By Winston Law Group in Medicaid (Masshealth), Medicare
What is Senior Care Options?
Low income seniors may be eligible for MassHealth Standard for comprehensive medical coverage. Seniors may also have Medicare Parts A and B, as well as supplemental health insurance, such as Blue Cross/Blue Shield or Tufts. Together, these segregated plans provide essential medical coverage to seniors with limited means.
But are multiple layers of health insurance the best health care plan for a particular senior? Often times the answer is no. A Senior Care Option, or commonly known as “SCO,” can provide eligible seniors with one unified health care plan that combines all the benefits of MassHealth and Medicare, but can also provide additional benefits and individualized care at no additional cost to the senior.
Am I Eligible?
SCOs coordinate MassHealth and Medicare benefits to provide an integrated health care package to eligible seniors. If you are at least sixty five years old, are enrolled on MassHealth Standard, do not have end-stage renal disease, and live in a designated service area covered by a SCO, then you are eligible. SCOs offer a comprehensive care model that integrates all aspects of a senior’s health plan with the goal of preventing acute long term nursing home care. SCO members use only one health care membership card instead of the various a senior needs for MassHealth, Medicare, Medicare Part D, and a Medicare Supplement.
Does It Cost Anything?
MassHealth and Medicare members may be responsible for prescription co-pays or deductibles, and they do not provide adequate dental coverage or hearing aids. SCOs, on the other hand, provide plans with zero co-pays or deductibles for office visits or prescriptions, free dental coverage, hearing aids, free transportation for medical visits, and an individualized care management plan with regular visits by geriatric support coordinators. The amount and type of visits depend on the specific needs of that particular senior. SCOs are available to members in the community and in nursing homes. There are no premiums and no added cost.
How Do I Apply?
There are five SCOs in Massachusetts and each has their own coverage areas and together they cover most of the state. Most counties are covered by multiple SCOs, while certain parts of the state are not covered at all. For example, Commonwealth Care Alliance, Navicare, Senior Whole Health, and United Health Care are all SCOs that cover Middlesex County. Parts of Hampshire County and the islands are not serviced by a SCO.
Although all SCOs have the same eligibility requirements and MassHealth and Medicare coordinated plan, each plan has their own unique benefits and their own network of doctors and providers. SCOs are similar to an HMO. The member must use the doctors within the SCO network, so one major factor in choosing a SCO is whether your doctor or physicians is within their network.
Senior MassHealth members that wish to enroll in a SCO can send an enrollment form to MassHealth, or can contact their local ASAPs or even contact the SCO directly. There is no additional application required. Once the referral is made, the SCO will reach out to the applicant for a telephone conference or personal meeting and coordinate the process with MassHealth. For many seniors, this individualized level of enhanced medical care is the key to staying at home for as long as possible.
To learn more, please visit: MassResources.org