Here's what you can do to find out what services are covered by your plan:
Call MassHealth at 1-888-665-9993 (TTY: 1-888-665-9997)
Look at your plan's list of services. To find this info, click the button below:
We suggest that you print the following lists of covered services and keep them for reference:
Prior AuthorizationThere are some services and medicines that MassHealth has to approve before you get them. The process of getting approval in advance is called Prior Authorization (PA). Learn more about this process by clicking the button below:
If you need a service or drug that requires Prior Authorization (PA):
MassHealth must first confirm that it is medically necessary
This can take 1-10 days
It will go faster if MassHealth has your Disability Supplement
A couple key notes:
Your doctor should get the PA from MassHealth. You don’t have to do it yourself. Your doctor will tell you if your request was approved or denied, and MassHealth will send you a letter as well.
- If you are on the PCC plan, see pages 13-17 of the PCC Member Handbook to see which services need PA. Click the link at the bottom of the page to download a PDF of the handbook.
Sources: MassHealth, Patient Advocate Foundation
Denial of coverageThere may be times when MassHealth denies coverage for a prescription drug or a service that your family member needs.If this happens, you have the right to appeal their decision.
To learn how, click the button below:
To request a fair hearing, click the Fair Hearing Request Form link at the bottom of the page to download a PDF of the form.
If your family member is over 18 and you have Power of Attorney or Guardianship, you must include a copy of those documents AND the MassHealth Authorized Representative Designation form.
Click the link at the bottom of the page to to download a PDF of the form.
After you fill out the form, you can mail it to:
Board of Hearings
Office of Medicaid
100 Hancock Street, 6th Floor
Quincy, MA 02171
If you do not request a hearing within 30 days after you receive the denial letter, there is a different process you must go through.
Click the Letter Template - Eligibility Appeal More than 30 Days link at the bottom of the page to download a PDF of the form.
Sources: Health Care for All, Health Law Advocates, MassHealth