Automatic assignment in a One Care plan

See below for more information about the auto-assignment process.

Automatic assignment (or “auto-assignment”) is the term MassHealth uses to describe how we automatically enroll someone in a One Care plan. It is sometimes also called “passive enrollment.”

1. A MassHealth member who becomes newly eligible for Medicare may be automatically enrolled in a One Care plan as of the date he or she becomes eligible for Medicare.
2. A MassHealth member who already has Medicare may be automatically enrolled in a One Care plan if he or she meets all of the following:

• Received an enrollment packet mailing, and did not enroll or opt out; and
• Is not enrolled in a Medicare Advantage or PACE plan

Not everyone who meets this description will be automatically enrolled in a One Care plan.

Before the coverage begins, MassHealth will send two notices to members who are being automatically enrolled in a One Care plan.

1. The first notice will say which plan MassHealth has enrolled the member in, and the date when coverage will begin. The member will get this notice at least 60 days before the coverage would start.
2. The second notice will remind members of the upcoming changes. The member will get this notice at least 30 days before the coverage would start.

Both notices will tell members how they can join a different One Care plan or choose not to enroll in One Care.

If you tell MassHealth that you would like to keep your care the way it is now, MassHealth will not enroll you in a One Care plan now or at a later date. You can always choose to join a One Care plan at any time.

60 day sample notices for members who are not yet eligible for, or enrolled in, Medicare

Below are samples of 60 day notices for members who are not yet eligible for, or enrolled in, Medicare.

Additional Resources

Commonwealth Care Alliance: 60-day notice for MassHealth members who do not yet have Medicare (sample)

Commonwealth Care Alliance: 60-day notice for MassHealth members who do not yet have Medicare (sample)

Tufts Health Plan: 60-day notice for MassHealth members who do not yet have Medicare (sample)

Tufts Health Plan: 60-day notice for MassHealth members who do not yet have Medicare (sample)

60 day sample notices for members who are already enrolled in MassHealth and Medicare

Below are samples of 60 day notices for members who are already enrolled in MassHealth and Medicare.

Additional Resources

Commonwealth Care Alliance: 60-day notice for MassHealth members already enrolled in Medicare (sample)

Commonwealth Care Alliance: 60-day notice for MassHealth members already enrolled in Medicare (sample)

Tufts Health Plan: 60-day notice for MassHealth members already enrolled in Medicare (sample)

Tufts Health Plan: 60-day notice for MassHealth members already enrolled in Medicare (sample)

More information about the auto-assignment process

Along with auto-assignment notices, if you are being auto-assigned into a One Care plan and you are already enrolled in Medicare, you may also receive a notice about One Care and Medicare Part D (see the additional resources section below for a sample Part D notice). This notice explains what auto-assignment in One Care means for Part D prescription drug coverage for members who already have a Part D plan. MassHealth sent this information to address concerns that members are getting notices from their Part D plans about losing their current prescription drug coverage.

When you enroll in One Care:

• You may receive a notice from your Part D plan that it will no longer cover your drugs as of your enrollment date into a One Care plan
• You will continue to receive your prescription drug benefits from your current plan until your enrollment date into a One Care plan.
• After you are enrolled in One Care, your One Care plan will cover your prescription drugs
• If you do not want to be in One Care, you may stay in your current prescription drug plan. You just need to call MassHealth before the date listed in the notice you receive
• There should be no gap in your prescription drug coverage no matter what you decide

Additional Resources

One Care and Medicare Part D

One Care and Medicare Part D

If you have questions, you can call

MassHealth Customer Service

Monday – Friday 8 a.m.-5 p.m.
[phone]
TTY: [phone] (for people who are deaf, hard of hearing, or speech disabled)

MEDICARE

24 hours a day, 7 days a week
1-800-Medicare (1-800-633-4227)
TTY: [phone] (for people who are deaf, hard of hearing, or speech disabled)

One Care Ombudsman (OCO)

The One Care Ombudsman (OCO) is an independent program that helps individuals address concerns or conflicts that may interfere with their enrollment in One Care or their access to One Care benefits and services. The OCO works with MassHealth and each of the three One Care plans to help resolve concerns so that persons with disabilities can receive their health care benefits and exercise the rights to which they are entitled in One Care. OCO staff can work with you in person or over the phone.

Monday – Friday 9 a.m. - 5 p.m.
[phone] (Toll Free)
MassRelay: dial 711 (for people who are deaf, hard of hearing, or speech disabled)

www.onecareombuds.org

SHINE (Serving the Health Insurance Needs of Everyone)

SHINE counselors can work with you and your caregivers to help you understand your options. They are trained to assist people who have Medicare and MassHealth and will provide impartial information about your health insurance options. SHINE counselors are available Monday–Friday, 9 a.m.–5 p.m. A counselor can work with you in person, by phone, or through e-mail.

Monday – Friday 9 a.m.-5 p.m.
[phone]
TTY: [phone] (for people who are deaf, hard of hearing, or speech disabled)