To be eligible for the program, any person age 55 and older must first live within the Summit ElderCare (SE) service area. Additionally, the Massachusetts Executive Office of Elder Affairs, also known as MassHealth, screening agent must certify that the applicant meets the Medicaid nursing facility clinical eligibility criteria. An annual recertification of this eligibility applies for some participants. The applicant must also be assessed by the Summit ElderCare interdisciplinary team and determined to be capable of living safely in the community.
The Summit ElderCare enrollment staff will guide prospective participants through the application and enrollment process and will coordinate the scheduling of these evaluations. Applicants are not responsible for any of the costs associated with the assessment and application process.
Although Fallon Community Health Plan sponsors SE, a participant does not have to be an FCHP member to enroll. Once new participants are enrolled in Summit ElderCare, it is no longer necessary to maintain additional health insurance coverage beyond any Medicare and or Medicaid plans that may be in place. In addition, to providing medical and social support to the participant, the program also includes insurance coverage for all medical services including hospitalizations and unlimited prescription drug coverage. Please click here for a summary of covered services.
There are no financial eligibility requirements to become a Summit ElderCare participant. However, a large majority of Summit ElderCare participants are enrolled in Medicare and also qualify for Medicaid assistance toward the cost of premiums. While many participants qualify for the program with no monthly premium costs, some participants may be responsible for paying a portion of the monthly premiums. A Summit ElderCare representative can answer your questions regarding program costs.
Once enrolled, all approved care and services are covered with no additional cost (beyond any monthly premium cost shares), including prescription medications. There are no insurance paperwork or claim forms, which allows participants and their caregivers to focus on care plans and the benefits of the program.
If a participant reaches a point where the interdisplinary care team and caregivers determine that care at home is no longer appropriate, Summit ElderCare will provide full coverage for nursing home services at one of our participating nursing facilities. A list of contracted facilities is available upon request.
Summit ElderCare has created a worksheet designed to help you compare current costs and coverage to estimated costs and coverage through the Summit ElderCare PACE program. If you would like to learn more about Summit ElderCare, please call 800-698-7566 (TDD/TTY: 800-439-2370) between the hours of 8:30 a.m. and 5:00 p.m. Monday through Friday, or you may request more information online.