MassHealth

Enrollment Guide

Your Choices Starting JULY 2021

LEARN about health plans

COMPARE health plans

ENROLL in a health plan

COMMONWEA LTH OF | 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 have health plans to choose from so you can get the health care you need. Please read this guide to learn about the plans and 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 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

Accountable Care Accountable Care Organizations (ACOs) Partnership Plans

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

The time of year when you CANNOT INFORMATION 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 will PCPs provide a wide range of health care 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 Community Partners blood pressure Community Partners are local organizations ■ Refers you to a specialist when needed that help certain MassHealth members with behavioral health (BH) and long-term services Changing Your PCP and supports (LTSS) needs. You can change from one PCP to another You may be eligible to get help from a within your health plan at any time and for Community Partner if you are enrolled in any reason. • an Accountable Care Organization (ACO), • a Managed Care Organization (MCO), or ACOs and MCOs • the Department of Mental Health’s Adult To change your PCP, call your health plan’s Community Clinical Services (ACCS) program. customer service department. Their phone Note: If you are transitioning out of the ACCS number is on the back of your health plan’s program, you may receive help from the member ID card. Community Partners program. PCC Plan A Community Partner helps you make a plan and works with your Primary Care Provider If you are a PCC Plan member and you (PCP) and other providers to meet your needs. would like to change your PCP, call us at To learn more about the program, visit (800) 841-2900 (TTY: (800) 497-4648). www.mass.gov/guides/masshealth- community-partners-cp-program-information- for-providers.

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 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 INFORMATION 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 Choosing a plan and a primary care provider is Health Plans simple when you use our online tool. There are many health plan options to www.MassHealthChoices.com allows you to search a complete list of primary care choose from. Each health plan has a different providers and compare health plans side by list of doctors, behavioral health providers, side based on what is important to you or and hospitals. The following pages provide your family. a summary of each of the health plans 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 Compare Your Service Area ■ 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 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 product discounts ■ Tobacco cessation program ■ Pharmacy discounts MORE ■ Access 90 prescriptions

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

www.mycarefamily.org Customer Service: (800) 462-5449

Behavioral Health: (844) 451-3519

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Accountable Care Partnership Plans

Hospitals Hospital Name City

Allways Health Partner’s Lawrence Memorial Hospital Medford Accountable Care Partnership Plan of Medford (MelroseWakefield Healthcare) includes the following hospitals in its network: Lowell Main Campus Lowell General Hospital Lowell My Care Family Saints Campus Martha’s Vineyard Hospital Oak Bluffs () Hospital Name City Mass. Eye and Ear Infirmary Addison Gilbert Hospital Gloucester Mass. General Hospital Boston (Lahey Health) (Mass General Brigham) Anna Jaques Hospital Newburyport MelroseWakefield Hospital Melrose Beverly Hospital (Lahey Health) Beverly (MelroseWakefield Healthcare) BI Deaconess Medical Center Boston Morton Hospital (Steward) Taunton BI Deaconess-Milton Milton Cottage Hospital Nantucket BI Deaconess-Needham Needham (Mass General Brigham) Nashoba Valley Medical Center Ayer BI Deaconess-Plymouth Plymouth (Steward) *Boston Children’s Hospital Boston New England Baptist Roxbury Crossing Boston Newton-Wellesley Hospital Newton Brigham and Women’s Hospital Boston (Mass General Brigham) (Mass General Brigham) (Steward) Norwood (CHA) Cambridge Salem Hospital Salem (Steward) Dorchester (NSMC/Mass General Brigham) *Dana-Farber Cancer Institute Boston (CHA) Somerville Concord Saint Anne’s Hospital (Steward) Fall River

Everett Hospital (CHA) Everett St. Elizabeth’s Medical Center Brighton (Steward) Faulkner Hospital Jamaica Plain (Mass General Brigham) Boston

Good Samaritan Medical Center Brockton Winchester (Steward) (Lahey Health)

Holy Family Hospital (Steward) Haverhill Holy Family Hospital Methuen The hospital list is subject to change, and the Methuen (Steward) hospitals may have service limits. Please check with the plan for specific questions about network Lahey Hospital and Burlington Medical Center hospitals. Lahey Medical Center-Peabody Peabody *Please call the health plan about availability. Lawrence General Hospital Lawrence

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 SERVICE AREAS (page 10) Attleboro Quincy BMC HealthNet Plan Signature Barnstable Revere COMPARE Boston Somerville Alliance (page 10) Brockton Southbridge BMC HealthNet Plan Southcoast Fall River Springfield Alliance (page 11) Falmouth Taunton Holyoke Waltham Malden Wareham New Bedford Westfield Northampton Woburn Plymouth 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 BMC HealthNet Plan is partnering with Boston services. For more information, call Medical Center, community health centers, and (888) 217-3501. other providers throughout Boston, southeast,

and western MA to provide high-quality health ENROLL care to local communities. We work together to understand your health goals so that we can give

you the right care at the right time.

Special Programs and Extra Benefits ■ Healthy cooking & ■ Free dental kits nutrition classes ■ Mobile ID card Fruit and vegetable ■ ■ Fitness vouchers reimbursements Free car seats & ■ ■ Pregnancy booster seats programs Free kids’ bike MORE ■ ■ Mail order helmets prescriptions

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

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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 Attleboro Springfield Brockton Westfield Plymouth Quincy Find your town and its Taunton service area on page 36. Find your town and its 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 kids’ bike ■ Parenting & family ■ Fitness management helmets classes reimbursements programs ■ Mobile ID card ■ Free Zumba & yoga ■ Free kids’ bike Mobile health ■ ■ Fitness classes helmets screening van reimbursements ■ Nutrition education ■ Free dental kits ■ Fruit & vegetable Pregnancy & fresh produce ■ ■ Pregnancy programs vouchers programs vouchers Mail order ■ Free car seats & ■ ■ Mail order ■ Free car seats prescriptions booster seats prescriptions & booster seats ■ Mobile ID card 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 Plans’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 Anna Jaques Hospital Newburyport Plymouth 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 Beverly Hospital Beverly center stage. BMC HealthNet Plan helps you get (Lahey Health) the right care at the right time—we listen more, BI Deaconess Boston plan better, and include you every step of the

Medical Center ENROLL way. Because working together for your health just makes sense. BI Deaconess-Milton Milton BI Deaconess-Needham Needham

Special Programs and Extra Benefits BI Deaconess-Plymouth Plymouth ■ Access to our ■ Free car seats Boston Children’s Hospital Boston Baby Café & booster seats (Not available in BMC Mercy or Mobile health Fitness BMC Signature Plans) ■ ■ screening van reimbursements Boston Medical Center Boston ■ Walking programs ■ Pregnancy **Brigham and Women’s Boston & yoga classes programs Hospital (Mass General Brigham)

■ Nutrition education ■ Mail order Brockton prescriptions (Signature Healthcare) MORE ■ Fruit & vegetable vouchers ■ Mobile ID card Cambridge Hospital (CHA) Cambridge

Cape Cod Hospital Hyannis INFORMATION Contact the plan for a full list of special programs and Carney Hospital (Steward) Dorchester extra benefits. Certain rules may apply. Charlton Hospital (Southcoast) Fall River www.bmchp.org/southcoast Clinton Hospital (UMass Clinton Memorial HealthAlliance)

Customer Service: (888) 566-0010 Behavioral Health: (888) 217-3501

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Accountable Care Partnership Plans

Hospital Name City Hospital Name City Cooley Dickinson Health Care Northampton Lowell General Hospital Lowell Saints Campus (Mass General Brigham) *Dana-Farber Cancer Institute Boston Marlborough Hospital Marlboro (UMass Memorial) Emerson Hospital Concord **Martha’s Vineyard Hospital Oak Bluffs Everett Hospital (CHA) Everett (Mass General Brigham)

Fairview Hospital Great Barrington Mass. Eye and Ear Infirmary Boston (Berkshire Health Systems) **Mass. General Hospital Boston Falmouth (Cape Cod Healthcare) (Mass General Brigham) MelroseWakefield Hospital Melrose **Faulkner Hospital Jamaica Plain (MelroseWakefield Healthcare) (Mass General Brigham) Mercy Medical Center Springfield Framingham Union Hospital Framingham Milford-Whitinsville Hospital Milford (Metrowest Medical Center) Miriam Hospital Providence, RI Franklin Medical Center Greenfield () Morton Hospital (Steward) Taunton

Good Samaritan Medical Center Brockton Mt. Auburn Hospital Cambridge (Steward) **Nantucket Cottage Hospital Nantucket Harrington Hospital Southbridge (Mass General Brigham) Health Alliance Hospital Leominster Nashoba Valley Medical Center Ayer (UMass Memorial) (Steward) Heywood Hospital Gardner **Newton-Wellesley Hospital Newton (Mass General Brigham) Holy Family Hospital (Steward) Haverhill Noble Hospital (Baystate) Westfield Holy Family Hospital Methuen Methuen (Steward) Norwood Hospital (Steward) Norwood

Holyoke Medical Center Holyoke Rhode Island Hospital Providence, RI Lahey Hospital and Burlington Salem Hospital Salem Medical Center (NSMC/Mass General Brigham) Lahey Medical Peabody Shriners Hospital for Boston Center-Peabody Children-Boston Lawrence General Hospital Lawrence Shriners Hospital for Springfield Children-Springfield Lawrence Memorial Hospital Medford of Medford Somerville Hospital (CHA) Somerville (MelroseWakefield Healthcare) South Weymouth

Leonard Morse Hospital Natick Southern NH Nashua, NH (MetroWest Medical Center) Medical Center Lowell General Hospital Lowell Saint Anne’s Hospital (Steward) Fall River Main Campus

12 MassHealth Enrollment Guide | COMPARE

Accountable Care Partnership Plans

Hospital Name City LEARN 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 Tufts Medical Center Boston UMass Memorial Medical Center Worcester COMPARE Memorial Campus UMass Memorial Medical Center Worcester University Campus

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 network hospitals.

*Please call the health plan about availability.

**Please call BMC HealthNet Plan Mercy Alliance, ENROLL BMC HealthNet Plan Signature Alliance, and BMC HealthNet Plan 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 • (888) 877-7183 Health Programs. BFHC is committed to 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

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 Framingham Beverly Plymouth COMPARE Gardner-Fitchburg 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 Quit to Win—quit smoking program ■ Oh Baby—baby wellness ■ Oh Baby—baby wellness ■ Pharmacy discount ■ Pharmacy discount ■ Healthwise Knowledgebase—health ■ encyclopedia ■ Healthwise Knowledgebase—health encyclopedia ■ Mobile ID card Mobile ID card ■ MORE

Contact the plan for a full list of special programs and Contact the plan for a full list of special programs and INFORMATION 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

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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) Hyannis

Hospital Name City Falmouth Hospital Falmouth Baystate Medical Center Springfield (Cape Cod Healthcare) Lawrence General Hospital Lawrence Berkshire Medical Center Pittsfield Lawrence Memorial Hospital Fairview Hospital Great Barrington of Medford Medford (Berkshire Health Systems) (MelroseWakefield Healthcare) Tufts Children’s Hospital Boston Lowell General Hospital Lowell Mass. Eye and Ear Infirmary Boston Main Campus Tufts Medical Center Boston Lowell General Hospital Lowell Saints Campus Mass. Eye and Ear Infirmary Boston Fallon 365 Care MelroseWakefield Hospital Melrose (MelroseWakefield Healthcare) 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 hospitals may have service limits. Please check Leonard Morse Hospital Natick (MetroWest Medical Center) with the plan for specific questions about network hospitals. Milford-Whitinsville Hospital Milford 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 wellness

Contact the plan for a full list of special programs and INFORMATION 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 Baystate Medical Center Springfield with the plan for specific questions about network Baystate Wing Hospital Palmer hospitals. Berkshire Medical Center Pittsfield *Please call the health plan about availability. *Clinton Hospital Clinton (UMass Memorial HealthAlliance) Fairview Hospital Great Barrington (Berkshire Health Systems) Franklin Medical Center Greenfield (Baystate Health)

*Health Alliance Hospital Leominster (UMass Memorial) Holyoke *Marlborough Hospital Marlboro (UMass Memorial) Mercy Medical Center Springfield

Noble Hospital (Baystate) Westfield *Shriners Hospital for Boston Children-Boston

Shriners Hospital for Springfield Children-Springfield

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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 Tufts Health Together with Beverly Malden COMPARE 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 (888) 257-1985 Atrius Health plan is to improve the health 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

■ Pregnancy programs

Healthy cooking & nutrition programs ■ ■ Pharmacy discount ■ Fitness reimbursements ■ Gift cards for healthy behaviors ■ Gift card toward car seats & booster seats MORE ■ Health assessment & health coaching ■ Specialized care coordination programs

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

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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 Malden Adams Lawrence Salem Barnstable Orleans Attleboro Lowell Somerville Beverly Plymouth Barnstable Lynn Southbridge Boston Quincy Beverly Malden Springfield Boston Nantucket Brockton Revere Taunton Brockton New Bedford Falmouth Salem Waltham Fall River Northampton Wareham Framingham Somerville Falmouth Oak Bluffs Westfield Haverhill Waltham Framingham Orleans Woburn Lowell Wareham Gardner-Fitchburg Plymouth Worcester Lynn Woburn Haverhill Quincy Holyoke Revere Find your town and its 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

■ Pregnancy programs ■ Gift card toward ■ Community-based ■ Gift card toward car seats & booster asthma program car seats & booster ■ Healthy cooking & seats seats nutrition programs ■ Healthy cooking & Gift cards for nutrition programs Gift cards for ■ Stress management ■ ■ healthy behaviors Pharmacy discount healthy behaviors ■ Pharmacy discount ■ Health assessment Health assessment ■ ■ Fitness ■ ■ Fitness & health coaching & health coaching reimbursements reimbursements

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

SERVICE AREAS Hospital Name City Boston Beverly Hospital Beverly Lynn (Lahey Health) COMPARE Malden BI Deaconess Medical Center Boston Revere Salem BI Deaconess-Milton Milton Somerville BI Deaconess-Needham Needham Waltham BI Deaconess-Plymouth Plymouth Woburn Boston Children’s Hospital Boston

Emerson Hospital Concord Lahey Hospital & Medical Center Burlington Find your town and its service area on page 36. Lowell General Hospital Lowell Main Campus Tufts Health Together with CHA provides person- Lowell General Hospital Lowell centered, coordinated health care to help you Saints Campus feel your best. We embrace diversity, speak ENROLL Mass. Eye and Ear Infirmary Boston many languages, respect culture, and believe everyone deserves to be treated with dignity. Mt. Auburn Hospital Cambridge New England Baptist Roxbury Crossing Special Programs and Extra Benefits *Newton-Wellesley Hospital Newton ■ Pregnancy programs ■ Gift card toward (Mass General Brigham)

Healthy cooking & car seats & booster ■ South Shore Hospital South Weymouth nutrition programs seats Winchester Hospital Winchester Gift cards for ■ Pharmacy discount ■ (Lahey Health) healthy behaviors ■ Fitness reimbursements ■ Health assessment *Please call the health plan about availability. & health coaching MORE

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

www.TuftsHealthTogether.com/CHA

Customer Service: (888) 257-1985 Behavioral Health: (888) 257-1985

21

Accountable Care Partnership Plans

Tufts Health Together with BIDCO Hospital Name City

Carney Hospital (Steward) Dorchester Hospital Name City Charlton Hospital (Southcoast) Fall River

Anna Jaques Hospital Newburyport Clinton Hospital Clinton BI Deaconess Medical Center Boston (UMass Memorial HealthAlliance)

BI Deaconess-Milton Milton Cooley Dickinson Health Care Northampton (Mass General Brigham) BI Deaconess-Needham Needham Dana-Farber Cancer Institute Boston BI Deaconess-Plymouth Plymouth Emerson Hospital Concord Tufts Children’s Hospital Boston Everett Hospital (CHA) Everett New England Baptist Roxbury Crossing Fairview Hospital Great Barrington Tufts Medical Center Boston (Berkshire Health Systems) Falmouth Hospital Falmouth (Cape Cod Healthcare) Tufts Health Together with Boston Children’s ACO and *Faulkner Hospital Jamaica Plain Tufts Health Together (MCO Plan) (Mass General Brigham) Tufts Children’s Hospital Boston 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 Baystate Medical Center Springfield Hasbro Children’s Hospital at Providence, RI Rhode Island Hospital Baystate Wing Hospital Palmer

Health Alliance Hospital Leominster Berkshire Medical Center Pittsfield (UMass Memorial) Beverly Hospital (Lahey Health) Beverly Heywood Hospital Gardner

BI Deaconess Medical Center Boston Holy Family Hospital (Steward) Haverhill BI Deaconess-Milton Milton Holy Family Hospital-Methuen Methuen BI Deaconess-Needham Needham (Steward) BI Deaconess-Plymouth Plymouth Holyoke Medical Center Holyoke

Boston Children’s Hospital Boston Kent County Memorial Hospital Warwick, RI Boston Medical Center Boston Lahey Hospital & Medical Center Burlington

*Brigham and Women’s Hospital Boston Lahey Medical Center-Peabody Peabody (Mass General Brigham) Landmark Medical Center Woonsocket, RI Brockton Hospital Brockton Lawrence General Hospital Lawrence (Signature Healthcare) Lawrence Memorial Hospital Medford Cambridge Hospital (CHA) Cambridge of Medford Cape Cod Hospital Hyannis (MelroseWakefield 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 (UMass Memorial) Tufts Medical Center Boston *Martha’s Vineyard Hospital Oak Bluffs (Mass General Brigham) UMass Memorial Medical Center Worcester

Memorial Campus COMPARE Mass. Eye and Ear Infirmary Boston UMass Memorial Medical Center Worcester *Mass. General Hospital Boston University Campus (Mass General Brigham) Winchester Hospital Winchester MelroseWakefield Hospital Melrose (Lahey Health) (MelroseWakefield Healthcare) Women & Infants Hospital Providence, RI Mercy Medical Center Springfield

Milford-Whitinsville Hospital Milford *Please call Tufts Health Together with Boston Miriam Hospital Providence, RI Children’s ACO about availability. Not available in Morton Hospital (Steward) Taunton Tufts Health Together (MCO Plan).

Mt. Auburn Hospital Cambridge *Nantucket Cottage Hospital Nantucket Tufts Health Together with CHA (Mass General Brigham)

ENROLL Nashoba Valley Medical Center Ayer Hospital Name City (Steward) New England Baptist Roxbury Crossing BI Deaconess Medical Center Boston

*Newton-Wellesley Hospital Newton Cambridge Hospital (CHA) Cambridge (Mass General Brigham) Everett Hospital (CHA) Everett Noble Hospital (Baystate) Westfield Tufts Children’s Hospital Boston

Norwood Hospital (Steward) Norwood *Mass. General Hospital Boston Rhode Island Hospital Providence, RI (Mass General Brigham) Somerville Hospital (CHA) Somerville *Salem Hospital Salem (NSMC/Mass General Brigham) Tufts Medical Center Boston

Shriners Hospital for Boston MORE Children-Boston *Please call the health plan about availability.

Shriners Hospital for Springfield The hospital list is subject to change, and the INFORMATION Children-Springfield hospitals may have service limits. Please check Somerville Hospital (CHA) Somerville with the plan for specific questions about network South Shore Hospital South Weymouth hospitals. Saint Anne’s Hospital (Steward) Fall River

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 (800) 495-0086 or visit primary care at a community health center and www.masspartnership.com. have access to the most MassHealth specialists 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— ■ Care 365—help in Primary Care ACO Plan uses care in your connecting to social the MassHealth network language and culture services 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 specialty care hospitals. 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

Mass General Brigham LEARN

Mass General Brigham ACO Plan

Mass General Brigham

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 Mass General Brigham helps doctors work (800) 495-0086 or visit with members to improve care. Mass General www.masspartnership.com. Brigham’s doctors, hospitals, and other health ENROLL care providers come together to provide coordinated, high-quality care to you as a

Hospitals member. Mass General Brigham’s Primary Special Programs and Extra Benefits Care ACO Plan uses the MassHealth Team-based care Customized ■ ■ network of hospitals. Please go to educational videos https://masshealth.ehs.state.ma.us/ ■ Smoking cessation support Educational providerdirectory/ for a list of ■ handouts hospitals. ■ Diabetes management & ■ Shared decision- education making tools MORE ■ Weight loss support ■ Patient portal

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

www.massgeneralbrigham.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 Health Steward Health Choice built a health care plan Partnership at around you. Our goal is to give you quality health (800) 495-0086 or visit care, programs, services and extra benefits to www.masspartnership.com. support you on your path to wellness. Doctors, nurses, hospitals and health care professionals work as a team to provide you with a personal Hospitals approach to health care right in your community. Steward Health Choice’s Primary Special Programs and Extra Benefits Care ACO Plan uses the MassHealth network of hospitals. Please go to ■ Gift cards for ■ Free kids’ bike https://masshealth.ehs.state.ma.us/ healthy behaviors helmets providerdirectory/ for a list of ■ Specialized care ■ Free car seats & hospitals. coordination booster seats programs ■ Gym discounts Childbirth classes ■ ■ Steward Community Connection 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 ■ Free dental kit MORE

Contact the plan for a full list of special programs and INFORMATION 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 Gardner- Quincy services. For more information, call Fitchburg Revere (888) 257-1985. Gloucester Salem Greenfield Somerville Haverhill Southbridge Hospitals Holyoke Springfield Please see page 22 for a list of Lawrence Waltham hospitals included in the Tufts Health Find your town and its service area on page 36. 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

■ Pregnancy programs ■ Gift card toward car seats & booster ■ Healthy cooking & nutrition programs seats Gift cards for ■ Pharmacy discount ■ healthy behaviors ■ Fitness reimbursements ■ Health assessment & health coaching

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 participate in Adult Community Clinical Services (ACCS), a Massachusetts Department of Mental Health program. ■ PCC Plan members can enroll in an ACO or The PCC Plan is a managed care health MCO at any time. plan for MassHealth members throughout Massachusetts. The PCC Plan provider network ENROLL includes doctors, nurse practitioners, hospitals, Behavioral Health Services pharmacies, and other health care providers.

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 (800) 495-0086 or visit Special Programs and Extra Benefits www.masspartnership.com. ■ Women & children educational materials

Disease management material

■ MORE Hospitals

The PCC Plan uses the MassHealth INFORMATION network of hospitals. Please go to Contact the plan for a full list of special programs and https://masshealth.ehs.state.ma.us/ benefits. Certain rules may apply. providerdirectory/ for a list of hospitals. www.mass.gov/service-details/primary-care- 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 that best fits you or your family’s health care needs. If you do not choose a health plan, If you do not enroll in a health MassHealth will choose one for you. plan, MassHealth will enroll for Ready to enroll? It’s easy! you. Choose the plan that’s best for you and enroll today!

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 • Click “Enroll Now” (800) 841-2900 MassHealth Program 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 Health Plan If you are enrolled in an MCO or ACO health plan, you will have a 90-day Plan Selection LEARN As a MassHealth member enrolled in a health Period every year. MassHealth will notify you about your Plan Selection Period. During that plan, you can change your health plan for any 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 ends, you will be in your ■ Newborns and children who are younger Fixed Enrollment Period. During your Fixed than one year old Enrollment Period, you will not be able to change your health plan until the next Plan ■ Members enrolled in the Primary Care 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 During this time, you CAN During this time, you CANNOT

INFORMATION 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 period, or Primary Care ACO violated a material you may only change your health plan for one provision of its contract with MassHealth. 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 You live in the Oak Bluffs or Nantucket health care needs. ■ service areas. ■ 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 Care ACO is not available in your service area. If MassHealth denies your request ■ You demonstrate to MassHealth that the to transfer to another health plan MCO, Accountable Care Partnership Plan, during your Fixed Enrollment or Primary Care ACO has not provided Period, you can ask for a fair hearing access to providers that meet your health care needs over time, even after you (appeal). Learn more about asking request assistance. for a fair hearing on page 35. ■ 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 and a health plan member ID card. 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 COMPARE get health care or fill a prescription. Carry Both ID Cards

Everyone in your family who is

Health Plan ID enrolled will have a health plan and MassHealth ID 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. ENROLL If your MassHealth member ID card is ever 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

concerns, or complaints, please call your Understanding health plan’s customer service department. Your Costs Their phone number is located on the back of your health plan member ID card. LEARN Copays for Drugs You can also contact the MassHealth A copay is a small amount that a person pays Customer Service Center at (800) 841-2900 when they get health services. The only time (TTY: (800) 497-4648). that you may have a copay is when you get certain prescription drugs. Appeals and Fair Hearings For more information about copays, please If you disagree with a decision made by your visit www.mass.gov/copayment-information- health plan or health plan providers, you can for-members. 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 COMPARE appeals and Fair Hearings. If you get a bill for a charge other than your 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 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 ENROLL that you are a MassHealth member and the If you have questions or need help getting name of your health plan. Give the provider benefits or services from your health plan, you can call My Ombudsman. My

your health plan and MassHealth member ID numbers. Ask them to bill your health plan for Ombudsman is a program that is separate the service. from MassHealth and your health plan. The program can give you information Your health plan will cover only medically about your rights and help you with any necessary services. concerns. The program can also help explain how to file a grievance or appeal. Grievances, Appeals, For more information about My Ombudsman and Fair Hearings MORE • visit their website at www.myombudsman.org,

Grievances INFORMATION • call them at (855) 781-9898, Your health plan is committed to making sure that all members have the best health • videophone (VP) at (339) 224-6831, or care experience. If you feel that you got • email them at [email protected]. unsatisfactory service, or have questions,

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 Waltham 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 New Bedford 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 Dracut Lowell Gardner Gardner-Fitchburg

Drury Adams Georgetown Haverhill INFORMATION 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 New Bedford 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 Marblehead Salem Housatonic Pittsfield Hubbardston Gardner-Fitchburg Marion New Bedford Marlborough Framingham Hudson 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 Pittsfield 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 Framingham 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 Nantucket Nantucket Norwood Quincy

Natick Framingham Nutting Lake Lowell INFORMATION 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 Waltham 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 Vineyard Haven Oak Bluffs West Yarmouth Barnstable

Waban Waltham Westborough Framingham INFORMATION 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 Framingham Yarmouth Barnstable Yarmouth Port Barnstable

42 MassHealth Enrollment Guide | MORE INFORMATION

Questions? Learn, Compare, and Enroll online We are here to help. 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. 07/21)