COMMONWEALTH CARE PATIENT FAQs
Are individuals receiving COBRA coverage, non-group coverage or in a waiting period for group coverage considered insured and therefore ineligible for Commonwealth Care?
Those individuals are not considered insured and therefore will not be disqualified from Commonwealth Care eligibility (assuming they meet all other Commonwealth Care eligibility criteria).
Because the program is being phased in, what should I do if I need medical services while I’m waiting to get Commonwealth Care?
You will continue to get care from the Uncompensated Care Pool for services provided by the Pool. However, it is important to look out for and respond to any mailings from the Connector or MassHealth.
Why would I get letters from MassHealth?
Commonwealth Care is not MassHealth, but MassHealth helps the Connector determine who is eligible for the Commonwealth Care program. This is why letters about your eligibility will come from MassHealth. It is important for you to respond to any requests for information from MassHealth.
Where can I learn more to compare MCO plans?
The Commonwealth Care enrollment guide provides detailed information about all the plans. You can also contact the plans directly or visit their websites:
Fallon Community Health Plan - 1-866-ASK-FCHP (866-275-3247), www.fchp.org
Network Health - 1-888-257-1985, www.network-health.org
Neighborhood Health Plan - 1-800-462-5449, www.nhp.org
Boston Medical Center HealthNet Plan - 1-888-566-0008, www.bmchp.org
Where are the provider networks listed for each MCO plan?
The Commonwealth Care Customer Service Center is able to answer questions about MCO provider networks and receives weekly information from the MCOs about providers in their networks. The MCOs are also available to answer questions about their provider networks and have printed Provider Directories that are sent to members once they enroll and are also available upon request.
When does the health plan coverage start?
If your income is at or below 100% of the federal poverty level (FPL):
In most cases, your health-plan coverage will start on the first day of the month following your health-plan selection. For example, if you select a plan on October 12, the effective date of your coverage would be November 1. However, if you choose your health plan on the last two days of each month, your enrollment may not start until the first day of the second month following your plan selection. For example, if you select a plan on October 31, the effective date of your coverage would be December 1. It is best to choose a health plan as soon as possible after you receive your Commonwealth Care enrollment packet.
If your income is more than 100% of the FPL and at or below 300% of the FPL:
More information will be available about the effective date of coverage for persons with income that is more than 100% of the FPL and at or below 300% of the FPL in the coming weeks.
What if I lose my Commonwealth Care eligibility?
If a member is found to no longer meet eligibility criteria for Commonwealth Care, their benefit will terminate the last day of the month from when the change in circumstance was reported.
What if Commonwealth Care members cannot pay the cost sharing?
The Connector is in the process of implementing a hardship policy for Commonwealth Care members at or below 100% FPL that cannot pay co-pays. The Connector will also have a hardship policy in place for the 100-300% FPL members that are not able to meet their cost sharing obligations.
More information on this will be posted as it becomes available.
Does Commonwealth Care have the option for payment plans?
Yes, this option is currently being developed for individuals with incomes at 100-300% FPL. More information on this will be posted as it becomes available.
Applicant/Member Inquiries about Commonwealth Care
Individuals interested in applying should call Commonwealth Care Customer Service at 1-877-MA-ENROLL
Individuals that have questions concerning an eligibility determination should contact the MassHealth Enrollment Center at 1-888-665-9993
-Adapted from Commonwealth Care FAQs retrieved from: www.mass.gov/Qhic/docs/faq.doc
11/06