Understanding SCOs in Massachusetts

On Behalf of | Nov 27, 2023 | Medicaid/Medicare

Massachusetts has gone to great lengths to provide various financial aid plans for its elderly citizens. While these plans often provide essential financial assistance for the state’s elderly residents, finding the right plan (or plans) and choosing the best options can be a daunting task. For this reason, several health care plans have joined forces to create what are called Senior Care Options (SCOs).

An overview of SCOs

An SCO is a comprehensive health plan providing al of the services normally obtained through Medicare and Medicaid. An SCO also provides social support services by combining health care specialized geriatric support services through a centralized agency (the SCO). SCO members are not charged for co-pays, and they may quit the SCO at any time.

Joining an SCO

In order to join an SCO, a person must meet the following eligibility requirements:

  1. Have reached the age of 65
  2. Be living at home or in a long term care facility
  3. Not subject to the six-month look back deductible under MassHealth regulations.
  4. Living in an area served by an SCO plan.

The application for membership is reviewed by the SCO and a primary care provider is selected by the SCO. If necessary, the application will then be forwarded to MassHealth and, if applicable, Medicare. At the current time, Massachusetts has six SCOs serving various areas of the state.

Limitations of belonging to an SCO

The principal downside of belonging to an SCO is the requirement that all health care services must be obtained from a provider who is a member of the same SCO as the patient. The only exception is emergency medical care.

Benefits of receiving care from an SCO

The principal advantage of an SCO is that members receive 24-hour coordinated medical care from a team of nurses, specialists, and a geriatric care coordinator who will work with the team members to develop a plan of care that specifically addresses the needs of the member.