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2026 SCO Eligibility Changes

Starting January 1, 2026, the eligibility requirements for Senior Care Options (SCO) plans will change. This page explains what's changing, and what resources are available for impacted members.
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2026 SCO Eligibility Changes

Key change: Beginning January 1, 2026, all SCO enrollees must be enrolled in both Medicare Parts A and B, as well as MassHealth Standard (Medicaid), to remain in a SCO plan.

The eligibility requirements are changing because Massachusetts laws (M.G.L. Ch. 118E, Sec. 9D) have changed.

Questions & Answers

What does this SCO eligibility change mean?
 
  • To stay in a SCO plan, you must be enrolled in Medicare Parts A and B and MassHealth Standard.
  • If you have only MassHealth Standard and not Medicare Parts A and B, you'll be moved to MassHealth Fee for Service.
I think I’m eligible for Medicare, but I’m not enrolled. I want to stay enrolled in my SCO plan. What should I do?
 
  • Call the MassHealth Customer Service Center to check if MassHealth records indicate you are eligible for Medicare.
    • Hours: Monday to Friday, 8:00 a.m. to 5:00 p.m.
    • Phone: (800) 841-2900, TDD/TTY: 711
    • Ask if you’re a “Qualified Medicare Beneficiary.” If you are, you may be eligible to enroll in Medicare.
  • If MassHealth records indicate that you are eligible, take these steps to enroll in Medicare.
    • Call your local Social Security Administration (SSA) office.
    • Set up a telephone or in-person appointment.
    • Request an interpreter for the appointment if you need one. 
    • Important: When speaking with SSA, say that you’re a Medicaid member instead of a MassHealth member. SSA is not always familiar with MassHealth.
    • Tell SSA that Medicaid’s records show that you’re a Qualified Medicare Beneficiary.
    • Key Date: Enroll in Medicare by December 31, 2025, to stay in your SCO plan.
    • If you need help, reach out to your SCO plan care coordinator/case manager.
    • If you reached out to your SCO plan care coordinator/case manager and Social Security but still need help, you can email susan.masshealth@mass.gov for further support.
Will I be able to keep my current providers?
 
  • Most providers are enrolled in MassHealth Fee for Service.
  • To confirm that your provider is enrolled, use the MassHealth provider directory to search for your providers.

  • If your provider is not currently registered as a MassHealth provider, you can keep seeing if your provider if they enroll in MassHealth Fee for Service. Please reach out to your provider and let them know that your insurance coverage is changing January 1, 2026 and ask them to enroll in MassHealth. They can enroll online: Apply to become a MassHealth provider.

What health care benefits are covered under MassHealth Fee for Service? 

MassHealth Standard provides a full range of health care benefits, including:  

  • Inpatient hospital services
  • Outpatient services: hospitals, clinics, doctors, dentists, family planning, vision care
  • Medical services: lab tests, X rays, therapies, pharmacy services, eyeglasses, hearing aids, medical equipment and supplies
  • Adult day health and adult foster care
  • Mental health and addiction services:  inpatient and outpatient
  • Long-term services and supports at home or in a long-term-care facility, including home health services
  • Transportation services
  • Services to help you quit smoking 
Are there any differences between SCO covered services and Fee for Service covered services?
 
  • Yes, there are differences between SCO covered services and   Fee for Service covered services.
  • In Fee for Service, laundry, shopping and meal prep can be provided through the Personal Care Attendant (PCA) program. Your SCO plan may have delivered these services to you differently. You should work with your SCO plan care coordinator/case manager prior to 1/1/26 to get PCA services in place.
  • In Fee for Service, members are not assigned a care coordinator/case manager. If you need a care coordinator/case manager, you can explore whether you are eligible for the Frail Elder Waiver (FEW). To learn more about the FEW and to enroll, please contact your local Aging Services Access Point (ASAP) to request a clinical eligibility assessment. You may contact MassOptions call center and ask for a referral to an options counselor located at your local ASAP agency by calling 800-243-4636. Alternatively, visit massoptions.org to fill out an online referral form.
    • To learn more about MassHealth FFS benefits:
      • Call the MassHealth Customer Service Center.
      • Hours: Monday to Friday, 8:00 a.m. to 5:00 p.m.
      • Phone: (800) 841-2900, TDD/TTY: 711
    • The Council on Aging can help answer questions about meals, transportation, social activities, and other services for older adults.
    • The Massachusetts Behavioral Health Help Line offers support for MassHealth FFS behavioral health benefits.

Member Resources

What other coverage options are available?
 
Whom can I call for questions?
 
  • Call the MassHealth Customer Service Center
  • Call your local ASAP to learn about programs and services designed specifically to support adults.
  • Your care coordinator is available for questions or support until December 31, 2025.

Member Notices

This is an example of a member notice you may receive.

Resources for SCO Providers

How do I apply to become a MassHealth provider?

Step 1: Visit Apply to become a MassHealth provider.
Step 2: Review your provider enrollment choices.
Step 3: Request a provider application form.

Questions?

Email: provider@masshealthquestions.com

Date published: September 2, 2025

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