What Type of Insurance is Masshealth ppo?

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Below are six MassHealth coverage options available to eligible people, families and people with disabilities. They are: Standard, CommonHealth and CarePlus. Family Assistance, Premium Assistance and Limited. Complete the Massachusetts Application for Health and Dental Coverage and Assistance Paying Costs (ACA-3) to apply for coverage. MassHealth will help you choose the right MassHealth program or coverage type. MassHealth will provide you with the best coverage possible. Your eligibility is determined by your income, citizenship, immigration status, age, special circumstances, and other factors. To receive any of these services, you must be a Massachusetts resident. Some services may require copayments.

MassHealth Standard

MassHealth Standard offers a wide range of health-care benefits.

Services covered

MassHealth Standard covers the following services: There might be limitations.

  • Services inpatient hospital
  • Outpatient services: Hospitals, clinics and doctors.
  • Medical services: Lab tests, X-rays, treatments, pharmacy services. Eyeglasses, hearing aids. Medical equipment and supplies.
  • Adult foster care and adult day health
  • Inpatient and outpatient mental health and addiction services
  • Well-child screenings for children younger than 21 include: hearing, vision, medical, and mental health services, shots, and addiction services.
  • Services and support at home, in long-term care facilities or at home.
  • Transport services
  • Services that can help you quit smoking
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MassHealth will pay the Medicare Premium and, if applicable the coinsurance and the deductibles for disabled adults who also have Medicare Part B.

Important information for youth and children with serious mental health problems or severe emotional disturbance (SED).

MassHealth provides certain behavioral health services to eligible children and youth aged under 21 who are enrolled at MassHealth CommonHealth or MassHealth Standard. MassHealth CommonHealth may be available for your child if your child isn’t eligible for MassHealth Standard, but a behavioral assessment shows that your child has serious mental health problems or an emotional disorder.

For those who are under 21, there are more services

MassHealth Standard is available to children, teens, and young adults aged under 21. They are also eligible to receive Early and Periodic Screening Diagnosis and Treatment (EPSDT). All medically required services are covered by the law.

MassHealth CommonHealth

MassHealth CommonHealth provides health care benefits similar in nature to MassHealth Premium to certain disabled adults or children who are unable to access MassHealth Standard.

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Services covered

MassHealth CommonHealth covers the following services: There might be limitations.

  • Services inpatient hospital
  • Outpatient services: Hospitals, clinics and doctors.
  • Medical services: Lab tests, X-rays, treatments, pharmacy services. Eyeglasses, hearing aids. Medical equipment and supplies.
  • Adult foster care and adult day health
  • Services for addiction and mental health
  • Well-child screenings for children under 21: hearing, vision, hearing, addiction, medical and developmental screenings, shots
  • Services and support at home, in long-term care facilities or at home.
  • Transport services
  • Services that can help you quit smoking

Important information for youth and children with serious mental health problems or severe emotional disturbance (SED).

MassHealth provides certain behavioral health services to eligible children and youth aged under 21 who are enrolled at MassHealth CommonHealth or MassHealth Standard. MassHealth CommonHealth may be available for your child if your child isn’t eligible for MassHealth Standard, but if a behavioral assessment shows that your child has serious mental health problems or an emotional disorder, MassHealth CommonHealth may be an option.

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For those who are under 21, there are more services

MassHealth CommonHealth is open to children, teens, and young adults aged under 21. They are eligible for Early and Periodic screening, diagnosis, and treatment (EPSDT). All medically required services are covered by the law.

MassHealth CarePlus

MassHealth CarePlus provides a wide range of health benefits for adults who aren’t otherwise eligible for MassHealth Standard.

Services covered

MassHealth CarePlus covers the following services: There might be limitations.

  • Services inpatient hospital
  • Outpatient services: Hospitals, clinics and doctors.
  • Medical services: Lab tests, X-rays, treatments, pharmacy services. Eyeglasses, hearing aids. Medical equipment and supplies.
  • Services for addiction and mental health
  • Services for home health
  • Transport services
  • Services that can help you quit smoking

Persons who are physically or mentally disabled

MassHealth Standard may be available to you if you are considered medically fragile. This gives you additional benefits. If:

  • A medical condition, mental illness, or addiction that restricts your ability to work, school, or study
  • Daily activities such as bathing and dressing require assistance.
  • Regular medical care, personal or other health services are provided at your home or in another setting such as adult day care.
  • You are terminally ill
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MassHealth Standard may require additional steps to receive the extra benefits MassHealth Standard offers. MassHealth may require additional information, or might need to verify that the benefits are right for you. These extra steps can be explained to you by your doctor or MassHealth Customer Service.

MassHealth Family Assistance

MassHealth Family Assistance may be available to you if your Massachusetts residency is not met by MassHealth Standard.

Services covered

MassHealth Family Assistance covers the following services: There might be limitations.

  • Services inpatient hospital
  • Outpatient services include hospitals, clinics and doctors as well as dentists and family planning. vision care
  • Medical services: Lab tests, X-rays, treatments, pharmacy services. Eyeglasses, hearing aids. Medical equipment and supplies.
  • Services for home health
  • Services for addiction and mental health
  • Developmental screens
  • Shots
  • Ambulance services for emergencies only
  • Services that can help you quit smoking

Premium Assistance

MassHealth may cover all or part of your household’s premiums if you have or have access to other health insurance. For more information, see Other health insurance and MassHealth Premium Assistance.

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MassHealth Limited

MassHealth Limited offers emergency services for people with a restricted immigration status who are unable to access other services.

Services covered

MassHealth Limited covers the following services. Only medical emergencies are covered. These conditions can cause severe harm if they are not treated. There might be limits.

  • Inpatient hospital emergency services, which include labor and delivery
  • Emergency visits to emergency rooms and outpatient hospital emergency services
  • Some medical services are provided outside of hospitals by doctors and clinics.
  • For an emergency medical condition, a pharmacy can be contacted immediately
  • Only for emergency medical conditions, ambulance transport