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Frequently Asked Questions
General Questions
- What is Commonwealth Care?
- What are the income guidelines for plan eligibility?
- What will my premiums and copayments be?
- How do I pay my monthly Commonwealth Care health insurance premiums?
- What if my doctor is not in the NHP Comprehensive Network?
- Once I'm enrolled in NHP, will the Connector allow me to change to another plan?
- When does my health plan coverage start?
- What if I need medical services before my NHP coverage becomes effective?
Dental Benefits (Plan Type 1 Only)
Routine Vision Benefit
What is Commonwealth Care?
The Commonwealth Care Health Insurance Program is run by the Commonwealth Health Insurance Connector Authority (known as the "Connector"). This program connects eligible Massachusetts residents with approved health insurance plans and helps them pay for health insurance coverage through the plans.
The Connector helps Commonwealth Care members join a health plan and find providers that meet their needs. A health plan works together with a certain group of providers, hospitals, and other health-care professionals to provide specific health-care services.
Commonwealth Care pays the total cost of health insurance for qualified individuals who meet certain income and/or other guidelines and helps pay for the cost of insurance for other qualified individuals who meet the criteria established by the Connector.
What are the income guidelines for plan eligibility?
Visit the Commonwealth Connector web site for help determining your eligibility for Commonwealth Care based on your income.
What will my premiums and copayments be?
Your premiums and copayment costs will vary depending on your income and city of residence and these are determined by the Commonwealth Connector.
How do I pay my monthly Commonwealth Care health insurance premiums?
If your Commonwealth Care health insurance requires you to pay a premium, please follow the directions provided to you by the Connector Authority for paying your premiums. Please do not send premium payments to NHP. Each month you will receive a bill from the Connector Authority. You must pay this bill every month for your health benefits to continue. You may apply for a waiver or reduction of your premiums payments; you may also qualify for a premium payment plan.
If you have any further questions about making premium payments or would like to learn more about premium payment options, please contact Commonwealth Care Customer Service Center at 1-877-MA-ENROLL or 1-877-623-6765, Monday through Friday from 8:00 a.m. to 5:00 p.m.
For people with partial or total hearing loss, please call TTY: 1-877-623-7773. Commonwealth Care Customer Service can also answer questions you have about your premium bill.
What if my doctor is not a part of the NHP Comprehensive Network?
The NHP online Provider Directory lists Primary Care Providers in the NHP Comprehensive network. You can also call the NHP Customer Care Center to get help finding a new doctor in your area.
Once I'm enrolled in NHP, will the Connector allow me to change to another plan?
Plan Type 1
After you have chosen or have been assigned to NHP and your enrollment starts, the Connector will allow you to change your health plan for the following reasons only:
- You move and your new address is outside of the NHP service area.
- You demonstrate to the Connector that NHP has not provided you with access to health-care providers that meet your health-care needs over time, even after you have asked NHP for help.
- Your primary care provider is no longer part of NHP's provider network, or there is a significant change in NHP's network of providers.
- You are homeless.
- Your mail was returned due to an incorrect mailing address.
Plan Types 2 & 3
After you have chosen NHP and your enrollment starts, you have 60 days to switch to another plan. After the 60-day period has passed, the Connector will allow you to change your health plan for the following reasons only:
- You move and your new address is outside of the NHP service area.
- You demonstrate to the Connector that NHP has not provided you with access to health-care providers that meet your health-care needs over time, even after you have asked NHP for help.
- Your primary care provider is no longer part of NHP's provider network, or there is a significant change in NHP's network of providers.
- You are homeless.
- Your mail was returned due to an incorrect mailing address.
When does my NHP coverage start?
In most cases, your NHP coverage will start on the first day of the month following your health-plan selection. For example, if you select NHP on October 12th, the effective date of your coverage would be November 1st. However, if you choose your health plan on the last two days of the month, your enrollment may not start until the first day of the second month following your plan selection. For example, if you select a plan on October 31st, the effective date of your coverage would be December 1st. It is best to choose a health plan as soon as possible after you receive your Commonwealth Care enrollment packet.
What if I need medical services before my NHP coverage becomes effective?
If necessary, you will be able to use the Health Safety Net (HSN) until the effective date of your NHP coverage. On the date that your Commonwealth Care coverage starts, your health services will be provided by NHP, not the HSN.
What is redetermination?
The Connector can perform redetermination to evaluate whether a member meets the eligibility criteria for a particular plan or plans. Redetermination may happen annually, or whenever major plan changes or eligibility criteria changes are implemented.
How do my Plan Type 1 dental benefits work and who are they provided by?
NHP covers routine preventive dental services for Members under Plan Type I. NHP's preventive dental care benefit includes a periodic exam and routine cleaning twice every 12 months; full mouth x-ray once every three (3) years, and bitewing or single tooth x-rays as needed. You do not need a referral for routine preventive dental services provided you obtain such services from an approved NHP Provider. Refer to your Benefit Summary to determine if you are covered for routine dental services. NHP does not provide coverage for orthodontics. For more information on routine dental call Dentaquest at 1-800-417-7140 or visit www.dentaquest.com
When do I become eligible to receive the routine vision benefit and who are they provided by?
You are eligible for the routine vision care benefit as soon as you become an NHP Commonwealth Care member. These services are provided by Spectera. For more information about the Spectera vision benefit, please visit the Spectera website or call Spectera at 1-866-223-5789.
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