Other pharmacy copay rules stay the same. Some examples of the rules that are staying the same are as follows:
The copay for covered brand-name drugs will stay $3 for both first-time prescriptions and refills;
Sometimes a copayment is not required. The rules for when a person does not have to pay a copay have not changed;
If your prescription is covered by MassHealth and you are not able to pay a copay at time of service, the pharmacy sill must fill your prescription. However, the pharmacy can bill you later. Your should not go without necessary medications because you cannot afford the copay now;
The cap on the amount of copays you must pay within a calendar year is not changing. The total amount you can be charged for pharmacy copays within a year is still $200;
Copays for the Children’s Medical Security Plan (CMSP) and Healthy Start are not changing;
The MCO pharmacy copay rules are the same as for all other MassHealth members.
This change will affect MassHealth members including MassHealth enrollees and HSN patients.
If you have questions about copayments and are a MassHealth member, call MassHealth Customer Service at 1-800-841-2900 V, 1-800-497-4684 TTY.
If you are enrolled in a MassHealth MCO, you may also contact the customer service center at the MCO.
Boston Medical Center HealthNet Plan (BMCHP): 1-88-566-0010 (English and other languages) or 1-888-566-0012 (Spanish) TTY: 1-877-608-7677.
Fallon community Health Plan (FCHP) 1-800-341-4848, 1-877-608-7677 TTY.
Health New England: 1-800-786-9999, 1-800-439-2370 TTY.
Neighborhood Health Plan (NHP) 1-800-462-5449, 1-800-655-1761 TTY.
Network Health (NH): 1-888-257-1985, 1-888-391-5535 TTY.
If you are a Health Safety Net patient and have questions about your copayments, call 1-877-910-2100.
Acute inpatient hospital stays
Effective for acute hospital admissions beginning October 1, 2010, MassHealth plans to no longer cover acute hospital inpatient stays after the first 20 days for MassHealth members who are 21 years of age or older. This change does not apply to inpatient stays provided in a Department of Mental Health (DMH)-licensed acute psychiatric unit within a Department of Public Health (DPH)-licensed acute hospital or in a rehabilitation unit within a DPH-licensed acute hospital.
MassHealth will continue to cover all medically necessary inpatient stays provided in a Department of Mental Health (DMH)-licensed acute hospital or in a rehabilitation unit within a DPH-licensed acute hospital.
If you have both Medicare and MassHealth, and MassHealth pays for your Medicare premiums, copays, and deductibles, and Medicare pays for the hospital stay described above for you then MassHealth will pay its portion of the coinsurance and deductible for that hospital stay.
A hospital may bill you for the portion of a hospital stay that is no longer covered by MassHealth.
If you have questions about his change, call MassHealth Customer Service at 1-800-841-2900, 1-800-497-4648 TTY.
Effective for transportation on or after July 1, 2010, MassHealth is changing certain nonemergency transportation benefits.
MassHealth is changing certain nonemergency transportation benefits. These changes will affect individuals currently eligible to get nonemergency transportation benefits.
Effective for transportation on or after July 1, 2010, you will no longer be able to get paid back for personal vehicle mileage costs or costs for arranging your own ride when going to MassHealth covered services. You will still be able to get paid back for the cost of taking public transportation to MassHealth covered services if the ride you take meets MassHealth requirements. If MassHealth decides that there are exceptional circumstances, you may be able to get paid back for transportation costs that are not for public transportation.
Individuals currently eligible to receive nonemergency transportation benefits may still get a ride to MassHealth covered services if the ride you need meets MassHealth requirements. If you need help getting to your MassHealth covered service you should talk to the doctor or other person who is providing the MassHealth covered service about how to request transportation services.
If you have any questions about this change call MassHealth Customer Service at 1-800-841-2900, 1800-497-4684 TTY.