Core eligibility requirements for Senior Whole Health
To be eligible for Senior Whole Health (SWH) in Massachusetts, individuals must meet specific criteria, which vary depending on the plan. All plans require residency and age qualifications, with the most significant factor being the applicant's status regarding Medicare and MassHealth.
Residency and age
Applicants must be Massachusetts residents. Eligibility is generally for seniors aged 65 and older. Individuals under 65 who qualify for long-term care services may be eligible for MassHealth programs that coordinate with these plans.
Dual eligibility: Medicare and MassHealth Standard
Most Senior Whole Health members enroll in a Dual Eligible Special Needs Plan (D-SNP), a Medicare Advantage plan that combines Medicare, MassHealth, and prescription drug coverage. For the D-SNP, individuals must reside within the plan's service area, have both Medicare Part A and Part B, and be eligible for MassHealth Standard.
Senior Care Options (SCO)
Individuals aged 65 or older with MassHealth Standard but without Medicare may be eligible for the Senior Care Options (SCO) plan. This plan covers all standard MassHealth benefits and provides additional supplemental benefits.
A comparison of Senior Whole Health plan types
Senior Whole Health offers different plans tailored to the needs of Massachusetts residents. The D-SNP and SCO plans are the most common.
| Feature | Dual Eligible Special Needs Plan (D-SNP) | Senior Care Options (SCO) |
|---|---|---|
| Target Population | Seniors 65+ with both Medicare and MassHealth Standard. | Seniors 65+ with MassHealth Standard only. |
| Coverage | Combines Medicare Parts A & B, MassHealth Standard, and Medicare Part D benefits. | Combines standard MassHealth benefits with supplemental benefits. |
| Key Benefit | Merges coverage from three sources into a single plan, often with $0 copayments. | Coordinates all healthcare and social support services for members who are not dually eligible. |
| Eligibility Factor | Enrollment requires having both Medicare Parts A & B and MassHealth Standard. | Enrollment requires having MassHealth Standard but not necessarily Medicare. |
Nursing Home Certifiable (NHC) plans
The Nursing Home Certifiable (NHC) D-SNP is available for dual-eligible seniors (65+) who require a nursing home level of care. This plan provides comprehensive coverage, including home and community-based support services, to help individuals stay in their homes.
How to apply for Senior Whole Health
Enrolling in a Senior Whole Health plan after confirming eligibility is a straightforward process, often assisted by the SWH organization or a representative.
Steps for enrollment
- Contact the plan provider: Reach out to Senior Whole Health (Molina Healthcare in Massachusetts) or MassHealth Customer Service to determine the appropriate plan.
- Complete the enrollment form: The chosen SWH organization will provide and help complete the enrollment form.
- Select a Primary Care Provider (PCP): Choose a PCP from the network during enrollment, and the organization will coordinate your care.
The role of a care team
A Personal Care Team, including a nurse care manager and community resource coordinator, is assigned to all SWH members. This team conducts home assessments to create personalized care plans addressing health and social needs.
Conclusion
Senior Whole Health offers integrated care in Massachusetts for eligible seniors by combining Medicare and MassHealth benefits. Eligibility primarily depends on being 65 or older, a Massachusetts resident, and having MassHealth Standard. The D-SNP is for those with both Medicare and MassHealth Standard, while the SCO plan is for those with only MassHealth Standard. Understanding these options helps seniors and caregivers find the right plan.
This article provides general information. Eligibility rules can change, and individual circumstances vary. For the most accurate and up-to-date information, it is recommended to visit the official {Link: Mass.gov https://www.mass.gov/senior-care-options-sco} or contact Senior Whole Health directly.
