What you need to know about MassHealth eligibility redeterminations

MassHealth needs to renew coverage for all members to make sure they are still eligible and receive the best benefit they qualify for. If you or the head of your household recently received a notice from MassHealth saying that you need to renew your coverage, you must respond by the due date on your renewal notice.


You should also report any changes to your mailing address if you have recently moved. Learn how to report these changes here.

Mass General Brigham ACO

Mass General Brigham ACO is a health plan for MassHealth members. This ACO offers the same benefits as MassHealth (the Massachusetts Medicaid program).

Our goal is to help you see the doctors you need to improve your health. A Mass General Brigham primary care provider will look after your care. You'll also have access to other benefits, support programs, and services.

What is an Accountable Care Organization (ACO)?

ACO is short for Accountable Care Organization. An ACO is a team of doctors and other providers. Your primary care provider (PCP) is a part of this team. The team shares your health information to make sure they are meeting your care needs. This also helps avoid unnecessary duplication of services and saves time on paperwork.
 
ACOs work with insurance companies to provide great healthcare. Together they set rules for the quality and cost of care. The goal of the ACO is to provide care that is high quality and low cost.

Coverage for all MassHealth benefits

Doctor/specialist visits and urgent or emergency services

Mental health and substance use benefits

Prescription drugs and money-saving pharmacy benefits

Routine eye exams, as well as other benefits and discounts

  • Your mental health and substance use benefits
    Mental health and substance use services offered in partnership with Optum

    Your benefits include counseling and treatment for:

    • Substance use disorders
    • Depression and postpartum depression
    • Eating disorders
    • Suicidal thoughts
    • ADHD
    • Many other mental health issues

    You do not need a referral from your PCP to seek outpatient services. To contact Optum, call 800-462-5449 (TTY 711).

    Access online resources and virtual care visits

    Optum’s Live and Work Well website is the best place to go for behavioral health information. With liveandworkwell.com, you’ll have access to:

    • Resources on topics like mental health, caregiving and parenting, and more. 
    • Virtual visits with a therapist who can test and treat many mental health conditions.
    • Information specific to your account, including your claims information.

    Click here to get started.

Where to go for care

Stethoscope

Primary care

When you're sick or need routine care, your primary care provider (PCP) can help. To find your PCP's office or choose a new PCP, please use our provider search tool.

If you need help finding a new PCP, you can contact Customer Service or a Care Manager.
Phone: 1-800-462-5449 (TTY 711)
Email: HealthPlanCustomerService-Members@mgb.org

 

Hospital

Specialty care

Your PCP will help connect you with specialists in the Mass General Brigham ACO network. You can also search for specialists using our provider search tool.

 

Wellness

Mental health care

Do you need mental health or substance use support? Contact Optum using the number on the back of your member ID card. You can also learn more about your behavioral health benefits in the section above or find a provider using our provider search tool.

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Urgent care

  1. Your PCP’s office will always have a nurse or doctor on call.
    You can even all your PCP’s office, even when they are closed. They will always have a nurse or doctor on call. This is the best option as they have access to your medical record and often have availability for appointments, walk-in hours, X-rays, and urgent care.
  2. Call our 24/7 Nurse Advice Line at 833-372-5644
    Medical professionals are available to answer your question at any time, day or night.
  3. Know your local urgent care center locations
    An urgent condition is one that requires immediate care but is not life-threatening. Examples include bleeding/cuts, sprains, rashes, or high fever. Urgent care centers are often open 7 days a week, with weekend and evening hours. To learn which ones are near you, check our Find doctors & care search tool at  Member.MassGeneralBrighamHealthPlan.org.

 

Important steps for new members

  • Sign in to your member portal to access your plan's important details

    Create your member account at 
    Member.MassGeneralBrighamHealthPlan.org by using your Member ID number and email address.

    Once you sign in, you can:

    • Select or change your primary care provider (PCP)
    • Complete your Health Profile to be connected to the right health programs and services. It will also help you start a wellness program built just for you.
    • See your plan’s important documents like your Member
    • Handbook, Covered Services List, and others. These materials are also available on our public website at MassGeneralBrighamHealthPlan.org. You can also get copies of these documents sent to you at no cost  by contacting Customer Service using the contact information later in this guide.
    • Download, print, or order an ID card
    • Get answers to frequently asked questions
    • See if a drug is covered
    • Submit eligible expenses like a fitness reimbursement and check the status of your claim
    • Request paper copies and translations

    Create your account

    Download the app to bring your ID card wherever you go

    Download the Mass General Brigham Health Plan app to access your ID card anytime, anywhere. This allows you to share your member ID card with doctors so they have the most up-to-date information on file. Your ID card includes important information, including how to contact us if you need help.

  • Connect with your primary care provider to get all the care you need

    It’s important to have a relationship with a primary care provider (PCP) who knows you and can coordinate any care you need. Always contact your PCP first when you need to be connected to medical and behavioral health care. Your PCP can also assist you with locating available social support resources you may need. Your PCP can provide or arrange the following:

    • Preventive care, including checkups and vaccinations
    • Treatment when you get sick
    • Care when you are unexpectedly ill or injured 
    • Help managing some chronic conditions
    • Health counseling and information
    • Referrals to see specialists when you need specialty care
  • Do you have a special health or social health need?

    We’re here to help. Get started with a Health Profile assessment at Member.MassGeneralBrighamHealthPlan.org
    The Health Profile is private, confidential, and only takes a few minutes to complete. After you complete the profile, we may contact you so we can connect you to the right health programs and services.

  • When you need care from a specialist or hospital?

    Talk to your PCP first to see if you need to be referred to a specialist or hospital. When your PCP and specialists have close working relationships, it helps deliver an effective care plan that is best for you.

Public resources for health-related social needs

You can find helpful resources related to housing, food, transportation, utilities and education assistance on Mass.gov. For additional help in these areas, call customer service at 1-800-462-5449 (TTY 711) and ask to speak with a health coach. You can also email a health coach directly at HealthPlanHealthandWellness@mgb.org.

More information about your plan

Waiting for your new member ID card to arrive?

If you're a new or soon-to-be member and haven’t received your member ID card in the mail, you can fill out the form at this link to access a digital ID card. You can then show providers your card on your phone or download a printable copy.

Have questions or need help?

For questions about Mass General Brigham ACO

Contact Customer Service at Mass General Brigham Health Plan.

Phone: 1-800-462-5449 (TTY 711)

Hours: Monday through Friday, 8:00 AM to 6:00 PM and Thursdays 8:00 AM to 8:00 PM

Email: HealthPlanCustomerService-Members@mgb.org

Address:
Mass General Brigham Health Plan
399 Revolution Drive, Suite 810
Somerville, MA 02145

For questions about MassHealth benefits

Contact Customer Service at MassHealth.

Phone: 1-800-841-2900 (TTY users should call 1-800-497-4648)

Hours: Monday through Friday, 8:00 AM – 5:00 PM. 

Website: mass.gov/MassHealth

To file an appeal or grievance with Mass General Brigham Health Plan

Phone: 1-800-462-5449 (TTY 711)

Hours: Monday through Friday, 8:00 AM to 6:00 PM and Thursdays 8:00 AM to 8:00 PM

Mailing address:
ATTN: Appeals and Grievance Department
399 Revolution Drive, Suite 810
Somerville, MA 02145

 

Do you need a health care advocate? Contact the My Ombudsman program

My Ombudsman will work with you to make sure you receive your benefits and exercise your rights within your health plan.

Phone: 1-855-781-9898 (Toll Free). For TTY users, use MassRelay at 711 to call the number above. 

Email: info@myombudsman.org

Website: myombudsman.org

Are you a provider in the Mass General Brigham ACO network?

You can find a provider training video and list of frequently asked questions on our Mass General Brigham ACO for Providers page.