Fixed Enrollment Period

Learn about the MassHealth Fixed Enrollment Period

If you are in an Accountable Care Organization (ACO) or Managed Care Organization (MCO) when your Plan Selection Period has ended, you will be in your Fixed Enrollment Period. During your Fixed Enrollment Period, you will not be able to change your health plan until the next Plan Selection Period, except for certain reasons.

Fixed Enrollment Period Exceptions

When you are in your Fixed Enrollment Period, you may only change your health plan for one of these reasons.

• You move out of the MCO, Accountable Care Partnership Plan or Primary Care ACO service area.
• The MCO, Accountable Care Partnership Plan or Primary Care ACO does not, because of moral or religious objections, cover the service you request.
• You need related services to be performed at the same time; not all related services are available within the network; and your primary care provider or another provider determines that receiving the services separately would subject you to unnecessary risk.
• You receive poor quality care, lack access to services covered, or lack access to providers experienced in dealing with your health care needs.
• The MCO or Accountable Care Partnership Plan is no longer contracted with MassHealth to cover your service area, or your PCP who participates in your Primary Care ACO is not available in your service area.
• You demonstrate to MassHealth that the MCO, Accountable Care Partnership Plan, or Primary Care ACO has not provided access to providers that meet your health care needs over time, even after you request assistance.
• You are homeless (and MassHealth’s records also indicate that you are homeless), and the MCO, Accountable Care Partnership Plan, or Primary Care ACO cannot accommodate your needs geographically.
• You demonstrate to MassHealth that the MCO, Accountable Care Partnership Plan, or Primary Care ACO substantially violated a material provision of its contract with MassHealth.
• MassHealth imposes a sanction on the MCO, Accountable Care Partnership Plan, or Primary Care ACO that specifically allows you to disenroll from your MCO, Accountable Care Partnership Plan, or Primary Care ACO without cause.
• You demonstrate to MassHealth that the MCO, Accountable Care Partnership Plan, or Primary Care ACO is not meeting your language, communication, or other accessibility preferences or needs.
• You demonstrate to MassHealth that your key network of providers, including PCPs, specialists, or behavioral health providers, have left the MCO, Accountable Care Partnership Plan, or Primary Care ACO network.
• You live in the Oak Bluffs or Nantucket service areas. (This last sentence applies to plans that begin 1/1/2020 and later.)

Information about exceptions to the Fixed Enrollment Period can be found in the MassHealth regulations at 130 CMR 508.000.

To request to change your health plan, call us at [phone]; TDD/TTY at 711.