What is a Managed Care Organization (MCO)?

MCOs are private insurance companies. They contract with MassHealth to provide health insurance coverage for certain people enrolled in MassHealth. Certain MassHealth enrollees must select an MCO. Otherwise, they will be assigned to another plan. Managed care members can switch plans at any time. Here are some things you should know about MCOs:

  • They cover the same services as MassHealth based on your coverage type.
  • They may provide extra benefits not covered by MassHealth (for example, car seats and bike helmets).
  • They use a network of doctors. You receive care and services within that network.

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Why do I have two insurance cards (MassHealth and MCO)?  


MassHealth members who choose an MCO have two insurance cards. One is your MassHealth card, the other is from the MCO. There are some services that are covered by your MCO and others that are covered by MassHealth. To learn more about covered services, please see our page on Coverage Types. When you see a provider, you should show both cards. Each provider may or may not work with your MCO plan. You should make sure to receive services from providers who work with your MCO. Refer to HNE’s Member Handbook for information on how to use an out of network provider if necessary.

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If I choose an MCO, do I lose my MassHealth? 

No, your MCO works with MassHealth to cover the services you are eligible for. You still are covered under MassHealth. Your MCO may provide extra benefits not covered by MassHealth. For example, HNE Be Healthy provides free:

  • car seats
  • bike helmets
  • birthday books
  • other items to those who qualify for them

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What is an Eligibility Review Form?

If I receive a form, must I complete it?   
Eligibility Review Forms (ERV) are usually annual reviews confirming your continued eligibility for MassHealth. Make sure to complete the form. Send it back to MassHealth right away. Not all reviews are annual. Reviews can take place every 6, 12 or 18 months. The ERV forms are mailed to your listed address.

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What changes do I have to report? 

You must report any changes that might affect your eligibility for MassHealth as soon as possible. Examples of the types of changes you must report are:

  • A change of income
  • Immigration status
  • Disability status
  • Health insurance
  • Address
  • Other

You may lose your benefits if you do not tell MassHealth about your changes.

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Will I get the same coverage if I change to an MCO? Will my meds be covered?

Each MCO must offer basic services required from MassHealth. The differences between MCOs and their coverage’s are based on:

  • providers
  • specialist
  • medical services
  • hospitals and health centers that are in plan

Make sure that your provider accepts the MCO plan before changing your MCO. HNE Be Healthy ensures that individuals’ changing to our plan will be able to continue medication coverage for a specified period of time. Our member service department can help you with questions around your medication. They can also provide you with advice and direction. Member Services can be reached at 800.786.9999 (TTY 800.439.2370) Monday - Friday, 8 a.m. to 5 p.m

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Why should I choose HNE Be Healthy if all MCOs cover the same benefits?

HNE Be Healthy gives you the support of people who live and work in your community. We’ve been serving Western Massachusetts for over 25 years. We know the importance of being a trusted member of our community. We work with a dedicated team of healthcare providers to bring you innovative health solutions aimed at making each of us in the Western Massachusetts community, healthier and happier.

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Is HNE’s Medicaid line new?  


HNE Be Healthy became a contracted MassHealth MCO as of July 1, 2010. However, we are not new to the health insurance business. We have been serving our community since 1985 with our commercial and Medicare lines of business. We are excited to offer our excellent medical coverage to our Western Massachusetts Medicaid members.

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Who do I call if I want to know more about MassHealth and/or HNE?


For questions regarding MassHealth and/or to learn about all of your managed care health plan options you can call or visit MassHealth website.

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What should I do if I need emergency medical care?


You are always covered for emergency care. If you believe you are having a life threatening emergency, call 911 or go to the nearest ER.

However, the ER is not usually the best place to go for minor injuries or illnesses. Inappropriate ER visits are a key cause of rising health care costs. ERs are often crowded, and patients are treated based on the severity of their condition. That means you may often have a long wait. Since they don’t know you at the ER, you won’t get the same personalized service that you get from your own doctor. The ER doctor won’t be familiar with your medical history, and may not be aware of conditions for which you are being treated. ERs also cost much more than the services you get from your own doctor – both for you and your health plan. For example, your ER copayment is most likely much higher than your office visit copayment.

HNE requires your doctor’s office to have 24 hour phone coverage. That way, if you need care after hours, you can call the office. Your doctor or someone covering will help you decide what to do – whether you should get care right away or wait to see your own doctor. HNE also has a 24 hour nurse line. If you can’t reach your doctor, call us at 413.787.4000 or toll free 800.842.4464, choose option 2 (member covered by HNE), then option 4 (HNE nurse line). An experienced nurse will listen carefully to your concerns and give you information to help you choose the care that’s right for you.

 

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