MassHealth is the name of the state of Massachusetts’ Children’s Health Insurance Program (CHIP) and Medicaid program. MassHealth is an independent health authority that provides health benefits to qualifying people in Massachusetts.
MassHealth may help cover some or and, at times, all healthcare costs for its members. Qualifying children, seniors, families and those living with disabilities are able to take advantage of MassHealth. Coverage from MassHealth includes doctor visits, prescription drugs, dental care, behavioral health services and a variety of other health care services for its members.
Who Accepts MassHealth Insurance?
All licensed physicians in Massachusetts are required to enroll in MassHealth, though they may enroll as a billing or a non-billing provider. This is a requirement in order to maintain a physician’s license in Massachusetts. Physicians that do not want to accept MassHealth patients must enroll as non-billing providers.
Because all doctors must enroll in MassHealth in order to get a license, it’s difficult to say at any given time how many doctors are included in the MassHealth network. The number of billing providers grows all the time.
MassHealth Care Plans
There are many MassHealth care plans. The type of MassHealth care plan you have will affect how much you have to pay for coverage and what kind of treatment your plan will pay for if you need addiction treatment in or around Massachusetts.
PPO stands for Preferred Provider Organization. These plans typically have high premiums, but for the cost, members enrolled in PPO plans also get flexible coverage. They have more ability to see providers and specialists from out-of-network offices, and usually without first getting a referral. While PPOs may have high premiums, the other fees associated with insurance are usually low, provided that they get services in-network.
HMO plans, better known as health maintenance organization plans, have low deductibles and low, fixed copays. HMOs require patients to see physicians in-network. In order to get care from an out-of-network doctor, members must first get a referral from their doctor.
Point-of-service plans function much like HMOs, with low costs and fixed copays. However, point-of-service plans usually have more out-of-network flexibility. If you’re planning to seek addiction treatment out-of-network, a POS plan is useful and may enable you to get the treatment you need for a relatively low cost.
Exclusive provider plans (EPO) provide in-network care, but usually have more providers in their network than HMOs.
HDHP with HSA
High deductible health plans (HDHP) are attractive to people who think they have little need for health insurance, because they have very low premiums and high deductibles. These plans also come with an HSA (health savings account) that can cover part of the deductible.
ACOs are accountable care organizations that consist of networks of doctors, hospitals and other providers that coordinate to provide care. Primary care providers and their teams work with other providers within the ACO to make decisions about your care. Your primary care physician will connect you with the other services you need to get care.
ACOs are divided into two groups: accountable care partnership plans and primary care ACO plans. Accountable care partnership plans provide members with a network of providers and specialists that take care of all member healthcare needs. Primary care ACO plans are groups of PCPs that join together to provide care, including providers in a referral circle.
Managed care organizations (MCOs) are health plans run by insurance companies. The network for an MCO includes hospitals, behavioral health providers, specialists and more.
Primary care clinician plan (PCC) is a statewide health plan for MassHealth members. Primary care providers and primary care clinicians make up the PCC plan. The MassHealth network delivers services. Under this plan, the MassHealth network also partners with the Massachusetts Behavioral Health Partnership to provide behavioral health services.
Can MassHealth Pay for Substance Abuse Treatment?
Yes, MassHealth can pay for substance abuse treatment. However, the coverage amount you’re eligible for and how much you’ll have to pay in copays and fees depends in large part upon the type of plan you have under MassHealth.
The best way to find out how much you’ll have to pay for your treatment is to meet with the care provider you have selected for your rehabilitation, and have a discussion with that provider about your treatment plan and how much is covered by your insurance.
If your provider has worked with an insurance plan type like yours in the past, they may be able to help you anticipate some costs. However, so many aspects of how much you’ll have to pay are dependent upon the specifics of your treatment and your plan, there’s no way to anticipate costs until you’re able to coordinate with your provider and your insurance company.
Does MassHealth Require Preauthorization for Addiction Treatment?
Preauthorization may be a requirement for seeking addiction treatment under the MassHealth plan. The purpose of requiring preauthorization is to ensure that your provider believes that treatment is medically necessary. If you would like preauthorization for your addiction treatment, contact your MassHealth insurance provider or MassHealth to seek the forms for your provider.
Regardless of the type of treatment you’re seeking, whether that’s inpatient or outpatient, residential, detox services or partial hospitalization, ask MassHealth about the preauthorization form to avoid problems with billing after services have been received.
Find Your Addiction Treatment Coverage and Cost
Substance abuse can ruin lives, so if you’ve made the decision to get treatment for your substance abuse problem, congratulations! You’ve made a good decision that can hopefully improve your quality of life and may have a lasting effect on your personal relationships, future jobs and more.
The final cost of addiction treatment can seem like an overwhelming amount, but that’s why it’s so important to work with your insurance provider. By contacting your insurance provider, you’ll be able to get more of your questions answered, and get the treatment you need to recover.
For your convenience, you can also use our addiction treatment insurance coverage tool to get more information about the final cost of addiction treatment.