Frequently asked questions

Depending on where you live and which program you qualify for (MassHealth, ConnectorCare or a Qualified Health Plan), you may be able to choose WellSense as your health coverage plan. If we offer a plan in your area that you qualify for, you will see us as one of your options when you apply online or hear about us when you apply by phone.

You may not need to do anything. Currently enrolled Massachusetts Health Connector members do not need to reapply if the same or similar plan is available this year. Just keep paying your premium. If you want to enroll in a different plan, you can shop and change plans during open enrollment. If your income or financial situation has changed, you need to log in to your account at MAhealthconnector.org to update your information.

Coverage for a Qualified Health Plan will end on December 31. Current Health Connector members do not need to reapply if the same or similar plan is available for the next year. Pay your first monthly premium by Dec 23 to avoid a lapse in coverage.

That depends on the program you qualify for. If you are enrolling in health insurance coverage for the first time, visit MAhealthconnector.org to learn more.

In some cases, open enrollment is the only time you can apply for coverage all year unless you have a qualifying life event like getting married, losing your job, having a child, or losing health insurance coverage. See a full list of qualifying events.

If you qualify for…	Open Enrollment
ConnectorCare	November 1 through May 23
Qualified Health Plan	November 1 through May 23

Go to MAhealthconnector.org starting Nov 1 to:

• Find out if you qualify for no-cost or low-cost health insurance on the spot
• Apply online 24/7
• Compare your health plan options side-by-side

You can also apply in person, over the phone, or using a paper application. Learn more.

You will be receiving your ID card and Welcome Kit in the mail. Remember to bring your ID card to all of your doctors appointments and whenever you pick up prescriptions.

In an emergency (inside or outside the service area), you should call 911 or seek care at the nearest emergency facility. If 911 services are not available in your area, call the local number for emergency medical services.

You need to choose a doctor for all your routine care. Your doctor, also called a primary care physician or PCP, should be the first person you call when you have medical issues (unless it is an emergency). Your doctor will help manage your health and send you to specialty doctors or hospitals when needed. If you do not choose a doctor, one will be assigned to you—but you can change at any time.

There may be times when you may need to see a specialist. A specialist is a healthcare provider who is trained to offer specific, often more detailed, treatments than your PCP. If you think you need to see a specialist, you should first call your PCP. Your PCP can help you identify your specialty care needs.

Generally, any doctor or hospital that you visit must be chosen from a list of providers who work with WellSense and accept your plan type. They are also called in-network providers. Your doctor will refer to you other doctors or hospitals on our approved list to make sure that your medical visit is covered by insurance (there are some exceptions). See a list of doctors and hospitals you can use. For a complete list of the services covered by WellSense, consult your plan benefit documents.

In general, you must get all your healthcare services from WellSense network doctors and providers. The only exceptions are:

• If you need emergency care or treatment at the closest emergency room for serious illness or injury in a life-threatening situation
• If you need urgent care when you are traveling outside our service area
• If you need family planning services
• If WellSense (or Beacon Health Strategies for behavioral health services) gives prior authorization for you to get care from an out-of-network provider

We partner with Carelon Behavioral Health to manage behavioral health services. Call Carelon for help finding a provider for behavioral health services. You can also access their online provider directory here.

• MassHealth members: 1-888-217-3501 toll-free, 24-hour behavioral health line
• ConnectorCare/Qualified Health Plan members: 1-877-957-5600 toll-free, 24-hour behavioral health line
• carelonbehavioralhealth.com

Some services and medications need prior authorization from WellSense before they will be covered. Your PCP will get this approval for you.

If you or your PCP did not receive prior authorization, WellSense will not pay for your care or services. You may be held responsible for the costs of your treatment.

Yes. Call the Nurse Advice Line at 1-800-973-6273 (MassHealth) or 1-866-763-4695 (ConnectorCare/Qualified Health Plan) and speak to a registered nurse when your doctor's office is closed or if you have a question about your health. All calls are confidential and you can call 24 hours a day, seven days a week.

Our free Care Management Program can make living with conditions like asthma, diabetes, cancer, or other special health needs easier. Pregnant members can get help through this program too. Call 1-866-853-5241 to see if you or your family members qualify.

An ACO is made up of doctors, hospitals, and other healthcare providers who work closely together to care for patients. Your health history and information are shared between your doctors, so your visits will be more personalized and efficient. Your doctors will be better prepared to help you stay healthy and out of the emergency room.

In an ACO, doctors work closely together and share information about their patients. This means your doctor will have the full picture of your health and will be able to make sure you get the care you need, when you need it. But an ACO can also help you out of the doctor’s office with benefits like access to community resources, support groups, and classes. These extra resources are there to help keep you healthy.

You can find out if your plan type is part of an ACO by checking your health insurance ID card. You can also contact Member Services for more information.

We are committed to improving your health and health care. WellSense has made it easier for you to access your personal health information which can help you make more informed decisions about your health care. Click here for more information on how to access your health information online.