Here are some frequently asked questions about Network Health Unify, our Medicare-Medicaid One Care plan for people
ages 21 – 64:
What is Network Health Unify?
- Network Health Unify is our Medicare-Medicaid One Care plan for people ages 21 – 64. It combines your client’s two programs into one high-quality comprehensive health plan, all at no cost to them.
- We partner with a network of trusted doctors, specialists, hospitals, and community organizations to better coordinate your client’s care.
Will my client get the same Medicare and MassHealth benefits in Network Health Unify that they get now?
- Yes, your client will get their Medicare and MassHealth benefits covered directly from Network Health Unify.
- To help coordinate your client’s care we also work with them and a
team of skilled and caring providers to keep them connected to the
services they need.
- Your client may also get other benefits the same way they do now,
directly from a state agency like the Department of Mental Health or the
Department of Developmental Services.
- See a list of Network Health Unify benefits.
Can my client go to the same doctor that they see now?
- In many cases they can. To find out if your client’s doctor or health care provider accepts Network Health Unify, use our Find a Doctor, Hospital, or Pharmacy tool. Or give us a call at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m. We're happy to help.
How does my client choose and keep a doctor with Network Health Unify?
- All Network Health Unify members need to have a primary care provider (PCP). Your client can choose their own PCP in our network, or we can choose one for them. Your client can find their own doctor using our Find a Doctor, Hospital, or Pharmacy tool, or call 888-257-1985.
- Your client can see most of our network doctors without prior authorization (permission). For certain network doctors, called “nonpreferred in-network” providers, and for most out-of-network doctors, including specialists, your client’s PCP has to get permission from us before scheduling a service for your client.
- And if your client needs emergency or urgent care, they can use any provider, including providers outside of our network.
Will my client be able to switch their primary care provider (PCP) once they join?
- Yes. To switch their PCP, your client can use our Find a Doctor, Hospital, or Pharmacy tool to find a new PCP in our network. Then they can go to Network Health Member Connect, our online self-service tool, or call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m., to let us know their new choice.
How does Network Health Unify manage my client’s care?
- After your client joins Network Health Unify, a Network Health care manager will call them to set up their initial health needs assessment. Once the assessment is complete, a Network Health care manager is assigned to your client.
- A Network Health care manager is a health care professional, such as a nurse, behavioral health (mental health and/or substance abuse) clinician, or a social worker, who will act as your client’s key point of contact. Care managers are dedicated to making sure your client gets the high-quality care they deserve, at the right time and in the right place — at home, at a provider’s office or hospital, at a community center, in school, in person, or by phone.
- A Network Health care manager will help your client:
- Develop a customized care plan to meet their personal health goals
- Coordinate services with their doctors, specialists, and long-term services and supports (LTSS) providers, if necessary
- Arrange for services and durable medical equipment (DME), if needed
- Track their progress using our online tools
- Your client’s care manager may also put them in contact with other medical, behavioral, or social need providers, if necessary.
How much does Network Health Unify cost?
- There are no premiums or co-payments for eligible members of Network Health Unify.
- If your client pays a premium to MassHealth for CommonHealth, they must continue to pay the premium to MassHealth to keep their coverage.
How long does my client’s membership last?
- For Network Health Unify members, in most cases their initial membership lasts one year, and they will need to renew their membership with the state every year to keep their benefits. We’ll send your client a reminder when it’s time for them to renew their membership.
- Please note: The state can renew your client’s eligibility throughout the year, so your client will need to keep an eye out for notices that come directly from MassHealth.
How do I enroll my client in Network Health Unify?
- To enroll in Network Health Unify, your client should call MassHealth at 800-841-2900 (TTY: 800-497-4648), Monday through Friday, from 8 a.m. to 5 p.m.
- If you need help with client enrollment, call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m. We’re happy to help.
How long will it take for my client to become a Network Health Unify member?
- If your client is already a Medicare and MassHealth member, they may be able to enroll in Network Health Unify at any time by calling MassHealth at 800-841-2900 (TTY: 800-497-4648), Monday through Friday, from 8 a.m. to 5 p.m.
- Once your client enrolls, their membership will start on the first day of the following month.
Will my client have co-payments for their medications?
- No, there are no co-payments for eligible members of Network Health Unify.
- For more pharmacy coverage information, see the Network Health Unify List of Covered Drugs (PDF).
- You can also call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m. We’re happy to help.
Who will have access to my client’s health information?
- We are required by law to keep your client’s individual health information, known as protected health information (PHI), private and secure in our organization, including oral, written, and electronic PHI. We do this in a number of ways, such as using computer passwords and screensavers. Our employees do not talk about your client’s PHI in public areas, and are not allowed to see your client’s PHI if they do not need it for their job. While we make sure that people without permission do not see or change your client’s records, we may share your client’s PHI with MassHealth and Medicare, if they need it. Sometimes we need your client’s written permission to release their PHI. Your client has the right to approve any release of their PHI beyond these federal and state agencies, and the right to get their medical records from their health care provider.
- For a copy of our Notice of Privacy Practices, call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m. You can also find this information online in our:
What should my client do in an emergency?
- In a health emergency, don’t wait. Call 911 or your client's local emergency number, or have them go to the nearest emergency room right away. For behavioral health (mental health and/or substance abuse) emergencies, your client may also call their local emergency services program (ESP) provider. For more information on emergency services, and for a statewide listing of emergency rooms and ESPs, check our Find a Doctor, Hospital, or Pharmacy tool, or call us at 855-393-3154 (TTY: 888-391-5535), seven days a week, from 8 a.m. to 8 p.m. We’re happy to help.
Are there any services that Network Health Unify does not cover for my client?
- Network Health Unify offers many benefits and services, including doctors’ office visits and checkups, prescriptions, emergency services, hospital stays, and much more.
- Some services we don’t cover include:
- Cosmetic surgery (with some exceptions)
- Infertility diagnoses and treatment
- Experimental treatments (with some exceptions)
- Personal comfort items, like air conditioners, radios, and televisions
- Certain laboratory services
- For a complete list of services we don’t cover, please see our Network Health Unify Member Handbook (PDF) or call us at 888-257-1985
(TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m. We’re happy to help.
Call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m. We’re happy to help.
For information on Network Health Unify and other options for your health care, call the MassHealth Customer Service Center at 800-841-2900 (TTY: 800-497-4648), Monday through Friday, from 8 a.m. to 5 p.m., or visit www.mass.gov/masshealth/onecare.