Resources
State websites and phone numbers
- Virtual Gateway (state portal)
- Medical Benefit Request (paper application)
- Commonwealth Care Customer Service
Telephone: 877-MA-ENROLL (877-623-6765)
Website
Health Plan Contact information for patients
BMC Healthnet Plan
Member Services: 800-792-4355
TTY: 866-765-0055
Alcohol, Drug Abuse and Mental Health Services: 877-957-5600
Website
Network Health
Customer Service: 888-257-1985
TTY: 617-806-8196
Alcohol, Drug Abuse and Mental Health Services: 888-257-1986
Website
Fallon Community Health Plan
Member Services: 800-868-5200
TTY: 877-608-7677
Alcohol, Drug Abuse and Mental Health Services (Beacon Health Strategies): 888-421-8861
TTY: 781-994-7660
Website
Neighborhood Health Plan
Customer Care Center: 800-462-5449
TTY: 800-655-1761
Alcohol, Drug Abuse and Mental Health Services (Beacon Health Strategies): 800-414-2820
TTY: 781-994-7660
Website
Estimated Premiums by region and health plan
Estimated premiums by health plan and region for individuals who qualify for the subsidized Commonwealth Care are available at this link: http://mass.gov/Qhic/docs/CommCareEnrolleeContribsv1_1.xls
Contact information for providers
Providers interested in Provider Enrollment and Provider billing may contact the MCOs directly:
- Fallon Community Health Plan - 866-ASK-FCHP (866-275-3247)
- Network Health - 888-257-1985
- Neighborhood Health Plan - 800-462-5449
- Boston Medical Center HealthNet Plan - 888-566-0008
More details from the health plans about their Commonwealth Care products
BMC HealthNet Plan - Commonwealth Cares- Only plan offering statewide coverage
- Will be building networks in new service areas to try to achieve continuity of care
- Will be now subject to the consumer protection provisions of M.G.L. c. 176O (pending promulgation of the Office of Patient Protection proposed regulation changes)*
- Website
- Access to the NHP Provider network
- Commonwealth Cares co-payments will be on the identification card
- Expansion into new service areas
- Website
- Reimbursements based on the current Network Health fee schedule
- Expansion into some new service areas
- Will be now subject to the consumer protection provisions of M.G.L. c. 176O (pending promulgation of the Office of Patient Protection proposed regulation changes)*
- Website
- Utilizes the FCHP Direct Care Network
- Acton Medical Associates, Charles River Medical Associates, Fallon Clinic, and Southboro Medical Group
- ID card will indicate “Commonwealth Care FCHP Direct Care”
- Reimbursements based on FCHP Direct Care fee schedules
- Expansion into some new service areas
- Website
*Chapter 141: 176O — member appeal rights, standing referrals, continuation of care
Subject to the consumer protection laws, including external appeal process. Plans have been being briefed on the process and will need to implement these steps to follow 176O.
Co-payment Structures as determined by the Commonwealth
Enrollees with incomes under 100% FPL:- $0
- Outpatient and Inpatient Care (Medical and Mental Health & Substance Abuse)
- Rehab Services
- Other Benefits such as Ambulance, Dental, Vision, Wellness
- $0 Office & Community Health Center visits, Outpatient and Inpatient Medical Care, Rehab Services, Dental, DME, Vision, Wellness
- $3 (Copay waived if admitted to an inpatient unit) Emergency Care
- $1/$3 Prescription Drugs (generic/brand)
- $200 Maximum Pharmacy Out-of-Pocket Expenses
- $5/$10 - PCP/Specialty visits (Office and Community Health Centers)
- $50 - Abortion Services, Outpatient Surgery, Inpatient Room & Board, Emergency Care, Inpatient Mental Health & Substance Abuse, Inpatient Rehab Hospital
- $5/$10/$30 -Medication via Pharmacy (via Mail is $10/$20/$90)
- $250 - Maximum out-of-pocket expense for
- Inpatient Surgery
- Pharmacy
- $10/$20 - PCP/Specialty visits (Office and Community Health Centers)
- $75 - Emergency Care
- $250 - Inpatient Room & Board, Inpatient Mental Health & Substance Abuse, Inpatient Rehab Hospital
- $10/$20/$40 - Medication via Pharmacy (via Mail is $20/$40/$120)
- $500 - Maximum out-of-pocket expense for
- Inpatient/Outpatient Surgery
- Pharmacy
- DME/Supplies/Prosthetics, etc.
Premium List, Resources, and Summaries
Commonwealth Care
Commonwealth Choice
Benefit and Premium Summaries will be available May 1.
