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Tufts Health Together

Here are some frequently asked questions about Tufts Health Together (MassHealth):

 

 

 

Answers

What is Tufts Health Plan?

  • Tufts Health Plan is a nonprofit, comprehensive health plan that provides access to affordable, high-quality health care for eligible Massachusetts residents.
  • Our plans serve more than 215,000 members living in more than 300 cities and towns.
  • We partner with a large and growing network of thousands of primary care providers (PCPs), specialists, hospitals, and community organizations across the state that work together to coordinate care.

What is Tufts Health Together?

Tufts Health Together is our health plan for individuals eligible for the state’s MassHealth program. See Tufts Health Together benefits.


What is the difference between MassHealth and Tufts Health Together, our MassHealth plan?

  • MassHealth is the Medicaid program in Massachusetts that pays part or all of health insurance costs for eligible individuals.
  • Tufts Health Together is one of several health plans you can choose from once you are approved for MassHealth.
  • Tufts Health Together offers all the comprehensive benefits of MassHealth benefits, plus great EXTRAS.

What benefits will I get with Tufts Health Together?

Tufts Health Together offers all the comprehensive health benefits of MassHealth, plus great EXTRAS, including FREE bike helmets, gift cards for car seats, FREE Weight Watchers registration PLUS $50 back on program costs, money back on gym memberships and fitness activities, and much more.

See a list of Tufts Health Together benefits.

 

Does my doctor accept Tufts Health Plan?

We partner with a large and growing network of thousands of primary care providers (PCPs), specialists, hospitals, and health centers across the state. To find out if your doctor or health care provider accepts Tufts Health Together, 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., and we can help!


How do I choose and keep a doctor with Tufts Health Plan?

All Tufts Health Plan members need to have a primary care provider (PCP). You can choose your own PCP in our network, or we can choose one for you. Your PCP coordinates your care, and will arrange for most or all of your covered services. You can call your PCP’s office, 24 hours a day, seven days a week. If your PCP is not available, somebody else will be able to help you. If you have problems getting in touch with your PCP, please 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.

You can see most of our in-network doctors without prior authorization (permission). For certain in-network doctors, called “nonpreferred in-network” providers, and for most out-of-network doctors, including specialists, your PCP has to get permission from us before scheduling a service for you. We will not cover any unauthorized visits to out-of-network doctors or specialists, with a few exceptions. Your PCP will not have to ask for permission before you get emergency, post-stabilization (examination and treatment for emergency medical needs before you go home or move to another hospital), and family-planning services. You can find out which doctors need prior authorization using our Find a Doctor, Hospital, or Pharmacy tool, 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.


Would I be able to switch my primary care provider (PCP) once I join?

  • Tufts Health Together members can change their PCP as many times as they need during the year.
  • To switch your PCP, you can use our Find a Doctor, Hospital, or Pharmacy tool to find a new PCP in our network. Then call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m., or go to Tufts Health Member Connect, our online self-service tool, to let us know your new choice.

How does Tufts Health Plan manage my care?

We want to make sure you get the right care in the right place. Our care managers and clinicians look at some of the services your doctors think you need before you get them, to see if they are medically necessary and planned for the right type of facility. If necessary, we give your doctors prior authorization (permission) before you get certain services. We also review some of your services as you get them (such as if you go to the hospital) to make sure you get the best care. We work with you and your doctors to make a plan for when you leave a facility or stop getting services. Finally, we review your services after you get them to make sure you got the best-quality care.

As part of our care management program, if you have a physical disability or other special health condition, such as a high-risk pregnancy, cancer, HIV/AIDS, or a behavioral health (mental health and/or substance abuse) concern, our clinicians can give you information, personalized resources (if eligible), and help coordinating your care. We also offer social care management services to help arrange, coordinate, and evaluate the services you may need; disease-management programs for asthma and diabetes; and health-coaching services if you have a chronic health condition.


How much does Tufts Health Together cost?

Tufts Health Together is a MassHealth plan offering free or low-cost high-quality health insurance to eligible Massachusetts residents. As you are a member of
Tufts Health Together, your costs are determined by MassHealth, and will depend on your eligibility, yearly income, and family size. In most cases, there are no premiums (monthly payments). Take our short quiz to estimate how much you might pay.

 

How long does membership last?

For Tufts Health Together members, in most cases initial membership lasts one year. You need to renew your membership with the state every year to keep your benefits. We’ll send you a reminder when it’s time for you to renew your membership.

Note: The state can renew your eligibility throughout the year, so keep an eye out for notices that come directly from MassHealth.


How do I join Tufts Health Plan?

  • To join Tufts Health Together, our MassHealth plan, you need to first be approved for MassHealth.
    • If you are already a MassHealth member, you can change your health plan at any time. Call MassHealth at 800-841-2900 (TTY: 800-497-4648), Monday through Friday, from 8 a.m. to 5 p.m., to learn about all your health plan options and to choose Tufts Health Plan. If you need help, please 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.
    • If you are not a MassHealth member, you’ll need to first apply with the state before you can see if you’re eligible to enroll in Tufts Health Plan. If you’d like help applying, 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 me to become a Tufts Health Plan member?

  • If you are already a MassHealth member, you may be able to enroll in Tufts Health Plan 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.
  • If you are not a MassHealth member, you first need to apply for MassHealth. Once approved for MassHealth, you may be able to enroll in Tufts Health Plan. The entire application process (from filling out the application to getting the state’s approval) can take between 4 and 12 weeks.
     
Will I have co-paymentsClick for Definition for my medications?

Some of our plans offer free prescription medications. Others require a small co-payment. To see what your co-payments might be, take our short quiz.

We work with your providers and pharmacists to cover the most important and useful drugs you’ll need for all kinds of conditions and diseases. We cover first-time prescriptions and refills. We also cover select over-the-counter (OTC) prescription drugs. Depending on your plan, we have different levels of drugs in our Preferred Drug List (PDL), and you’ll pay a different amount for the drug depending on its level. Some members will pay nothing. If your provider feels you need to use a drug we do not cover, they can ask us for permission and a Tufts Health Plan clinician will review the request.


Where do I send my premiums (monthly payments)?

Most MassHealth members do not pay a premium. If you qualify for Family Assistance or CommonHealth, an affordable monthly premium may apply. You should send this premium to MassHealth. If you have any questions about paying premiums, please contact MassHealth at 800-841-2900 (TTY: 800-497-4648), Monday through Friday, from 8 a.m. to 5 p.m.

Who will have access to my health information?

We are required by law to keep your 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. Employees do not talk about your PHI in public areas, and are not allowed to see your PHI if they do not need it for their job. While we make sure that people without permission do not see or change your records, we may share your PHI with MassHealth, if they need it, depending on your plan. Sometimes we need your written permission to release your PHI. You have the right to approve any release of your PHI beyond these state agencies, and you have the right to get your medical records from your 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 the:


What should I do in an emergency?

In a health emergency, don’t wait. Call 911 or your local emergency number, or go to the nearest emergency room right away. For behavioral health (mental health and/or substance abuse) emergencies, you may also call your local Emergency Services Program (ESP) provider. For more information on emergency services, and for a statewide listing of emergency rooms and ESPs, use our Find a Doctor, Hospital, or Pharmacy tool, 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.


Are there any services Tufts Health Plan does not cover?

Tufts Health Plan offers many benefits and services, including doctors' office visits, 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 Covered Services List (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.

More questions?

 

Call us at 888-257-1985, Monday through Friday, from 8 a.m. to 5 p.m. We're happy to help.

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