- Network Health is a nonprofit,comprehensive health plan that provides access to affordable, high-quality health care for people who live in Massachusetts who cannot otherwise afford it.
- Our Network Health Together (MassHealth) and Network Health Forward (Commonwealth Care) insurance plans serve more than 160,000 members living in more than 300 cities and towns.
- We partner with a large and growing network of more than 18,000 primary care providers, specialists, hospitals, and community organizations that work together to coordinate care.
What is the difference between Network Health Together and Network Health Forward?
What is the difference between MassHealth and Network Health Together (our MassHealth plan)?
- MassHealth is the Medicaid program in Massachusetts that pays part or all of health care insurance costs for people who qualify.
- Network Health Together is one of several health plans you can choose from once you are eligible for MassHealth.
- Our Network Health Together plan offers all MassHealth benefits, PLUS many additional benefits and services.
What is the difference between Commonwealth Care and Network Health Forward (our Commonwealth Care plan)?
- Commonwealth Care is a state insurance program the Commonwealth Health Insurance Connector Authority (the Connector) runs. This program connects eligible Massachusetts residents with approved health plans and helps them pay for health care.
- Network Health Forward is one of several health plans you can choose from once you are eligible for Commonwealth Care.
- Our Network Health Forward plan offers comprehensive high-quality, low-cost health care with many additional benefits and services.
What benefits will I get with Network Health Together? Network Health Together offers all the benefits of MassHealth plus additional benefits and services, free bike helmets, gift cards for car seats, discounts on
Weight Watchers, money back on gym memberships and fitness activities, and much more.
See a complete list of Network Health Together benefits.
What benefits will I get with Network Health Forward? Network Health Forward offers complete health coverage, plus additional free and discounted benefits and services, including free health support by phone any time, discounts on Weight Watchers, money back on gym memberships and fitness activities, rewards for getting a yearly checkup, and much more.
See a complete list of Network Health Forward benefits.
Does my health care provider accept Network Health? We partner with a large and growing network of more than 18,000 primary care providers, specialists, hospitals, and community organizations. To find out if your health care provider accepts Network Health Together or Network Health Forward, use our Provider Directory. Or give us a call at 888-257-1985, and we can help!
How do I choose and keep a doctor with Network Health? Network Health members must have a primary care provider (PCP). You can choose your own PCP in our network, or we can choose one for you. Your PCP will arrange for most or all of your covered services. You can call your PCP’s office 24 hours a day, seven days a week. If your PCP is not available, somebody else will be able to help you. If you have problems getting in touch with your PCP, please call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to
5 p.m. We can help.
You can see most of our in-network doctors without prior authorization (permission). For certain in-network doctors, called “nonpreferred in-network” providers, and for most out-of-network doctors, including specialists, your PCP has to get permission from us before scheduling a service for you. We will not cover any unauthorized visits to out-of-network doctors or specialists, with a few exceptions. However, your PCP will not have to ask for permission before you get emergency, post-stabilization (examination and treatment for emergency medical needs before you go home or move to another hospital), and family-planning services. You can find out which doctors need prior authorization in our Provider Directory, or call us at 888-257-1985.
How does Network Health manage my care? We want to make sure you get the right care in the right place. Our care managers and clinicians look at some of the services your doctors think you need before you get them to see if they are medically necessary and planned for the right type of facility. If necessary, we give your doctors prior authorization (permission) before you get the services. We also review some of your services as you get them (such as if you go in the hospital) to make sure you get the best care. We work with you and your doctors to make a plan for when you leave a facility or stop getting services. Finally, we review your services after you get them to make sure you got the best quality care.
As part of our care-management program, if you have a physical disability or other special health condition such as a high-risk pregnancy, cancer, HIV/AIDS, or a behavioral health (mental health and/or substance abuse) concern, our clinicians can give you information, personalized resources (if eligible), and help coordinating your care. We also offer social care management services to help arrange, coordinate, and evaluate the services you may need; disease-management programs for asthma and diabetes; and health-coaching services if you have a chronic health condition.
How much does Network Health Together cost? Network Health Together is a MassHealth plan offering free or low-cost quality health insurance to eligible people who live in Massachusetts. Your costs will depend on your eligibility, yearly income, and family size. See our explanation of costs to estimate how much you would pay.
How much does Network Health Forward cost? Network Health Forward offers three different Commonwealth Care Plan Types for eligible Massachusetts residents. Your Plan Type and costs will depend on your yearly income and family size. See our explanation of costs to estimate how much you would pay.
How long does membership last? In most cases, your initial membership lasts one year, and you need to renew your membership every year to keep your benefits. We’ll send you a reminder when it’s time for you to renew your membership.
Please note: the state can renew your eligibility throughout the year, so keep an eye out for notices that come directly from MassHealth. If you have questions, we can help. Call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m.
How do I join Network Health? You need to be a member of either MassHealth or Commonwealth Care to enroll with Network Health.
If you’re already a MassHealth member, call MassHealth at 800-841-2900 (TTY: 800-497-4648), Monday through Friday, 8 a.m. to 5 p.m., to learn about all your health plan options and to choose Network Health. If you need help, please call us at 888-257-1985. You can change your health plan at any time.
If you’re already a Commonwealth Care member, call Commonwealth Care at 877-623-6765 (TTY: 877-623-7773), Monday through Friday, 8 a.m. to 5 p.m., to learn about all your health plan options and to choose Network Health. You can switch to Network Health during your first 60 days of Commonwealth Care enrollment and during open enrollment each year.
If you are not a MassHealth or Commonwealth Care member, you’ll need to apply. If you’d like help applying, call us at 888-257-1985 (TTY: 888-391-5535),
Monday through Friday, from 8 a.m. to 5 p.m.
How long will it take me to become a Network Health member? Network Health Together:
- If you’re already a MassHealth member, you can join Network Health at any time.
- If you are not a MassHealth member, you need to apply for MassHealth. Once approved for MassHealth, you can choose Network Health at any time. The entire application process (from filling out the application to getting the state’s approval) can take between 4 and 12 weeks.
Network Health Forward:
- If you are a new Commonwealth Care member (within the first 60 days of your enrollment) you can join Network Health if you live in our coverage area. You will be a Network Health member on the first calendar day of the following month.
- If you are switching to Network Health during open enrollment, you will be a Network Health member on July 1 of that year.
- If you are not a Commonwealth Care member, you need to apply. Once approved for Commonwealth Care, you can choose Network Health. The entire application process (from filling out the application to getting the state’s approval) can take between 4 and 12 weeks.
Would I be able to switch my doctor once I join? You can change your health care provider or PCP at any time, up to three times per year for Commonwealth Care, and as many times as you need for MassHealth.
You don’t need to provide a reason. Just use our Provider Directory to find a new PCP in our network, and call us at 888-257-1985 to let us know your new choice.
Will I have co-payments
for my medications? Several Network Health plans offer free prescription medications. Others require a small co-payment. To see what your co-payments would be, see costs for
Network Health Together and Network Health Forward.
We work with your providers and pharmacists to cover the most important and useful drugs you’ll need for all kinds of conditions and diseases. We cover first-time prescriptions and refills. We also cover select over-the-counter (OTC) prescription drugs. Depending on your plan, we have different levels of drugs in our
Preferred Drug List (PDL),and you’ll pay a different amount for the drug depending on its level. Some MassHealth members will pay nothing. If your provider feels you need to use a drug we do not cover, he or she can ask us for permission. A clinician will review the request.
If you want more pharmacy coverage information, see the Network Health Together Member Handbook (MassHealth) or
Network Health Forward Member Handbook (Commonwealth Care), or Covered Services List , or call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m.
Where do I send my premiums (monthly payments)? For Network Health Forward:
You should send all Commonwealth Care monthly payments (premiums) to the Commonwealth Health Insurance Connector Authority. Please contact
Commonwealth Care at 877-623-6765 (TTY: 877-623-7773) if you have any questions about paying premiums.
For Network Health Together:
Most MassHealth members do not pay a premium (monthly payment).
If you qualify for Family Assistance or CommonHealth, an affordable premium may apply. You should send this premium to MassHealth. Please contact MassHealth at 800-841-2900 (TTY: 800-497-4648) if you have any questions about paying premiums.
Who will have access to my health information? We are required by law to keep your individual health information, known as protected health information (PHI), private and secure in our organization, including oral, written, and electronic PHI. We do this in a number of ways, such as using computer passwords and screensavers. Employees do not talk about your PHI in public areas, and are not allowed to see your PHI if they do not need it for their job. While we make sure that people without permission do not see or change your records, we may share your PHI with MassHealth or the Commonwealth Health Insurance Connector Authority if they need it, depending on your plan. Sometimes we need your written permission to release your PHI. You have the right to approve any release of your PHI, and you have the right to get your medical records from your provider.
We will send you a yearly reminder about our Notice of Privacy Practices. We may revise this Notice at any time. If we do, the changes will apply to all of your PHI that we have.
For more details, you can get a copy of our Notice of Privacy Practices by calling our customer service team at 888-257-1985, Monday through Friday, from 8 a.m. to
5 p.m. You can also find this information online:
What should I do in an emergency? In a health emergency, don’t wait. Call 911, your local emergency number, or go to the nearest emergency room right away. For behavioral health (mental health and/or substance abuse) emergencies, you may also call your local Emergency Services Program (ESP) provider. For more information on emergency services, and for a statewide listing of emergency rooms and ESPs, see our Network Health Together Member Handbook (MassHealth) or
Network Health Forward Member Handbook (Commonwealth Care), and our Provider Directory, or call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m.
Are there any services Network Health does not cover? Network Health offers many benefits and services, including doctors' office visits and checkups, prescriptions, emergency services, hospital stays, and much more. For a complete list of services we offer, please see our Network Health Together Member Handbook (MassHealth) or
Network Health Forward Member Handbook (Commonwealth Care).
Some services we don't cover include:
- Cosmetic surgery (with some exceptions)
- Infertility diagnoses and treatment
- Experimental treatments (with some exceptions)
- Personal comfort items, like air conditioners, radios, and televisions
- Certain laboratory services
For a full list of services we don't cover, please please see our Network Health Together Member Handbook (MassHealth) or
Network Health Forward Member Handbook (Commonwealth Care), or call us at 888-257-1985, Monday through Friday, from 8 a.m. to 5 p.m.