Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth

	Eligibility Operations Memo 09-20
	December 15, 2009

TO:	MassHealth Eligibility Operations Staff

FROM:	Russ Kulp, Director, MassHealth Operations

RE:	Medex Premium Rate Increase

Introduction
Blue Cross and Blue Shield of Massachusetts has received approval from 
the Division of Insurance on the following premium rates for all of its 
nongroup Medex plans:  Medex Gold, Medex Silver, Medex Standard, Medex Basic, 
Medex Bronze, Medex Core, and Medex Core Plus, effective January 1, 2010.

New Plans for 2010
There are two new plans being offered this year, Basic without Prescription 
Coverage and Core Plus without Prescription Coverage.

Rate Changes and PACES Codes
The Medex plans, PACES codes, old and new quarterly rates, and new monthly 
premiums appear in the chart below. The new monthly premium is the amount 
allowed as a patient-paid amount (PPA) deduction after other deductions that get 
priority under our regulations at 130 CMR 520.026. Fees for special billing 
arrangements that cause a premium to exceed these amounts are not allowable PPA 
deductions.

Medex Plan		PACES		2009 			2010		2010
			Code 		Quarterly 		Quarterly	Monthly
					Rate			Rate		Premium 

Basic			1		$1,053.45		$1,132.62	$377.54
Bronze		2		$  486.78		$  517.44	$172.48
Gold			3		$1,997.10		$2,123.19	$707.73
Standard		4		$1,425.69		$1,503.84	$501.28
Core Plus		6		$  462.36		$  473.91	$157.97
Core			7		$  257.76		$  273.12	$ 91.04
Silver		8		$1,472.67		$1,530.12	$510.04
Basic without 
Rx			B		N/A			$  499.89	$166.63
Core Plus 
without Rx		C		N/A			$  356.43	$118.81

(continued on next page)

Rate Changes and PACES Codes (cont.)
Important:  The correct use of PACES codes prevents values greater than the 
maximum premium amount from being entered. Workers can enter an amount that is 
less than the current maximum premium amount to calculate a retroactive PPA.

Medex Basic, Gold, Silver, Core Plus, and Standard Plans are closed to 
new members. The monthly premiums for every plan have increased.

System Changes
Community MassHealth cases with Medex coding will be updated with the new 
premium amounts for both MA21 and PACES.

Long-term-care MassHealth cases with Medex coding will also be updated with the 
new premium amounts by the system. MassHealth will recalculate their PPAs in 
January 2010.

PPA Notices
During the month of January 2010, MassHealth will mail system-generated notices 
containing information about the new PPAs to affected long-term-care members, 
conservators, and nursing facilities.

Reports
The PACES system will issue the following two reports about the Medex 
premium rate increase.

*	The first report will list updated long-term-care members with their 
old and new Medex premiums and old and new PPAs.
*	The second report will be an update-exception report that identifies 
members with Medex premiums on file that do not correspond to the Medex plan for 
which the member is coded.

Questions
If you have any questions about this memo, please have your MEC designee contact 
the Policy Hotline.