Helping Tufts Health Together (MassHealth) Members During the Coronavirus (COVID-19) Outbreak
We want to make it as safe and easy as possible for you to access your health care.
For that reason, we are making coverage changes to our Tufts Health Together plans.
Until further notice:
- Tufts Health Together plan members are fully covered to receive medically necessary testing and in-person treatment for COVID-19 from any health care provider within our provider network and with out-of-network providers if a member has trouble accessing such services in-network.
- Please note: Members do not need a referral or prior authorization to get testing or treatment related to COVID-19 in-network or out-of-network. A referral or prior authorization is required for any out-of-network service that is not related to COVID-19.
- If you have received a bill for a service that you believe was related to seeking care for COVID-19 but was considered not related to COVID-19, please contact us at 888.257.1985 (TTY: 711)
- Testing for COVID-19 is only covered for reasons that are medically necessary. Tufts Health Together will not cover testing for COVID-19 for reasons solely related to travel, work or school.
- Tufts Health Together members are covered for antibody testing when testing is determined by a primary care provider (PCP) or another provider to be medically necessary. Please contact your PCP or other provider to find out whether this testing is appropriate for you.
- Tufts Health Together members are fully covered to receive telehealth services from network providers. Telehealth is the term for checking in or receiving health care from a provider by phone or another technology virtually. Contact your provider to see if this option is available.
- Tufts Health Together members should continue to see providers in their network whenever possible. Members do not need a referral from their primary care provider to see in-network specialists.
- Tufts Health Together members do not need a referral to see out-of-network providers for certain covered services, such as emergency and urgent care, outpatient behavioral health and primary care. Call member services at 888.257.1985 (TTY: 711) if you have questions about out-of-network coverage.
These changes apply to our managed care organization (MCO) and accountable care organization (ACO) MassHealth plans.
If you have questions about your coverage, call the Member Services number on your member ID card.
Members can get an early refill of their prescriptions prior to the expiration date so they have a supply of their maintenance medications should they need it.
We will waive the refill limitation for maintenance medications to permit refills of up to a 90-day supply. Early refills are not be allowed for controlled substance drugs.
If a member has multiple maintenance medications, each drug can be refilled early just once.
Please note: Most members ages 21 and older still have to pay a small copayment for covered prescription drugs.
Do You Have a Child Under Age 2? Keep Up With Their Immunizations.
During the COVID-19 pandemic, it’s still important for children to get their immunizations. Make sure you protect your kids from preventable diseases. Measles, mumps and whooping cough are some of the illnesses we can prevent through vaccines. They are serious risks for young children even now. Providers’ offices are taking steps to see kids in a safe and controlled way when they need an in-office visit.
Call your child’s primary care provider. Make a plan to keep your child on schedule for their immunizations safely. Well visits and immunizations are covered at no cost to members. Members who get their immunizations by their second birthday may qualify for a $25 gift card reward!
When and How to Get Care
Here are some steps you can take based on your situation:
- If you have questions about coronavirus or any health issue, call our free 24/7 NurseLine at 888.697.6546 to speak to a registered nurse.
- If you have mild, flu-like symptoms, call your health care provider. Call before going to a health care facility. This will prevent you from exposing others to COVID-19.
- Your provider may offer check-ins by phone or video chat. Contact your provider to see if this option is available. Virtual check-ins related to COVID-19 are covered in full. If you don’t have reliable phone or internet service or you’re having trouble paying for the services you have, you may qualify for help through the federal Lifeline program. Learn more.
- Virtual check-ins and telehealth enable members to make inquiries regarding symptoms or treatment for COVID-19 in order to reduce the need for members to go to medical offices where the risk of coming in contact with COVID-19 may be higher.
- If you believe you have COVID-19 or another flu-like illness, stay home. People with COVID-19 have had a wide range of symptoms. This may include: a cough, shortness of breath, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell. This list is not a full list. Follow the CDC’s guidance for separating yourself from others. Your close contacts should stay home too. But if your symptoms get worse, call your health care provider before you visit them or go to urgent care. Follow any rules that a health care facility has in place.
- In an emergency, call 911. Or go to an emergency room right away.
Where to Find Testing for COVID-19
If you are experiencing COVID-19 symptoms or have been exposed to someone that has, you should call your health care provider. You do not need a referral or prior approval (authorization) to get testing or treatment related to COVID-19. Based on where you live, you can find a location near you to get tested for COVID-19. Just click one of the links below to search for a location.
Please call ahead to check the rules for each location before you seek a test. For help understanding any symptoms you may be having, you can also check your symptoms online.
For more information, visit the CDC and the Massachusetts Department of Health websites.