How Do I Enroll?
NOTE: Glossary words are highlighted. Click on any glossary word to see its definition.
What happens once I am approved for MassHealth?
Once you are approved for MassHealth:
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You will be offered the coverage type with the most benefits for which you and your family are eligible.
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MassHealth will send you an enrollment package explaining your choices and the enrollment process. The enrollment package contains an enrollment guide.
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You must choose a health plan IF:
- you are under 65
- you are not institutionalized
- you do not have private insurance
- AND you are approved for MassHealth Standard, Family Assistance, or Basic.
The enrollment guide has a list of all the health plans from which you can choose and an enrollment form. You will have 14 days to choose a health plan. (If, after 14 days, you have not chosen a health plan, MassHealth will select a health plan for you.)
Once you choose a health plan, you must fill out the enrollment form and mail it to MassHealth. MassHealth will send you confirmation of your enrollment. Once you get this information, you must choose a primary doctor who will provide medical services for you and your family.
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You do not have to choose a health plan or fill out an enrollment form IF:
- you are 65 or older
- you are approved for MassHealth CommonHealth, Limited, Prenatal, or Buy-In
- OR you have private health insurance
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You will receive a MassHealth card, which you should carry with you at all times. Note: If your MassHealth coverage only helps pay for your private insurance premiums, you will not get a card.
You will get a separate card for each member of your family who gets MassHealth. The card will show the member's MassHealth ID number. Whenever you go to the doctor or other health care provider, you must show your card.
Your MassHealth card is not proof of coverage. Your doctor or other service provider will check your MassHealth coverage each time you get health services.
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Once you are accepted into a MassHealth program, your eligibility will be reviewed every 12 months. In some cases the review can be more frequent.
What health plan choices do I have?
MassHealth offers two choices: a Primary Care Clinician (PCC) plan and a Managed Care Organization (MCO) plan.
With the PCC plan, you choose a primary care doctor who is part of the MassHealth PCC plan and has agreed to treat MassHealth members. MassHealth will give you a list of doctors who are part of this plan. The doctor you choose will do your checkups, provide you with primary care, and manage your health care services. If you want to see a specialist or need other services, you must get a referral from your primary doctor. You can only see doctors who accept MassHealth.
With an MCO plan, you choose from several managed care organizations that accept MassHealth members. An MCO is a group of doctors and other health care providers who work together to provide health care for their members. For more information about MassHealth MCOs, see MassHealth MCO Managed Care Health Plans.
Women who are in the MassHealth Breast and Cervical Cancer Treatment Program (BCCTP) must use the PCC plan.
How do I choose a health plan?
Choosing a health plan and a primary care doctor for your family is an important decision. You may want to talk to a Health Benefits Advisor at the MassHealth Customer Service Center (1-800-841-2900; TTY: 1-800-497-4648) or one of the Massachusetts Community Health Centers. If your friends or relatives have MassHealth, you might want to ask them about their health plans and doctors.
For information about managed care plans, you can call the plans directly or visit their web sites. For MassHealth MCO contact information and web site links, see MassHealth MCO Managed Care Health Plans.
These are some questions you might want to ask before choosing a health plan:
- Is the doctor I am seeing now part of the plan?
- Can I see a doctor outside of the plan?
- Are the doctors in the plan accepting new MassHealth patients?
- Can I change doctors if I am not satisfied with the care I am receiving?
- Do I pay extra for a second opinion?
- Are the doctors' offices, hospitals, etc. close to my home or public transportation?
- Are there evening and weekend appointments?
- Does the plan cover prescriptions?
- Is there a limit on the number of days I can spend in a hospital?
- If I become ill out of town, what happens?
- What are the limits on various treatments (mental health, substance abuse, etc.)?
- Are home health services included?
- Can I get emergency treatment out of state?
- Do I need to get a referral each time I go to a specialist?
Can I keep the doctor I see now?
To keep your doctor, your doctor must accept MassHealth insurance and be part of the MassHealth health plan that you choose. Many doctors belong to these plans. If your doctor does not belong to a MassHealth plan, you will have to choose a new doctor to care for you and your family.
Once I enroll, can I change my health plan or primary care doctor?
You may change your health plan or your primary care doctor at any time.
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To change your health plan, you should speak to a MassHealth Health Benefits Advisor by calling 1-800-841-2900 (TTY: 1-800-497-4648). MassHealth can change your health plan over the phone.
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To change your primary care doctor, you must call the Member Services Department of your health plan. This phone number is on your MassHealth card.
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