On October 1, 2016, MassHealth will introduce new rules for members of managed care organization (MCO) health plans as well as the Primary Care Clinician (PCC) plan.  

Here is what you need to know:

  • If you are enrolled in an MCO health plan, you will only be able to change health plans during certain times of the year. You can change your health plan for any reason during your Plan Selection Period. During your Fixed Enrollment Period, you  cannot change your health plan until the next Plan Selection Period, except for certain reasons.
  • If you are enrolled in the PCC Plan, you will need referrals from your primary care doctor for certain health care services that did not previously require referrals. A referral is permission from your doctor to get certain types of health care services.

 

Plan Selection Period

If you or members of your family are in a MassHealth managed care organization (MCO) health plan, you can change to another MCO health plan or to the Primary Care Clinician (PCC) plan for any reason during your 90-day Plan Selection Period. Learn more about the Plan Selection Period . You do not need to do anything if you are happy with your current health plan.

 

Fixed Enrollment Period

If you are enrolled in an MCO health plan, your Fixed Enrollment Period will begin after your 90-day Plan Selection Period ends. During your Fixed Enrollment Period, you will not be able to change your MCO health plan except for certain reasons. This means you will have to stay in your MCO health plan until your next Plan Selection Period begins. Learn more about the Fixed Enrollment Period .

 
Do these changes apply to all members?

No. These changes do not apply to the following individuals:

  • MassHealth will let you know if you are required to enroll in a MassHealth health plan (if you are not required to enroll in a health plan, these changes do not apply to you).
  • Children in the care or custody of Department of Youth Services (DYS) or the Department of Children and Families (DCF).
  • If you are enrolled in the PCC Plan. You can choose an MCO health plan at any time.

However, if you do choose an MCO health plan, the new Plan Selection and Fixed Enrollment Periods above will apply. 

Important Dates!


If you are enrolled in an MCO health plan on or BEFORE October 1, 2016

October 1, 2016 Start of Plan Selection Period.
December 31, 2016 Last day to change your health plan for any reason.
January 1, 2017 Start of Fixed Enrollment Period. Members enrolled in an MCO cannot change their health plan until the next Plan Selection Period on October 1, 2017, except for certain reasons. 

If you are enrolled in an MCO health plan AFTER October 1, 2016

Your Plan Selection Period starts on the day you’re enrolled in a MCO Health Plan 

 

MassHealth will send you a letter letting your know your Plan Selection Start Date.

For example, if you enroll in an MCO health plan on November 3, that is the start of your Plan Selection Period.

Your Plan Selection Period is for 90 days For example, if your Plan Selection Period started on Nov. 3, you have until Jan. 30 (90 days) to change your health plan for any reason.
Your Fixed Enrollment Period starts when your Plan Selection Period Ends 

MassHealth will send you a letter letting your know your Fixed Enrollment Period has started.

For example, if your Plan Selection Period was from Nov. 3 – Jan 30. Your Fixed Enrollment Period starts Feb. 1 (90 days and you can only change your health plan if you meet a special exception.

 

Changes to Primary Care Clinician (PCC) Plan Referrals

If you or members of your family are enrolled in the MassHealth PCC Plan, certain services that did not previously require a referral will require a referral starting October 1, 2016. A referral is an approval you must get from your primary care doctor before you can make some appointments. Your doctor will help you to get any needed referrals. These changes do not impact the benefits you receive from MassHealth.

Learn more about the PCC Plan and services that require referrals here.

To learn more about your current MCO or PCC health plan, call us at 1-800-841-2900 (TTY: 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled).

 


This information is provided by MassHealth.