The Davis Square Community

[X-posted to both b0st0n and davis_square]

tl;dr: If you have MassHealth, you may have been assigned to the CeltiCare plan without knowing it. Many people think this is a bad thing. You have until this Friday, Jan 31, to call MassHealth and change it. Otherwise, you're stuck with it until the next open enrollment period, no idea when that will be.

More info:

Today, my clinic learned that MassHealth had notified all members that plain-old MassHealth is going away, there is a new thing called MassHealth Careplus they were now in, in which they had to choose plans, and if members didn't choose plans by a certain date (Jan 1?), they were defaulted to CeltiCare. Expect apparently a lot of people didn't get the notification? Or didn't understand they had to do something? Or didn't realize the consequences?

People are apparently discovering this only after they try to use their insurance. CeltiCare has a very small number of providers, all(?) clustered in Boston, and I gather very demanding prescription pre-auth requirements. My clinic doesn't take it at all, and now all our patients who were defaulted to CeltiCare need to fix this in the next 48hrs or they lose access to their doctors and therapists.

Because the current open enrollment period ends 1/31. After that, you're stuck with whatever plan you're in until the next open enrollment period. No idea when that is.

If you are a MassHealth member, and didn't realize you had to pick a plan, you may have been assigned one -- possibly one that really doesn't work for you.

If you are a MassHealth member, to find out what plan MassHealth has you in, call the main number, the one on the back of your MassHealth card: 800-841-2900. They're open 8am to 5pm, M-F. They will change your plan if you ask them to by Friday.

You may want to call your doctors, pharmacies, therapist, etc and ask which MassHealth plans they take, if you are affected by this change over. Apparently a lot of clinics which previously could be characterized as "take MassHealth" as of the end of the month no longer do -- they take specific plans within MassHealth. This is part of the confusion; members don't realize they have to make sure their providers, whom they've been seeing for years on MassHealth, will take their new MassHealth Careplus plan.

Please also be aware, just because you used your MassHealth coverage to get medical care this month doesn't mean that everything is fine: during this month, because of open enrollment transition, all previous MassHealth providers were (I am told) allowed to bill all plans, regardless of their contractual agreements. That goes away 2/1/2014, and providers can only bill to the plans they're signed up to take. So my clinic has been able to see CeltiCare patients all this month, because they come up on our computer as "sure, the insurance will pay." We didn't realize there was a problem until now.