Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth

	Eligibility Operations Memo 11-01
	January 1, 2011

TO:	MassHealth Eligibility Operations Staff

FROM:	Amy Andrade, Acting 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, Medex Core Plus, Medex Basic without Pharmacy, and 
Medex Core Plus without Pharmacy, effective January 1, 2011.

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 MassHealth 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 Code	2010 Quarterly	2011 Quarterly	2011 Monthly
				Rate			Rate			Premium

Basic		1		$1,132.62		$1,104.84		$368.28
Bronze	2		$  517.44		$  544.23		$181.41
Gold		3		$2,123.19		$2,015.10		$671.70
Standard	4		$1,503.84		$1,453.05		$484.35
Core Plus	6		$  473.91		$  467.10		$155.70
Core		7		$  273.12		$  286.53		$ 95.51
Silver	8		$1,530.12		$1,477.95		$492.65
Basic 
without Rx	B		$  499.89		$  549.39		$183.13
Core Plus 
without Rx	C		$  356.43		$  376.32		$125.44

(continued on next page)

Eligibility Operations Memo 11-01
January 1, 2011
Page 2

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, Standard, Basic without Pharmacy, and Core 
Plus without Pharmacy are closed to new members. The monthly premiums for every 
plan except Basic without Pharmacy and Core Plus without Pharmacy have 
decreased.

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 the PPAs for 
these cases in January 2011.

PPA Notices
During the month of January 2011, MassHealth will mail system-generated notices 
containing information about the new PPAs to affected long-term-care members, 
eligibility representatives, 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.