION reimbursements

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.TuftsHealthTogether.com/CHA Customer Service: (888) 888-257-1985 Behavioral Health: (888) 257-1985

21 Accountable Care Partnership Plans

Tufts Health Together with BIDCO Hospital Name City Cambridge Hospital (CHA) Cambridge Hospital Name City Cape Cod Hospital Hyannis Anna Jaques Hospital Newburyport Carney Hospital (Steward) Dorchester BI Deaconess Medical Center Boston Charlton Hospital (Southcoast) Fall River BI Deaconess-Milton Milton Clinton Hospital Clinton BI Deaconess-Needham Needham (UMassMemorial HealthAlliance) BI Deaconess-Plymouth Plymouth Cooley Dickinson Health Care Northampton (Partners HealthCare) New England Baptist Roxbury Crossing Dana-Farber Cancer Institute Boston Tufts Medical Center Boston Emerson Hospital Concord Everett Hospital (CHA) Everett Tufts Health Together with Fairview Hospital Great Barrington Boston Children’s ACO and (Berkshire Health Systems) Tufts Health Together (MCO Plan) Falmouth Hospital Falmouth (Cape Cod Healthcare) Framingham Union Hospital Framingham Hospital Name City (MetroWest Medical Center) Addison Gilbert Hospital Gloucester Franklin Medical Center Greenfield (Lahey Health) (Baystate Health) Anna Jaques Hospital Newburyport Good Samaritan Medical Center Brockton (Steward) Athol Hospital Athol (Heywood Healthcare) Harrington Hospital Southbridge (Southbridge) Baystate Medical Center Springfield Health Alliance Hospital Leominster Baystate Wing Hospital Palmer (UMassMemorial) Berkshire Medical Center Pittsfield Heywood Hospital Gardner Beverly Hospital (Lahey Health) Beverly Holy Family Hospital (Steward) Haverhill BI Deaconess Medical Center Boston Holy Family Hospital-Methuen Methuen BI Deaconess-Milton Milton (Steward) BI Deaconess-Needham Needham Holyoke Medical Center Holyoke BI Deaconess-Plymouth Plymouth Kent County Memorial Hospital Warwick, RI Boston Children’s Hospital Boston Lahey Hospital & Medical Center Burlington Boston Medical Center Boston Lahey Medical Center-Peabody Peabody *Brigham and Women’s Hospital Jamaica Plain Landmark Medical Center Woonsocket, RI (Partners HealthCare) Lawrence General Hospital Lawrence *Brigham and Women’s Hospital Boston Lawrence Memorial Hospital Medford (Partners HealthCare) of Medford Brockton Hospital Brockton (Signature Healthcare)

22 MassHealth Enrollment Guide | COMPARE Accountable Care Partnership Plans

Hospital Name City Hospital Name City LEARN Leonard Morse Hospital Natick St. Elizabeth’s Medical Center Brighton (MetroWest Medical Center) (Steward) Lowell General Hospital Lowell St. Luke’s Hospital New Bedford Main Campus (Southcoast) Lowell General Hospital Lowell Saint Vincent Hospital Worcester Saints Campus Sturdy Memorial Hospital Attleboro Marlborough Hospital Marlboro Tobey Hospital (Southcoast) Wareham *Martha’s Vineyard Hospital Oak Bluffs Tufts Medical Center Boston (Partners HealthCare) UMass Memorial Medical Center Worcester Mass. Eye and Ear Infirmary Boston Memorial Campus COMPARE *Mass. General Hospital Boston UMass Memorial Medical Center Worcester (Partners HealthCare) University Campus MelroseWakefield Hospital Melrose *Union Hospital Lynn (Hallmark) (NSMC/Partners HealthCare) Mercy Medical Center Springfield Winchester Hospital Winchester Milford-Whitinsville Hospital Milford (Lahey Health) Miriam Hospital Providence, RI Women & Infants Hospital Providence, RI Morton Hospital (Steward) Taunton *Please call Tufts Health Together with Boston Mt. Auburn Hospital Cambridge Children’s ACO about availability. Not available in *Nantucket Cottage Hospital Nantucket Tufts Health Together (MCO Plan). (Partners HealthCare)

Nashoba Valley Medical Center Ayer ENROLL (Steward) Tufts Health Together with CHA New England Baptist Roxbury Crossing *Newton-Wellesley Hospital Newton (Partners HealthCare) Hospital Name City Noble Hospital (Baystate) Westfield BI Deaconess Medical Center Boston Norwood Hospital (Steward) Norwood Cambridge Hospital (CHA) Cambridge Rhode Island Hospital Providence, RI Everett Hospital (CHA) Everett *Salem Hospital Salem *Mass. General Hospital Boston (NSMC/Partners HealthCare) (Partners HealthCare) Shriners Hospital for Boston Somerville Hospital (CHA) Somerville Children-Boston Tufts Medical Center Boston MORE INFORMATION Shriners Hospital for Springfield Children-Springfield *Please call the health plan about availability. Somerville Hospital (CHA) Somerville The hospital list is subject to change, and the South Shore Hospital South Weymouth hospitals may have service limits. Please check Saint Anne’s Hospital (Steward) Fall River with the plan for specific questions about network hospitals.

23 Primary Care ACO Plans

Community Care Cooperative (C3)

Primary Care ACO Plan

Community Care Cooperative (C3)

SERVICE AREAS Please Note: Service Areas All Service Areas To enroll in a Primary Care ACO, you will need to also select a PCP in that ACO’s network. PCPs may not be available in all service areas.

Behavioral Health Services Members can get a full range of mental health and substance use services. For more information, call the Massachusetts Behavioral Health Partnership at Community Care Cooperative (C3) members get primary care at a community health center and (800) 495-0086 or visit have access to the most MassHealth specialists www.masspartnership.com. and hospitals. See our website for a list of our health centers: www.C3aco.org. Hospitals Special Programs and Extra Benefits Community Care Cooperative’s ■ Welcoming ■ Care 365—help with Primary Care ACO Plan uses Care—care in your social needs like rent the MassHealth network language and culture and transportation of hospitals. Please go to ■ Care Navigation— ■ Nurse advice line https://masshealth.ehs.state.ma.us/ from health ■ Just You and Your providerdirectory/ for a list of screenings to Provider—no hospitals. specialty care insurance company between you and your provider

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.C3aco.org Customer Service: (866) 676-9226

24 MassHealth Enrollment Guide | COMPARE Primary Care ACO Plans

Partners HealthCare Choice LEARN

Primary Care ACO Plan

Partners HealthCare Choice

SERVICE AREAS

Please Note: Service Areas All Service Areas COMPARE To enroll in a Primary Care ACO, you will need to also select a PCP in that ACO’s network. PCPs may not be available in all service areas.

Behavioral Health Members can get a full range of mental health and substance use services. For more information, call the Massachusetts Behavioral Health Partnership at Partners HealthCare Choice helps doctors work with members to improve care. Partners’ (800) 495-0086 or visit

doctors, hospitals, and other health care ENROLL www.masspartnership.com. providers come together to provide coordinated, high-quality care to you as a member. Hospitals Special Programs and Extra Benefits Partners HealthCare’s Primary Care ■ Team-based care ■ Customized ACO Plan uses the MassHealth ■ Smoking cessation educational videos network of hospitals. Please go to support ■ Educational https://masshealth.ehs.state.ma.us/ ■ Diabetes handouts providerdirectory/ for a list of management & ■ Shared decision hospitals. education making tools ■ Weight loss ■ Patient portal support MORE INFORMATION

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.partners.org/MassHealthACO Customer Service: (800) 231-2722

25 Primary Care ACO Plans

Steward Health Choice

Primary Care ACO Plan

Steward Health Choice

SERVICE AREAS Please Note: Service Areas All Service Areas To enroll in a Primary Care ACO, you will need to also select a PCP in that ACO’s network. PCPs may not be available in all service areas.

Behavioral Health Services Members can get a full range of mental health and substance use services. For more information, call the Massachusetts Behavioral Steward Health Choice’s doctors, nurses, Health Partnership at hospitals, and health care professionals work as (800) 495-0086 or visit a team to provide you high-quality care in your www.masspartnership.com. community. Our goal is to keep you healthy, and we are here for you if you get sick. We offer programs and services to support your care Hospitals needs. Steward Health Choice’s Primary Special Programs and Extra Benefits Care ACO Plan uses the MassHealth network of hospitals. Please go to ■ Steward Healthy ■ Health coaches Rewards—Earn gift ■ Childbirth classes https://masshealth.ehs.state.ma.us/ cards & other rewards providerdirectory/ for a list of for completing ■ Bike helmets hospitals. healthcare activities. ■ Caregiver support ■ Wellness activities

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.stewardhealthchoice.org/massachusetts Customer Service: (855) 860-4949

26 MassHealth Enrollment Guide | COMPARE Managed Care Organizations

BMC HealthNet Plan LEARN

Managed Care Organization

BMC HealthNet Plan

SERVICE AREAS

Behavioral Health Services All Service Areas COMPARE Members can get a full range of mental health and substance use services. For more information, call (888) 217-3501.

Hospitals Please see page 11 for a list of hospitals included in BMC HealthNet Plan’s network. Healthy is easier when you have a community to back you up. That’s why BMC HealthNet

Plan gets to know you and your family’s needs. ENROLL We connect you to care and local resources, supporting you on your road to healthy.

Special Programs and Extra Benefits

■ Health text messaging ■ Incentives for pregnant women & new moms ■ Lifestyle & wellness programs ■ Free car seats & booster seats ■ Fitness reimbursement ■ Free kids’ bike helmets MORE INFORMATION ■ Free dental kit

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.bmchp.org Customer Service: (888) 566-0010 Behavioral Health: (888) 217-3501

27 Managed Care Organizations

Tufts Health Together

Managed Care Organization

Tufts Health Together

SERVICE AREAS Adams Lowell Athol Lynn Behavioral Health Services Beverly Malden Westfield Members can get a full range of Boston Northampton Woburn mental health and substance use Framingham Pittsfield Worcester services. For more information, call Gardner- Quincy Fitchburg Revere (888) 257-1985. Gloucester Salem Greenfield Somerville Haverhill Southbridge Hospitals Holyoke Springfield Lawrence Waltham Please see page 22 for a list of hospitals included in the Tufts Find your town and its service area on page 36. Health Together Plan’s network. Tufts Health Together focuses on improving the health and wellness of members, aiming to be the best MassHealth managed care plan in Massachusetts, achieving exceptional outcomes in quality and member experience in a cost- effective manner.

Special Programs and Extra Benefits

■ Health assessment & health coaching ■ Pregnancy programs ■ Pharmacy discount ■ Fitness reimbursement ■ Gift card towards car seats & booster seats ■ Yearly checkup rewards

Contact the plan for a full list of special programs and extra benefits. Certain rules may apply.

www.tuftshealthplan.com/together Customer Service: (888) 257-1985 Behavioral Health: (888) 257-1985

28 MassHealth Enrollment Guide | COMPARE Primary Care Clinician Plan

Primary Care Clinician (PCC) Plan LEARN

Primary Care Clinician (PCC) Plan

Please Note: SERVICE AREAS ■ To enroll in the Primary Care Clinician (PCC) Plan, you will also need to select a PCP in All Service Areas COMPARE the PCC Plan’s network. PCPs may not be available in all service areas. ■ Community Partners, who provide long- term services and supports, are not available in the PCC Plan. ■ Behavioral Health Community Partners are only available for PCC Plan members who also participate in Community Based Flexible Supports (CBFS), a Massachusetts Department of Mental Health program. ■ PCC Plan members can enroll in an ACO or The PCC Plan is a managed care health plan for MassHealth members throughout MCO at any time.

Massachusetts. The PCC Plan provider network ENROLL includes doctors, nurse practitioners, hospitals, pharmacies, and other health care providers. Behavioral Health Services As a PCC Plan member, you can get behavioral Members can get a full range of health services from the Massachusetts mental health and substance use Behavioral Health Partnership (MBHP). services. For more information, Please Note: Care in the PCC Plan may not be as call the Massachusetts Behavioral integrated or coordinated as care in ACOs or MCOs. Health Partnership at Special Programs and Extra Benefits (800) 495-0086 or visit www.masspartnership.com. ■ Women & children educational materials ■ Disease management material MORE INFORMATION Hospitals

The PCC Plan uses the MassHealth Contact the plan for a full list of special programs and network of hospitals. Please go to benefits. Certain rules may apply. https://masshealth.ehs.state.ma.us/ providerdirectory/ for a list of www.mass.gov/service-details/primary-care- hospitals. clinician-pcc-plan-for-masshealth-members Customer Service: (800) 841-2900

29 Enroll in or Change a Health Plan

Enrolling in a IMPORTANT Health Plan

Choose a health plan offered in your area, but do it by the date listed in the letter that came with this guide. Choose the health plan If you do not enroll in a health that best fits you or your family’s health care needs. If you do not choose a health plan, plan, MassHealth will enroll for MassHealth will choose one for you. you. Choose the plan that’s best for you and enroll today! Ready to enroll? It’s easy!

Enroll Online Enroll by Phone Enroll by Mail (RECOMMENDED) Our customer service Fill out a MassHealth The fastest way to enroll in representatives can enroll Health Plan Enrollment a health plan is online. you into a health plan over Form. Mail the completed the phone. form to: www.MassHealthChoices.com MassHealth Program • Click “Enroll Now” (800) 841-2900 P.O. Box 120045 • Fill out the form TTY: (800) 497-4648 Boston, MA 02112-9912 • Click “Submit” Monday–Friday 8:00 a.m.–5:00 p.m. Fax: (617) 988-8903

30 MassHealth Enrollment Guide | ENROLL Changing Your Plan Selection Period If you are enrolled in an MCO or ACO health

Health Plan LEARN plan, you will have a 90-day Plan Selection As a MassHealth member enrolled in a health Period every year. MassHealth will notify you plan, you can change your health plan for any about your Plan Selection Period. During that reason only during your Plan Selection Period. period, you can change health plans for any Once you are in your Fixed Enrollment Period, reason. you will be able to change your health plan If you are enrolled in the PCC Plan, you can only for certain reasons. change to an ACO or an MCO at any time. The following members can change health If you decide to change your health plan, be plans at any time for any reason. sure to check www.MassHealthChoices.com ■ Children who are in the care or custody of for health plan options available in your area. the Department of Children and Families COMPARE (DCF) Fixed Enrollment Period ■ Youth who are in the care or custody of If you are in an ACO or MCO when your Plan the Department of Youth Services (DYS) Selection Period has ended, you will be in ■ Newborns and children who are younger your Fixed Enrollment Period. During your than one year old Fixed Enrollment Period, you will not be able ■ Members enrolled in the Primary Care to change your health plan until the next Plan Clinician (PCC) Plan Selection Period, except for certain reasons. (See page 32.) ENROLL

PLAN SELECTION PERIOD VS. FIXED ENROLLMENT PERIOD

Plan Selection Period Fixed Enrollment Period MORE INFORMATION

During this time, you CAN During this time, you CANNOT change your health plan. change your health plan. Except for certain reasons (See page 32.)

31 Fixed Enrollment Period Exceptions ■ You demonstrate to MassHealth that the MCO, Accountable Care Partnership Plan, When you are in your fixed enrollment or Primary Care ACO violated a material period, you may only change your health plan provision of its contract with MassHealth. for one of these reasons. ■ MassHealth imposes a sanction on the ■ You move out of the MCO, Accountable MCO, Accountable Care Partnership Plan, Care Partnership Plan, or Primary Care or Primary Care ACO that specifically ACO service area. allows you to disenroll from your MCO, ■ The MCO, Accountable Care Partnership Accountable Care Partnership Plan, or Plan, or Primary Care ACO does not, Primary Care ACO without cause. because of moral or religious objections, ■ You demonstrate to MassHealth that cover the service you request. the MCO, Accountable Care Partnership ■ You need related services to be performed Plan, or Primary Care ACO is not meeting at the same time. Not all related services your language, communication, or other are available within the network, and accessibility preferences or needs. your primary care provider or another ■ You demonstrate to MassHealth that provider determines that receiving the your key network providers, including services separately would subject you to PCPs, specialists, or behavioral health unnecessary risk. providers, leave the MCO, Accountable ■ You receive poor quality care, lack access Care Partnership Plan, or Primary Care to services covered, or lack access to ACO network. providers experienced in dealing with your health care needs. ■ The MCO or Accountable Care Partnership Plan is no longer contracted with MassHealth to cover your service area, or your PCP who participates in your Primary If MassHealth denies your request Care ACO is not available in your service to transfer to another health plan area. during your Fixed Enrollment ■ You demonstrate to MassHealth that the Period, you can ask for a fair hearing MCO, Accountable Care Partnership Plan, (appeal). Learn more about asking or Primary Care ACO has not provided for a fair hearing on page 35. access to providers that meet your health care needs over time, even after you request assistance. ■ You are homeless (and MassHealth’s records also indicate that you are homeless), and the MCO, Accountable Care Partnership Plan, or Primary Care ACO cannot accommodate your needs geographically.

32 MassHealth Enrollment Guide | ENROLL Using Your Member

ID Cards LEARN

After you enroll in a health plan, MassHealth will send you a letter confirming your enrollment. The health plan you selected will send you a welcome packet in the mail with important details about your health plan. Always carry both your health plan and MassHealth member ID cards with you so you have them when you need care. Be sure to show both member ID cards whenever you get health care or fill a prescription.

Carry Both ID Cards COMPARE

Everyone in your family who is Health Plan ID enrolled will receive a health plan MassHealth ID and MassHealth member ID card. Be sure to show both member ID cards whenever you get health care or fill a prescription. If your health plan member ID card is ever damaged, lost, or stolen, call the health plan’s member service department for a replacement card.

If your MassHealth member ID card is ever ENROLL damaged, lost, or stolen, call the MassHealth Customer Service Center at (800) 841-2900 (TTY: (800) 497-4648) for a replacement card. MORE INFORMATION

33 More Information

Rights and Your responsibilities ■ Arrive on time to your health care Responsibilities appointments. ■ Call your health care provider if you are Your rights going to be late or if you need to cancel an ■ You can ask for a copy of your health appointment. records at any time. ■ Tell your primary care provider if you went ■ Your health care providers will keep your to the emergency room. health information and records private. Reporting Changes ■ Your health care providers will give you easy-to-understand information about It is important to keep MassHealth and your treatment options. health plan up to date. ■ Your providers will make you part of all decisions about your health care. Who should I call? MassHealth Health Plan ■ You can refuse health care treatment at any time and for any reason. Change of ■ You can file a grievance or appeal if you address think your health plan or MassHealth denied you a medically necessary service or treatment. New Phone number

New baby or adoption

Key Term

Medically Necessary Services EMERGENCY SERVICES or Supplies

Health care services or supplies needed Generally, if you are enrolled in an ACO to prevent, diagnose, or treat an Partnership Plan or an MCO, you must see illness, injury, condition, disease, or providers only in your plan’s network. In its symptoms and that meet accepted emergencies, however, you can receive standards of medicine. care at any hospital, whether or not it is in your plan’s network.

34 MassHealth Enrollment Guide | MORE INFORMATION You can also contact the MassHealth Understanding Customer Service Center at (800) 841-2900 (TTY: (800) 497-4648).

Your Costs LEARN Appeals and Fair Hearings Copays If you disagree with a decision made by your Copays are a small amount that you must pay health plan or health plan providers, you can toward your services. file an appeal or request a MassHealth Fair Hearing. Look in your health plan’s member If you get a bill handbook for more detailed information on If you get a bill for a charge other than your appeals and Fair Hearings. copay for any covered service or benefit, If you have questions or concerns about call your health plan’s customer service the process, you can call your health plan’s department. You can find their phone number customer service department. Their phone COMPARE on the back of your health plan member number is located on the back of your health ID card. If you are a PCC Plan member or plan member ID card. You can also contact enrolled in a Primary Care ACO, however, call the MassHealth Customer Service Center at the MassHealth Customer Service Center at (800) 841-2900 (TTY: (800) 497-4648). (800) 841-2900 (TTY: (800) 497-4648). If you are enrolled in an Accountable Care Partnership Plan or an MCO, you can call the My Ombudsman provider who sent the bill. Tell the provider that you are a MassHealth member and the My Ombudsman is an independent name of your health plan. Give the provider organization that provides assistance to your health plan and MassHealth member ID members. The organization: numbers. Ask them to bill your health plan ■ Provides information about your benefits for the service. and rights in your plan ENROLL Your health plan will cover only medically ■ Addresses problems or concerns—will necessary services. listen, investigate, and discuss options with you; and ■ Helps with grievances and appeals—will Grievances, Appeals, explain how to file a grievance or appeal and what to expect. and Fair Hearings Contact My Ombudsman Grievances Call: (855) 781-9898 (For TTY users, use MassRelay at 711 to call the number above) Your health plan is committed to making MORE INFORMATION sure that all members have the best health Hours: Monday–Friday 9 a.m.–4 p.m. care experience. If you feel that you got Email: [email protected] unsatisfactory service, or have questions, Online: www.myombudsman.org concerns, or complaints, please call your health plan’s customer service department. Visit: 11 Dartmouth Street, Suite 301, Their phone number is located on the back of Malden, MA 02148. Walk-in hours: Mondays your health plan member ID card. 1 p.m.–4 p.m. and Thursdays 9 a.m.–12 p.m.

35 Service Areas

Each health plan covers specific service areas. Service areas are regional groups of cities and towns. Remember, you can choose a health plan only in your service area.

Your Town Service Area Your Town Service Area Abington Brockton Berkshire Pittsfield Accord Quincy Berlin Gardner-Fitchburg Acton Lowell Bernardston Greenfield Acushnet New Bedford Beverly Beverly Adams Adams Billerica Lowell Agawam Westfield Blackstone Framingham Alford Pittsfield Blanford Westfield Allston Boston Bolton Gardner-Fitchburg Amesbury Haverhill Bondsville Springfield Amherst Northampton Boston Boston Andover Lawrence Bourne Falmouth Aquinnah Oak Bluffs Boxboro Framingham Arlington Somerville Boxford Haverhill Arlington Heights Somerville Boylston Worcester Ashburnham Gardner-Fitchburg Braintree Quincy Ashby Gardner-Fitchburg Brant Rock Plymouth Ashfield Greenfield Brewster Orleans Ashland Framingham Bridgewater Brockton Ashley Falls Pittsfield Brighton Boston Assonet Fall River Brimfield Southbridge Athol Athol Brockton Brockton Attleboro Attleboro Brookfield Southbridge Auburn Worcester Brookline Boston Auburndale Waltham Brookline Village Boston Avon Brockton Bryantville Plymouth Ayer Gardner-Fitchburg Buckland Greenfield Babson Park Boston Burlington Woburn Baldwinville Athol Buzzards Bay Falmouth Barnstable Barnstable Byfield Haverhill Barre Athol Cambridge Somerville Becket Pittsfield Canton Brockton Bedford Woburn Carlisle Lowell Belchertown Holyoke Carver Plymouth Bellingham Framingham Cataumet Falmouth Belmont Waltham Centerville Barnstable Berkley Taunton Charlemont Greenfield

36 MassHealth Enrollment Guide | MORE INFORMATION Your Town Service Area Your Town Service Area Charlestown Boston East Bridgewater Brockton

Charlton Southbridge East Brookfield Southbridge LEARN Charlton City Southbridge East Dennis Orleans Charlton Depot Southbridge East Douglas Framingham Chartley Attleboro East Falmouth Falmouth Chatham Orleans East Freetown Fall River Chelmsford Lowell East Longmeadow Springfield Chelsea Revere East Mansfield Attleboro Cheshire Adams East Orleans Orleans Chester Westfield East Otis Pittsfield Chesterfield Northampton East Princeton Gardner-Fitchburg Chestnut Hill Boston East Sandwich Falmouth COMPARE Chicopee Springfield East Templeton Athol Chilmark Oak Bluffs East Walpole Framingham Clarksburg Adams East Wareham Wareham Clinton Gardner-Fitchburg Eastham Orleans Cohasset Quincy Easthampton Northampton Colrain Greenfield Easton Brockton Concord Lowell Edgartown Oak Bluffs Conway Greenfield Egremont Pittsfield Cotuit Barnstable Elmwood Brockton Cummaquid Barnstable Erving Greenfield Cummington Northampton Essex Gloucester Cuttyhunk Falmouth Everett Malden

Dalton Pittsfield Fairhaven New Bedford ENROLL Danvers Salem Fall River Fall River Dartmouth New Bedford Falmouth Falmouth Dedham Quincy Feeding Hills Westfield Deerfield Greenfield Fiskdale Southbridge Dennis Orleans Fitchburg Gardner-Fitchburg Dennis Port Orleans Florida Adams Devens Gardner-Fitchburg Forestdale Falmouth Dighton Taunton Foxboro Attleboro Dorchester Boston Framingham Framingham Douglas Framingham Franklin Framingham Dover Framingham Freetown Fall River MORE INFORMATION Dracut Lowell Gardner Gardner-Fitchburg Drury Adams Georgetown Haverhill Dudley Southbridge Gilbertville Athol Dunstable Lowell Gill Greenfield Duxbury Plymouth Glendale Pittsfield East Boston Revere Gloucester Gloucester

37 Your Town Service Area Your Town Service Area Goshen Northampton Huntington Westfield Gosnold Falmouth Hyannis Barnstable Grafton Framingham Hyannis Port Barnstable Granby Holyoke Hyde Park Boston Granville Westfield Ipswich Gloucester Great Barrington Pittsfield Jamaica Plain Boston Green Harbor Plymouth Jefferson Worcester Greenbush Quincy Kingston Plymouth Greenfield Greenfield Lake Pleasant Greenfield Groton Gardner-Fitchburg Lakeville Taunton Groveland Haverhill Lancaster Gardner-Fitchburg Hadley Northampton Lanesboro Adams Halifax Plymouth Lawrence Lawrence Hamilton Beverly Lee Pittsfield Hampden Springfield Leeds Northampton Hancock Adams Leicester Worcester Hanover Plymouth Lenox Pittsfield Hanson Plymouth Lenox Dale Pittsfield Hardwick Athol Leominster Gardner-Fitchburg Harvard Gardner-Fitchburg Leverett Greenfield Harwich Orleans Lexington Woburn Harwich Port Orleans Leyden Greenfield Hatfield Northampton Lincoln Lowell Hathorne Salem Linwood Framingham Haverhill Haverhill Littleton Lowell Hawley Greenfield Longmeadow Springfield Haydenville Northampton Lowell Lowell Heath Greenfield Ludlow Springfield Hingham Quincy Lunenburg Gardner-Fitchburg Hinsdale Pittsfield Lynn Lynn Holbrook Brockton Lynnfield Lynn Holden Worcester Malden Malden Holland Southbridge Manchaug Framingham Holliston Framingham Manchester-by- Beverly Holyoke Holyoke the-Sea Hopedale Framingham Manomet Plymouth Hopkinton Framingham Mansfield Attleboro Housatonic Pittsfield Marblehead Salem Hubbardston Gardner-Fitchburg Marion New Bedford Hudson Framingham Marlborough Framingham Hull Quincy Marshfield Plymouth Humarock Plymouth

38 MassHealth Enrollment Guide | MORE INFORMATION Your Town Service Area Your Town Service Area Marshfield Hills Plymouth New Marlborough Pittsfield

Marstons Mills Barnstable New Salem Athol LEARN Mashpee Falmouth Newbury Haverhill Mattapan Boston Newburyport Haverhill Mattapoisett New Bedford Newton Waltham Maynard Framingham Norfolk Framingham Medfield Framingham North Adams Adams Medford Malden North Amherst Northampton Medway Framingham North Andover Lawrence Melrose Malden North Attleboro Attleboro Mendon Framingham North Billerica Lowell Menemsha Oak Bluffs North Brookfield Southbridge COMPARE Merrimac Haverhill North Carver Plymouth Methuen Lawrence North Chatham Orleans Middleboro Taunton North Chelmsford Lowell Middlefield Northampton North Dartmouth New Bedford Middleton Salem North Dighton Taunton Milford Framingham North Eastham Orleans Mill River Northampton North Easton Brockton Millbury Worcester North Egremont Pittsfield Millis Framingham North Falmouth Falmouth Millville Framingham North Grafton Framingham Milton Quincy North Hatfield Northampton Milton Village Quincy North Marshfield Plymouth

Minot Quincy North Oxford Southbridge ENROLL Monponsett Plymouth North Pembroke Plymouth Monroe Adams North Reading Woburn Monroe Bridge Adams North Scituate Quincy Monson Springfield North Truro Orleans Montague Greenfield North Uxbridge Southbridge Monterey Pittsfield Northampton Northampton Montgomery Westfield Northborough Framingham Monument Beach Falmouth Northbridge Framingham Mount Hermon Greenfield Northfield Greenfield Mount Washington Pittsfield Norton Attleboro Nahant Lynn Norwell Quincy MORE INFORMATION Nantucket Nantucket Norwood Quincy Natick Framingham Nutting Lake Lowell Needham Waltham Oak Bluffs Oak Bluffs New Ashford Adams Oakdale Framingham New Bedford New Bedford Oakham Worcester New Braintree Worcester Onset Wareham

39 Your Town Service Area Your Town Service Area Orange Athol Russell Westfield Orleans Orleans Rutland Worcester Osterville Barnstable Sagamore Falmouth Otis Pittsfield Sagamore Beach Falmouth Oxford Southbridge Salem Salem Palmer Springfield Salisbury Haverhill Paxton Worcester Sandisfield Pittsfield Peabody Salem Sandwich Falmouth Pelham Northampton Saugus Lynn Pembroke Plymouth Savoy Adams Pepperell Gardner-Fitchburg Scituate Quincy Peru Pittsfield Seekonk Taunton Petersham Athol Sharon Brockton Phillipston Athol Shattuckville Greenfield Pinehurst Lowell Sheffield Pittsfield Pittsfield Pittsfield Shelburne Greenfield Plainfield Northampton Shelburne Falls Greenfield Plainville Attleboro Sheldonville Attleboro Plymouth Plymouth Sherborn Framingham Plympton Plymouth Shirley Gardner-Fitchburg Pocasset Falmouth Shrewsbury Worcester Prides Crossing Beverly Shutesbury Greenfield Princeton Gardner-Fitchburg Siasconset Nantucket Provincetown Orleans Somerset Fall River Quincy Quincy Somerville Somerville Randolph Quincy South Barre Athol Raynham Taunton South Carver Plymouth Raynham Center Taunton South Chatham Orleans Reading Woburn South Dartmouth New Bedford Readville Boston South Deerfield Greenfield Rehoboth Taunton South Dennis Orleans Revere Revere South Easton Brockton Richmond Pittsfield South Egremont Pittsfield Rochdale Worcester South Grafton Framingham Rochester New Bedford South Hadley Holyoke Rockland Brockton South Hamilton Beverly Rockport Gloucester South Harwich Orleans Roslindale Boston South Lancaster Gardner-Fitchburg Rowe Greenfield South Lee Pittsfield Rowley Haverhill South Orleans Orleans Roxbury Boston South Walpole Framingham Royalston Athol South Wellfleet Orleans

40 MassHealth Enrollment Guide | MORE INFORMATION Your Town Service Area Your Town Service Area South Yarmouth Barnstable Ware Springfield

Southampton Holyoke Wareham Wareham LEARN Southborough Framingham Warren Southbridge Southbridge Southbridge Warwick Athol Southfield Pittsfield Washington Pittsfield Southwick Westfield Watertown Waltham Spencer Southbridge Waverley Boston Springfield Springfield Wayland Framingham Sterling Gardner-Fitchburg Webster Southbridge Still River Gardner-Fitchburg Wellesley Waltham Stockbridge Pittsfield Wellfleet Orleans Stoneham Woburn Wendell Greenfield COMPARE Stoughton Brockton Wendell Depot Greenfield Stow Framingham Wenham Beverly Sturbridge Southbridge West Barnstable Barnstable Sudbury Framingham West Boxford Haverhill Sunderland Greenfield West Boylston Worcester Sutton Framingham West Bridgewater Brockton Swampscott Lynn West Brookfield Southbridge Swansea Fall River West Chatham Orleans Taunton Taunton West Chesterfield Northampton Templeton Athol West Dennis Orleans Tewksbury Lowell West Falmouth Falmouth Thorndike Springfield West Groton Gardner-Fitchburg

Three Rivers Springfield West Harwich Orleans ENROLL Tisbury Oak Bluffs West Hatfield Northampton Tolland Westfield West Hyannisport Barnstable Topsfield Beverly West Medford Malden Townsend Gardner-Fitchburg West Newbury Haverhill Truro Orleans West Roxbury Boston Turners Falls Greenfield West Springfield Westfield Tyngsboro Lowell West Stockbridge Pittsfield Tyringham Pittsfield West Tisbury Oak Bluffs Upton Framingham West Upton Framingham Uxbridge Framingham West Wareham Wareham Vill. of Nagog Woods Lowell West Warren Southbridge MORE INFORMATION Vineyard Haven Oak Bluffs West Yarmouth Barnstable Waban Boston Westborough Framingham Wakefield Malden Westfield Westfield Wales Southbridge Westford Lowell Walpole Framingham Westhampton Northampton Waltham Waltham Westminster Gardner-Fitchburg

41 Your Town Service Area Weston Waltham Westport Fall River Westport Point Fall River Westwood Quincy Weymouth Quincy Whately Northampton Wheelwright Athol White Horse Beach Plymouth Whitinsville Framingham Whitman Brockton Wilbraham Springfield Wilkinsonville Framingham Williamsburg Northampton Williamstown Adams Wilmington Woburn Winchendon Gardner-Fitchburg Winchendon Springs Gardner-Fitchburg Winchester Woburn Windsor Adams Winthrop Revere Woburn Woburn Woods Hole Falmouth Woodville Framingham Worcester Worcester Woronoco Westfield Worthington Northampton Wrentham Attleboro Yarmouth Barnstable Yarmouth Port Barnstable

42 MassHealth Enrollment Guide | MORE INFORMATION Questions? Learn, Compare, and

We are here to help. Enroll online MassHealth Customer Service Center Find a doctor, compare plans, (800) 841-2900 and enroll online at TTY: (800) 497-4648 for people www.MassHealthChoices.com. who are deaf, hard of hearing, or speech disabled. For information about the MassHealth program, visit www.mass.gov/masshealth.

EG-MH (Rev. 09/18)