During the MassHealth Fixed Enrollment Period, you will not be able to change your MCO health plan unless you meet one of the special reasons listed below. This means you will have to stay in your MCO health plan until your next Plan Selection Period.
If you are in a Fixed Enrollment Period, you may request to change your health plan if one of the following reasons applies to you:
- You move out of your health plan’s service area.
- You need related services to be performed at the same time, and those related services are not all available within your health plan’s network, and your primary care provider or another provider determines that receiving those related services separately would be an unnecessary risk to you.
- Your health plan is not meeting your needs for other reasons including but not limited to poor quality of care, lack of access to covered services, or lack of access to providers experienced in dealing with your health care needs.
- Your MCO no longer serves your geographic area. MassHealth will let you know if this happens.
- Your MCO has not provided access to health care providers that meet your health care needs over time, even after you’ve asked for help.
- MassHealth has information that you are homeless, and your MCO does not have providers who can meet your specific geographic needs.
- Your MCO is not meeting your language, communication, or other accessibility needs or preferences.
- Your key network providers, including primary care physicians, specialists, or behavioral health providers, have left your MCO’s network.
- Your health plan, because of moral or religious objections, does not cover a service you seek.
- Your MCO has substantially violated a material provision of its contract with MassHealth.
- MassHealth sanctions your MCO by allowing members to dis-enroll from the health plan. MassHealth will let you know if this happens.
MassHealth will send you a letter at the start of your Fixed Enrollment Period that gives you more information. Information about exceptions to the Fixed Enrollment Period can be found in the MassHealth regulations (130 CMR 508).
To request to change your health plan, call us at 1-800-841-2900 (TTY: 1-800-497-4648).
This information is provided by MassHealth.