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

Eligibility Operations Memo 13-01
January 1, 2013




TO:	MassHealth Eligibility Operations Staff

FROM:	Amy Andrade, Director, Member and Provider Services

RE:	Medex Premium Rate Change
		

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, 2013.
		

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
2012 
Quarterly 
Rate
2013 
Quarterly 
Rate
2013 
Monthly 
Premium
Basic
1
$1,141.11
$1,047.06
$349.02
Bronze
2
$   558.33
$   550.14
$183.38
Gold
3
$2,063.49
$1,951.71
$650.57
Standard
4
$1,501.47
$1,377.36
$459.12
Core Plus
6
$   479.79
$   460.59
$153.53
Core
7
$   297.87
$   288.57
$  
96.19
Silver
8
$1,564.23
$1,410.69
$470.23
Basic without 
Rx

B

$   601.71

$   534.75

$178.25
Core Plus 
without Rx

C

$   395.43

$   385.11

$128.37

		
 (continued on next page)
Eligibility Operations Memo 13-01
January 1, 2013
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 retroactive PPA.

Medex Basic, Gold, Silver, Core Plus, Standard, Basic without Pharmacy, 
and Core Plus without Pharmacy are closed to new members.
		

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 early January 2013.
		

PPA Notices

During the month of December 2012, MassHealth mailed system-
generated notices containing information about the new PPAs to affected 
long-term-care members, eligibility representatives, and nursing facilities.
		

Questions

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