We’re here to help you understand your health care choices. Your questions are important. This is a good place to start if you want to learn about MassHealth, health plans, and primary care providers (PCPs).
If you can't find an answer here, call us at 1-800-841-2900 (TTY: 1-800-497-4648).
What is the MassHealth Program?
MassHealth is the Massachusetts Medicaid program. In MassHealth, you choose a health plan and primary care provider (PCP) for each family member. To learn more, go to Learn.
What is an Accountable Care Organization?
Accountable care organizations (ACOs) are groups of doctors, hospitals and other health care providers who work together to coordinate your care.
In an ACO, your PCP and their team work with you and your ACO's network of providers. Your PCP knows your needs and works with you directly to make decisions about your care. Your PCP also connects you with services and supports. They help you get the right care at the right time.
You can choose an Accountable Care Partnership Plan or Primary Care ACO. To learn more, go to Choosing a health plan.
What is a Managed Care Organization?
Managed Care Organizations (MCOs) are health plans run by insurance companies. They provide care through their own network. Each MCO’s network includes PCPs, hospitals, behavioral health providers, and specialists. The care coordinators work for the MCO.
If you choose an MCO plan, you cannot choose a PCP who is part of an ACO.
With an MCO, you:
- Must live in the service area the MCO covers
- Must use the MCO network of providers
- Must choose a PCP, or one is assigned to you
- Can change your PCP within the MCO's network at any time
- Have a plan selection period and a fixed enrollment period.
- May get behavioral health or long-term services and supports (LTSS) from a Community Partner.
To learn more, go to Choosing a health plan.
What is the Primary Care Clinician (PCC) Plan?
The Primary Care Clinician (PCC) Plan is a statewide managed-care health plan for MassHealth members. In the PCC Plan, primary care providers (PCPs) are called primary care clinicians (PCCs). The MassHealth network of PCCs, specialists and hospitals deliver services. The Massachusetts Behavioral Health Partnership (MBHP) provides behavioral health services. They work with MassHealth to give you care.
If you choose the PCC Plan, you cannot choose a PCP who is part of an ACO to be your PCC.
In the PCC Plan, you:
- Must choose a PCC from the MassHealth list, or one is assigned to you
- Can change your PCC within your plan at any time
- Can change from the PCC plan to an ACO or MCO at any time
Can I change my health plan?
Yes. If you are in an ACO or MCO plan, you have a 90-day plan selection period each year. At other times, you may ask to change your plan if you have a special reason. If you are in the PCC Plan, you can change your health plan at any time, for any reason. To learn more, go to Changing your health plan.
What is a primary care provider (PCP)?
Your PCP can be a family doctor, nurse practitioner, pediatrician, or OB/GYN. Your PCP helps you get the care you need. Your PCP gives you health care services such as:
- Yearly check-ups
- Sick visits
- Health screenings
Can a doctor I see now become my PCP?
Yes, if your doctor works with one of the health plans in your area. To find out which health plans your doctor works with, go to Find a primary care provider.
Can I change my PCP?
ACO and MCO Plan members
Yes. You can change your PCP to any other PCP in your health plan. You can do this at any time, for any reason. To change your PCP, call your health plan member services department. The phone number is on the back of your health plan member ID card. It is also on the health plan website or go to Contacting health plans.
PCC Plan members
If you are a PCC Plan member and want to change your PCP, call us at 1-800-841-2900 (TTY: 1-800-497-4648).
How do I find other providers such as specialists and behavioral health providers?
To find a MassHealth specialist, go to https://masshealth.ehs.state.ma.us/providerdirectory/. If you are in a health plan, search for specialists on the plan's website. To find the plan's website, go to Contacting health plans.
To find a behavioral health provider, go to https://www.masspartnership.com/member/FindBHProvider.aspx.