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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. When an ACO spends health care dollars wisely and provides you with good care, MassHealth will reward the ACO.

In an ACO, your primary care provider (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 plan, To learn more, go to Choosing a health plan.

What is a Managed Care Organization?

Managed Care Organization (MCO) plans are health plans run by insurance companies. They provide care through their own network. Each MCO’s network includes primary care physicians (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 Accountable Care Organization (ACO) plan.

With an MCO, you: 

  • Must live in the MCO service area

  • 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 Accountable Care Organization (ACO) plan 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 plan or Managed Care Organization (MCO) plan at any time

Can I change my health plan?

Yes. If you are in an Accountable Care Organization (ACO) plan or Managed Care Organization (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, such as:

  • Yearly check-ups
  • Shots
  • Sick visits
  • Health screenings

Can a doctor I see now become my primary care provider (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 primary care provider (PCP)?

Accountable Care Organization (ACO) plan and Managed Care Organization (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. 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.

Primary Care Clinician (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.

What if I already have a primary care provider (PCP) I want to keep?

You can keep your PCP if he or she is in your health plan. See if your PCP is in the health plan you want in your service area. Or see which plans in your service area your PCP is in. To find out if your PCP works with your health plan, go to Find a primary care provider. Or call us at 1-800-841-2900 (TTY: 1-800-497-4648).

 

Do I need to call to change my primary care provider (PCP)?

Yes, you need to call to change to a new PCP that works with your current plan. If you are in an Accountable Care Organization (ACO) plan or Managed Care Organization (MCO) plan, call the phone number on the back of your health plan member ID card. If you are a Primary Care Clinician (PCC) plan member, call us at 1-800-841-2900 (TTY: 1-800-497-4648).

If your new PCP is not in your plan, call us at 1-800-841-2900 (TTY: 1-800-497-4648).

I want to find a specific hospital. Is there an easier way than using the hospital list?

You can ask your health plan. To find your health plan contact information, go to Contacting health plans. Or you can call us at 1-800-841-2900 (TTY: 1-800-497-4648).

How do I get a new ID card if I need one?

  • If your health plan member ID card is damaged, lost, or stolen, call the health plan member services to ask for a new card. To find your health plan's contact information, go to Contacting health plans.
  • If your MassHealth member ID card is damaged, lost, or stolen, call us at 1-800-841-2900 (TTY: 1-800-497-4648). We will send you a new card.

How do I enroll in a new health plan?

Visit our Compare page. Follow these 3 steps: 

  1. Learn about the plans near where you live.
  2. Compare available primary care providers in the health plans.
  3. Once you choose a health plan that meets your needs, go to Enroll.

For questions or help choosing a health plan, call us at 1-800-841-2900 (TTY: 1-800-497-4648).

How do I find my provider?

Accountable Care Organization (ACO) plans:

To find a primary care provider, go to Find a primary care provider. Enter information such as your provider’s address, ZIP code or city. Put your provider’s name in the “Provider name” field and click “Find providers.”

Managed Care Organization (MCO) plans:

  • BMC HealthNet Plan (MCO): Visit https://www.bmchp.org/utility-nav/find-a-provider. Click “MassHealth MCO Plan.” Click “Medical Doctor or Hospital.” Put your provider’s name in the search bar and click “Go.”

  • Tufts Health Together (MCO): Visit http://networkhealth.prismisp.com/?plan=together&str=together-en. Keep “Tufts Health Together (MassHealth)” selected as your plan. Enter your provider’s name in “Do you know the name of the doctor you are looking for?” You can also enter your doctor’s ZIP code in “Are you looking for a doctor near you?” Click “Search.”          

Primary Care Clinician (PCC) plans:

Go to the MassHealth Provider Directory. From the Health Plans drop-down menu, scroll down to “Primary Care Clinician (PCC) plan.” In the “Type of provider” section, choose one. For example, you can choose “Family/General Practice.”

In the Location section, enter your provider’s office, city or ZIP code. For the Keyword Search, enter your provider’s last and first name, such as Smith, John. Or you can use the name of the practice or clinic, such as “Geiger Gibson Community Health Center.” Click “Search Providers.”

How do I know if I qualify for MassHealth?

To find out if you qualify for MassHealth, fill out a Massachusetts Application for Health and Dental Coverage and Help Paying Costs. You can find the form at https://www.mass.gov/lists/masshealth-member-applications.

To learn more about MassHealth, go to https://www.mass.gov/topics/masshealth. Or call 1-800-841-2900 (TTY: 1-800-497-4648). To meet with someone in person, go to In-person help.

How do I know if I have MassHealth?

When you qualify for MassHealth, you will get a letter in the mail.

To find out if you have MassHealth, go to https://www.mahealthconnector.org/. Or call us at 1-800-841-2900 (TTY: 1-800-497-4648). To meet with someone in person, go to In-person help.