Tufts Medicine Care Plan

Have MassHealth Insurance Coverage? Make sure you are enrolled in Tufts Medicine Care Plan to continue seeing your Tufts MC/Tufts Children's Hospital primary care physician today!

MassHealth has recently changed its health plan options. Tufts Medical Center and Tufts Children's Hospital primary care physicians are now part of a new MassHealth health plan called Tufts Medicine Care Plan - a MassHealth Accountable Care Organization (ACO) Partnership Plan with Fallon Health. Our Tufts MC/Tufts Children's Hospital primary care physicians are part of the Tufts Medicine Care Plan.

If you have MassHealth insurance coverage, you will need to select the Tufts Medicine Care Plan option by June 30, 2018 to continue seeing your Tufts MC/Tufts Children's Hospital primary care physician.

We want to make sure you can continue to see your trusted primary care physician at Tufts MC/Tufts Children's Hospital. Please contact your Tufts MC/Tufts Children's Hospital primary care physician as soon as possible so we can assist you with any questions and ensure you are in the health plan you want. It is important that you act prior to June 30, 2018.

Your primary care provider or staff can answer questions about the Tufts Medicine Care Plan. You can also call Fallon Health at 1-855-508-4715 (TRS 711) from 8 am to 6 pm, Monday – Friday, or visit fallonhealth.org/tufts medicine.

Frequently asked questions about Tufts Medicine Care Plan and MassHealth coverage

What is an Accountable Care Organization (ACO)?

An ACO is a group of providers who agree to work closely with patients and their families for all their health care needs. Doctors and other health care providers choose to participate in an ACO because they are committed to providing patients with a better care experience. In an ACO, your PCP is responsible for coordinating your care and connecting you with available services and supports. This coordination will help you get the right care at the right time, in the right place.

What ACO are Tufts Medical Center and Tufts Children's Hospital a part of?

Tufts Medical Center and Tufts Children's Hospital are part of the Tufts Medicine Care Plan - a MassHealth Accountable Care Organization (ACO) Partnership Plan with Fallon Health.

Tufts Medicine Care Plan is a group of hospitals and providers who have agreed to work closely together to take good care of you and your family. Fallon Health is a leading health care services company that has been caring for MassHealth members for more than 40 years.

How do I know if my primary care physician (PCP) is part of Tufts Medicine Care Plan?

All primary care physicians affiliated with Tufts Medical Center and Tufts Children's Hospital are part of Tufts Medicine Care Plan.

How do I know if I am enrolled with Tufts Medicine Care Plan?

If you have a Tufts Medical Center or Tufts Children's Hospital PCP, then MassHealth should have enrolled you in the Tufts Medicine Care Plan for 3/1/2018. However, we have learned that some of our patients may have been incorrectly assigned to other plans. If you are in another plan and want to continue to see your Tufts MC/Tufts Children's Hospital physician, you will need to enroll in the Tufts Medicine Care Plan. You can do this by calling Fallon Health at 1-855-508-4715 (TRS 711) from 8 am to 6 pm, Monday - Friday. If you aren’t sure that you have been enrolled with Tufts Medicine Care Plan, call your primary care physician at 617-636-5400 or pediatrician at 617-636-5255 as soon as possible.

How is Tufts Medicine Care Plan different from my current MassHealth plan?

As a member of the Tufts Medicine Care Plan, all your health care is managed by your primary care provider (PCP). Your PCP will work with Tufts Medicine Care Plan’s group of doctors, hospitals and community health centers to provide you with great health care.

Will I pay more for Tufts Medicine Care Plan?

No. There’s no cost to join Tufts Medicine Care Plan.

Will my MassHealth benefits change with Tufts Medicine Care Plan?

No. You’ll have the same benefits you’ve always had with MassHealth, including behavioral health services and free rides for emergencies. You’ll also get these healthy extras:

  • $10 CVS select gift care when you fill out your health survey
  • Free prenatal vitamins, a free car seat, and other “little extras” for expectant parents through the Oh Baby! program
  • A free online health resource with info on conditions, medicines, and other health topics
  • Free help for individuals with asthma, heart disease, or chronic obstructive pulmonary disease (COPD)

Tufts Medicine Care Plan can also help you get behavioral health counseling services. They can teach you about children’s services. And they can show you how to apply for food stamps and other benefits.

Will I be able to continue to see my specialists?

If you have a Tufts Medicine Care Plan PCP, and your specialists are part of the Tufts Medicine Care Plan network, you will be able to continue to see your specialists with a referral from your PCP.

 You will need to get a prior authorization from your PCP to see an out-of-network specialist.

When can I change my plan?

  • For MassHealth members who moved to a new plan on March 1, 2018, this year’s Plan Selection Period runs from March 1, 2018 through May 31, 2018. During this time, you can explore new health plan options and change your plan for any reason.
  • On June 1, 2018, if you are enrolled in an Accountable Care Partnership Plan, a Primary Care ACO or a MCO, you will be in your Fixed Enrollment Period and will only be able to change plans for certain reasons. If you are in the PCC Plan, you can change at any time. You can find out more about these reasons in the MassHealth Enrollment Guide, which was sent to your household.