Frequently Asked Questions

What counties does Tufts Health Unify cover?

Tufts Health Unify, our Medicare-Medicaid One Care plan for people ages 21–64, offers services in Worcester and Suffolk counties. Our service area includes parts of Middlesex County with the following ZIP codes: 

City/Town Zip Code
Billerica 01821, 01822
Chelmsford 01824
Dracut 01826
Lowell 01850, 01851, 01852, 01853, 01854
North Billerica 01862
North Chelmsford 01863
Tewksbury 01876
Tyngsborough 01879
Westford 01886

Use our Find a Doctor, Hospital or Pharmacy tool to search for doctors, hospitals or facilities, or community-based services in your area.

What are long-term services and supports (LTSS)?

Long-term services and supports are services offered to members who need assistance to do everyday tasks, such as taking a bath, getting dressed, making food and taking medicine. Most of these services are provided in your community, and they may be provided at your home, or in a nursing home or hospital.

What is an initial assessment?

Shortly after you become a member, your care manager will reach out to you to schedule an in-person appointment for your health needs assessment. After the assessment is complete, your care manager works with you to create a personalized care plan.

Your care manager will then coordinate your care team by working with you and all of your health and social care providers. Your care team may include your medical care providers (such as a primary care provider or a mental health or substance use counselor), pharmacy professionals and social care managers. Your care team may also include advocates, family members, caregivers, friends, mentors and/or peer supports.

Based on your health needs assessment, your care manager will also help you connect with and coordinate any additional nonmedical resources you may need.

How long does membership last?

To maintain eligibility, a member must remain eligible for both Medicare and Medicaid.

 

What benefits* do I get?

Tufts Health Unify is a health plan that contracts with both Medicare and MassHealth to provide benefits of both programs to enrollees. 

As a Tufts Health Unify member, you get access to high-quality health care at no cost to you. Services include:

  • Visits to doctors and specialists, and hospital stays
  • X-rays and lab tests
  • Prescription medications and prescribed over-the-counter medications
  • Dental services for preventive and medically necessary care

We provide a personalized care plan, community-based services, and long-term services and supports (LTSS), if appropriate.

*This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information, contact the plan or read the Member Handbook (PDF).

Limitations and restrictions may apply. For more information, call Tufts Health Plan member services or read the Tufts Health Unify Member Handbook (PDF).

Benefits, the List of Covered Drugs (PDF), and pharmacy and provider networks may change from time to time throughout the year and on January 1 of each year.

What are the costs?

As a Tufts Health Unify member, you can take advantage of our comprehensive health care benefits at no cost to you. There are no medical or pharmacy co-payments, and no monthly premiums. There also is no balance billing for any covered service.

Please note: If you pay a premium to MassHealth for CommonHealth, you must continue to pay the premium to MassHealth to keep your coverage.

How do I know when I need prior authorization for services?

You may need prior authorization (permission) for certain services. To find detailed information about prior authorization requirements, please refer to Chapter 4 of our Tufts Health Unify Member Handbook.

Are primary care provider (PCP) referrals or prior authorization needed for all of my care?

No. You can get some services, such as those listed below, without getting approval ahead of time from your PCP. 

  • Emergency services from network providers or out-of-network providers
  • Urgently needed care from network providers
  • Urgently needed care from out-of-network providers when you can't get to a network provider (for example, when you are outside the plan's service area)
  • Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are outside the plan's service area. (If possible, please call member services before you leave the service area. We can help you get dialysis while you are away.)
  • Flu shots and a shingles vaccine as long as you get them from a network provider
  • Routine women's health care, including breast exams, screening mammograms (X-rays of the breast), Pap tests, pelvic exams and family-planning services from a network provider
  • Post-stabilization care services
  • The first 12 outpatient behavioral health therapy visits each benefit year from a network provider
  • Laboratory services to maintain health and diagnose, treat and prevent disease, including blood tests, urinalysis, Pap tests, throat cultures and vaccines not covered by the Department of Public Health
  • Emergency transportation, including land, air and specialty care transport between facilities
Does Tufts Health Unify cover services by out-of-network providers?

Tufts Health Plan covers the following services offered by out-of-network providers:

  • Emergency care or urgent care
  • Certain medical care when the providers in our network cannot provide this care
  • Kidney dialysis services at a Medicare-certified dialysis facility when you are outside our service area for a short period of time
How can I update my personal information?

You can update your personal information, like address (residential/mailing), phone number or email address, 24/7 through Tufts Health Member Connect (link opens outside Tufts Health Plan's website), our self-service tool. All you need to create an account is your Tufts Health Plan member ID number and your date of birth. If you do not know your member ID number, check your member ID card (jpg).

How can I order a new member ID card?

To order a new member ID card 24/7, sign up for Tufts Health Member Connect (link opens outside Tufts Health Plan's website), our self-service tool, or log in if you already have an account. All you need to create an account is your Tufts Health Plan member ID number and date of birth.

If you don't know your member ID number, call us at 855.393.3154, and we'll be happy to help. Once you order your new member ID card, you can expect to receive it in the mail within 15 business days.

What pharmacy benefits do I have, and how do I know if my prescription is covered?

We aim to provide high-quality, cost-effective options for drug therapy. We work with your providers and pharmacists to make sure we cover the most important and useful drugs for a variety of conditions and diseases. Covered drugs are provided at no cost to you. We cover first-time prescriptions and refills. We also cover some over-the-counter (OTC) drugs with a doctor's prescription.

To find out if we cover a specific drug, look it up in our List of Covered Drugs (PDF). We update the list every month. The list applies only to drugs you get at retail and specialty pharmacies. The list does not apply to drugs you get if you are in the hospital.

More questions?

Call us at 855.393.3154 (TTY: 711), seven days a week. from 8 a.m. to 8 p.m. We’re happy to help. 

For information on Tufts 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 (link opens outside of Tufts Health Plan's website).

If you need a Member Handbook or the List of Covered Drugs in an alternative format, please call us at 855.393.3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m.. We will do our best to accommodate your request.
 


H7419_4520_CMS Approved
Page modified on: 8/30/2018 3:02:34 PM

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