Mas Health Can you apply for Mass health if you already have health insurance. We are paying out of pocket for speech therapy since our regular health  insurance will not cover it.    What is the best way to apply for it? we have mass health as our secondary insurance for my son only.  anything our insurance does not cover Mass Health picks up the cost. www.mass.gov/masshealth 1-800-841-2900 Can anyone tell me more about this? We currently do private pay speech. I doubt MassHealth would pay so long as Ben is of EI eligible age, but what about after that? What kind of therapies do they pay for? I think, but am not certain, that if you have primary private insurance and masshealth secondary, masshealth will cover co-pays,co-insurance and expenses that are allowed on your primary plan,  BUT  if your primary plan excludes something- like speech, than masshealth will not cover it either.  The best part of masshealth is that once your child is covered, your family is eligible for premuim assistance that helps pay for your private insurance. Also, if your private insurance covers speech, masshealth will cover your copay, so long as your provider takes masshealth. Also, masshealth coveres diapers and pullups for kids over 3yrs old with a dx. Hope that helps.  You would want to apply for CommonHealth plan if you are over income and applying based on your child's disability. This is what I was able to find out about services What are MassHealth home services? Home health services include nursing care; home health aide care; and occupational, physical, and speech/language therapy. MassHealth pays home health agencies to provide these services for eligible MassHealth members. To be covered by MassHealth, home health care services must be medically necessary and part of a doctor’s plan of care. Am I eligible? To be eligible for MassHealth home health services: •         Your MassHealth coverage type must include home health services. Home health services are included in:    *   MassHealth Standard    *   CommonHealth    *   MassHealth Family Assistance (Direct Care, and Premium Assistance for HIV members) MassHealth members with Prenatal, Limited, or Essential do not get home health services. Members with Premium Assistance or Buy-In are covered only if their private insurance plan includes these services. Members with MassHealth Basic (Managed Care) get limited coverage for home health services. •         You must be living in a private or group home or other non-institutional setting. This can be a temporary residence such as a homeless shelter. •         You must be under the care of a doctor. This can be your own doctor, or a doctor working for a home health agency. Your doctor can be a medical doctor, a dentist, or a podiatrist. •         The home health services must be part of your doctor’s plan of care. Your doctor must review and sign your plan every 60 days. •         The home health services must be medically necessary. If a family member or other caregiver is providing the services you need, then MassHealth will not pay for a home health agency to provide the services. •         The home health services you need cannot cost more than care in an institution. Your doctor and home health agency must agree that you can live safely at home with home health care services. MassHealth members age 60 or older must have a referral from What benefits will I get? Home health services must be part-time or intermittent, not full-time for a long period of time. MassHealth limits the number of hours of service and the number of visits you can get. Some services require prior authorization. MassHealth will pay for home nursing services, home health aide services, and home therapy services for eligible MassHealth members: •         Physical, occupational, and speech/language therapy Therapy must be prescribed by a doctor. The therapy must be needed for treatment of a specific illness, injury, or condition. The doctor must review the need for therapy every 60 days. this sounds very confusing, especially the part about it's only covered if your main insurance covers it what about medical appts? we just got what i am sure will be the first of many rejected claims from those mo-fos at tufts... this time for neurology, so what is next if i understand my health policy correctly (god help me) tufts only pays for st, for example under diagnosis "autism" but we have diagnosis pdd-nos, so i don't think they will payMass Health is my sons secondary insurance.  Whatever my insurance plan does not cover Mass Health picks up.  I am not sure about what Tufts covers with a PDD-NOS diagnosis, I have Cigna and my son has a diagnosis of AutismI guess there is one way to find out, eh? I am having them send me an application Yeah, I believe from talking to them that we are eligible for the CommonHealth route. From what it SOUNDED like, it seems like it provides the same options, but at potentially greater expense to us. I guess we're going to have to try and find out. I still don't understand the premium assistance thing, but I guess that's something else to look into. Premuim assistance helps to pay for your primary insurance- it reimburses you a portion of what you pay for your health insurance.  The idea behind it is it is much cheaper for the state to be the secondary insurance so they want to help you keep your primary insurance.  You would get a check in the mail each month, based on your income and how much you pay out of pocket for your insurance premuim.  In essence this means more money coming into your house each month (since you are getting reimbursed)   I know many people who use this extra money to help cover autism expenses.   You can apply for prem assistance once your child is on masshealth. Im not an expert on masshealth, but this is my understanding, hope it helps.
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