The Plans We Serve

ACOs are health plans that provide care through groups of doctors, hospitals, and other healthcare providers who come together to give coordinated care to MassHealth members. In an ACO, a member’s primary care provider (PCP) must be in the network for coverage, and the member must live in the service area (exceptions can be made). The PCP works with members and their ACO’s heath plan. The member’s PCP also connects them to services and supports. If for some reason a member would like to switch to another health plan, a member can do so during their annual 90-day plan selection period. If a member is in a fixed enrollment period, they are only permitted to change to a new health plan for specific reasons. 

Enrollment is open to members who meet the following criteria: 

1. Under 65 with MassHealth as their only insurance 

2. Living in the community (not a nursing home) 

3. In MassHealth Standard, MassHealth CommonHealth, MassHealth CarePlus, or MassHealth Family Assistance 

4. Living in the service area of the plan 

There are two types of ACOs members can enroll in: 

1. Accountable Care Partnership Plans 

In this type of ACO, a group of PCPs work with just one managed care organization to create a full network that includes PCPs, specialists, behavioral health providers, and hospitals. PCPs plan and coordinate care to meet your health care needs.

• Fallon Health-Atrius Health Care Collaborative

• Berkshire Fallon Health Collaborative

• Fallon 365

• Be Healthy Partnership

• Mass General Brigham Health

• Tufts Health Together with Cambridge Health Alliance (CHA)

• Tufts Health Together with UMass Memorial Health

• East Boston Neighborhood Health WellSense Alliance

• WellSense Beth Israel Lahey Performance Network (BIHL)

• WellSense Boston Children’s ACO

• WellSense Community Alliance

• WellSense Mercy Alliance

• WellSense Signature Alliance

• WellSEnse SouthCoast Alliance

  2. Primary Care ACOs 

In this type of ACO, a group of PCPs have joined together into an ACO to be responsible for your care. The ACO contracts directly with MassHealth to provide primary care and coordinate the full range of services for its enrollees. Primary Care ACOs work with the MassHealth network of specialists and hospitals and may have certain providers in their “referral circle.” This circle gives you direct access to other providers. The Massachusetts Behavioral Health Partnership (MBHP) provides behavioral health services. ACOs currently available are: 

• Community Care Cooperative (C3)  

• Revere Health Choice  

For more information about ACOs and their service areas, please visit MassHealthChoices.com. For more information about plan selection and fixed enrollment periods, visit Plan Selection Period | Mass.gov, Fixed Enrollment Period | Mass.gov.

MCOs are health plans run by insurance companies that provide care through their own provider network which includes PCPs, specialists, behavioral health providers, and hospitals. Care coordinators are employed by the MCO. Please note: PCPs who are part of an ACO will not be available as PCPs in MCO plans. For individuals choosing an MCO, a PCP must be within the network for coverage, and the member must live in the service area.  This makes it easier for the member to stay connected to their provider. If for some reason the member would like to switch to another health plan, they can do so during their annual 90-day plan selection period. If the member is in their fixed enrollment period, they are only permitted to change to a new health plan for specific reasons.  

Enrollment is open to members who meet the following criteria: 

1. Under 65 with MassHealth as their only insurance 

2. Living in the community (not a nursing home) 

3. In MassHealth Standard, MassHealth CommonHealth, MassHealth CarePlus, or MassHealth Family Assistance 

4. Living in the service area of the plan 

There are currently two MCO options for MassHealth members: 

• WellSense Essential MCO 

• Tufts Health Together 

For more information about MCOs and their service areas, please visit MassHealthChoices.com. For more information about plan selection and fixed enrollment periods, visit Plan Selection Period | Mass.gov, Fixed Enrollment Period | Mass.gov.

In the Primary Care Clinician Plan, the member chooses a PCP in the MassHealth network, and medical services are provided through the MassHealth network.  Members in the PCC Plan receive behavioral health services through the Massachusetts Behavioral Health Partnership (MBHP). As a PCC member, it is possible to switch to an ACO/MCO at any time. For more information, please visit MassHealthChoices.com.

The Massachusetts Behavioral Health Partnership (MBHP) manages behavioral healthcare for MassHealth members statewide, including members in the PCC Plan and Primary Care ACOs. For more information, please visit www.MassPartnership.com.

One Care is a health plan for adults with disabilities living in Massachusetts who are enrolled in both Medicare and MassHealth. With One Care, there is one plan, one card, and one person to coordinate the member’s healthcare. One Care covers all the services a person gets with Medicare and MassHealth. This includes medical, prescription drug, behavioral health, and community support services. 

Enrollment is open to members who meet the following criteria: 

1. Age 21 to 64 at the time of enrollment 

1. Eligible for MassHealth Standard or CommonHealth 

1. Enrolled in Medicare Parts A & B and eligible for Medicare Part D 

1. Without other public or private comprehensive insurance 

1. Not enrolled in a Home and Community-based Services (HCBS) waiver 

1. Not residing in an Intermediate Care Facility (ICF/MR) 

The three One Care plans currently available are: 

• Commonwealth Care Alliance 

• Tufts Health Unify 

• UnitedHealthcare Connected

The plans service areas can be found on the two plan websites.  Enrollment is voluntary. A member can enroll and disenroll any month of the year. 

For more information on One Care, please visit www.mass.gov/one-care.

Senior Care Options (SCO) is a health plan offered by MassHealth that covers all the services normally paid for through Medicare and MassHealth through a senior care organization and its network of providers. SCOs combine health and social support services by using care coordination, geriatric support services, and respite care for families and caregivers. 

Enrollment is open to members who meet the following criteria: 

1. Aged 65 or older 

2. Live at home or in a long-term care facility (member cannot be an inpatient at a chronic or rehabilitation hospital or reside in an intermediate care facility for people with intellectual disabilities) 

3. In MassHealth Standard 

4. Are not subject to a six-month deductible period under MassHealth regulations 

5. Are not diagnosed with end-stage renal disease 

6. Live in an area served by a SCO plan 

There are six SCO plans currently available to MassHealth members: 

• Boston Medical Center HealthNet Plan Senior Care Options 

• Commonwealth Care Alliance 

• NaviCare (HMO) 

• Senior Whole Health 

• Tufts Health Plan Senior Care Options 

• UnitedHealthCare Senior Care Options 

The service areas for each of these six plans can be found by visiting their websites. 

Enrollment is voluntary; a member can enroll and disenroll any month of the year. For more information on SCO, please visit www.mass.gov/senior-care-options-sco. 

Enrollment is open to members who meet the following criteria:

1. Aged 65 or older

2. Live at home or in a long-term care facility (member cannot be an inpatient at a chronic or rehabilitation hospital or reside in an intermediate care facility for people with intellectual disabilities)

3. In MassHealth Standard

4. Are not subject to a six-month deductible period under MassHealth regulations

5. Are not diagnosed with end-stage renal disease

6. Live in an area served by a SCO plan

There are six SCO plans currently available to MassHealth members:

• Boston Medical Center HealthNet Plan Senior Care Options

• Commonwealth Care Alliance

• NaviCare (HMO)

• Senior Whole Health

• Tufts Health Plan Senior Care Options

• UnitedHealthCare Senior Care Options

The service areas for each of these six plans can be found by visiting their websites.

Enrollment is voluntary; a member can enroll and disenroll any month of the year. For more information on SCO, please visit www.mass.gov/senior-care-options-sco.