What is the Senior Care Options (SCO) Program?
Senior Care Options (SCO) is a Massachusetts-specific program for residents aged 65 and older who qualify for MassHealth Standard. The program allows eligible seniors to enroll in a managed care plan offered by a participating Senior Care Organization, such as Tufts Health Plan. Unlike traditional fee-for-service care, SCO provides members with a coordinated, all-inclusive approach to healthcare, combining medical, behavioral health, and social support services.
Integrating Medicare and MassHealth
One of the most significant advantages of the Tufts SCO program is its ability to integrate benefits from both Medicare and MassHealth. For seniors who are "dual-eligible" (qualify for both programs), Tufts SCO functions as a Medicare Advantage Special Needs Plan (HMO D-SNP). For those with only MassHealth Standard, it operates as a MassHealth SCO plan. In both cases, the plan works to eliminate gaps in coverage, simplify the healthcare experience, and reduce out-of-pocket costs, often to zero.
Eligibility for Tufts Senior Care Options
To enroll in Tufts Health Plan Senior Care Options, specific criteria must be met, as the program is designed for a particular segment of the senior population.
Who can join?
- Age: Must be 65 years or older.
- MassHealth Status: Must be eligible for or enrolled in MassHealth Standard. There are different plan offerings depending on whether you are enrolled in MassHealth Standard alone or are dual-eligible for both MassHealth and Medicare Parts A and B.
- Residency: Must be a Massachusetts resident living within the plan's service area. Certain counties, such as Berkshire, Dukes, Franklin, and Nantucket, are excluded for some offerings.
- Other Insurance: Must not be enrolled in any other comprehensive health insurance plan, with the exception of Medicare.
Extensive Benefits Covered by Tufts SCO
Tufts SCO offers a wide array of benefits that go beyond what is covered by Original Medicare and standard MassHealth, many at no cost to the member.
- Complete Medical Coverage: This includes doctor visits, hospital stays, and emergency services worldwide.
- Dental Services: Comprehensive dental care, including exams, fillings, dentures, crowns, and implants.
- Vision Coverage: Free routine eye exams and an annual eyewear allowance.
- Hearing Aids: Coverage for routine hearing exams and hearing aids.
- Prescription Drugs: All covered prescription drugs with a $0 copay, plus home delivery options.
- Wellness Programs: Includes allowances for fitness memberships, like a local Massachusetts YMCA facility membership, and activity trackers.
- OTC and Grocery Allowance: A quarterly allowance on an Instant Savings Card for approved over-the-counter health items and groceries.
- Transportation: Non-emergency rides to and from medical appointments.
The Role of the Coordinated Care Team
A key feature of Tufts SCO is its coordinated care model, which ensures members receive personalized, holistic support. Every member is assigned a dedicated Care Manager who leads a Primary Care Team to manage and coordinate services.
The Coordinated Care Process
- Initial Assessment: A nurse or geriatric support services coordinator visits the member at home to assess their health and social needs.
- Personalized Care Plan: The Care Manager works with the member, family members, and caregivers to develop a customized care plan.
- Coordination of Services: The team coordinates all necessary services, from specialist appointments to home care and social support.
- Ongoing Support: The team provides continuous support, with 24/7 access to representatives for health care questions.
Tufts SCO vs. Other Medicare Options: A Comparison
| Feature | Tufts Health Plan Senior Care Options (SCO) | Original Medicare (Parts A & B) | Tufts Medicare Advantage (HMO) | MassHealth Standard |
|---|---|---|---|---|
| Eligibility | Age 65+ & MassHealth Standard | Age 65+ or with certain disabilities | Age 65+ or with certain disabilities | Low income based |
| Cost | Often $0 premium for eligible members | Premiums and cost-sharing apply | May have $0 premium, but cost-sharing varies | Low to no cost based on income |
| Benefits | Integrated medical, behavioral, and social support | Limited coverage for medical care and hospitalization | Combines Original Medicare with extra benefits | Limited coverage for medical care |
| Care Coordination | Dedicated Care Manager and Primary Care Team | No formal care coordination | May offer some care coordination | Varies depending on provider |
| Extras | Dental, vision, hearing, OTC allowance, wellness | No dental, vision, or hearing coverage | May include dental, vision, hearing, and wellness benefits | Limited or no additional benefits |
| Network | Network of providers | Any provider that accepts Medicare | Network of providers | MassHealth providers |
How to Enroll in Tufts Senior Care Options
Enrollment in the SCO program is voluntary and can be done at any time of the year. The process is designed to be straightforward for eligible individuals.
Enrollment Steps
- Confirm Eligibility: Verify you meet the age, MassHealth, and residency requirements.
- Contact Tufts or MassHealth: Reach out to the Tufts Health Plan directly or the MassHealth Customer Service Center to get detailed information about the plan and service area.
- Select a PCP: Choose a Primary Care Provider (PCP) from the Tufts SCO network.
- Complete Enrollment: The selected Senior Care Organization will assist in completing the necessary enrollment forms.
The Impact on Seniors' Quality of Life
Tufts Senior Care Options represents a significant step forward in senior care, particularly for low-income residents in Massachusetts. By providing a comprehensive, coordinated, and often no-cost health plan, it addresses the complex needs of this population. The program empowers seniors to age in place with dignity and reduces the financial stress associated with healthcare costs, as evidenced by positive member testimonials. The integrated approach, combining clinical care with social support, ensures that members receive the right care at the right time, leading to better health outcomes and a higher quality of life. The extensive list of benefits, from dental care to transportation, further supports an active and independent lifestyle.
To learn more about the program and eligibility in Massachusetts, visit the Mass.gov SCO overview page: Senior Care Options (SCO) - Mass.gov
