Benefits and Services

Senior Whole Health provides health coverage for seniors in Massachusetts.

When you join one of our plans, you get Medicaid, Medicare and prescription drug benefits in one plan designed to keep you healthy, safe and independent in your own home and community—all at no cost to you.

With Senior Whole Health, our seniors pay no annual deductible, no premiums and no copays.

You get all your MassHealth (Medicaid) benefits, Medicare benefits and Part D prescription drug benefits, plus:

  • Doctor visits
  • Dental benefits including
  • Free YMCA membership or $55 per month for another gym membership
  • No cost eye exams and $305 per year towards frames
  • $100 per quarter, or $400 per year, for certain over-the-counter and health-related items with the Healthy You card
  • Transportation to and from medical appointments (limitations may apply)
  • 24/7 phone access to a SWH Nurse Care Manager
  • And much more

Every member is assigned a Personal Care Team that coordinates every aspect of your care, every step of the way, to meet your individual needs.

Your Personal Care Team

We put you in the center of everything we do. Your Personal Care team includes your Care Manager, your primary care provider, a SWH Community Resource Coordinator and local elder agencies, your support system of family and friends (if you choose), and other care and service providers important to your care. This team works together with you to design an Individual Care Plan centered around your unique needs and goals.

Your Nurse Care Manager will:

  • Get to know you and your health in order to understand your needs and wishes
  • Manage your care and services, and ensure effective communication among caregivers, providers and community supports
  • Communicate on and ongoing basis with your PCP and other providers
  • Identify and prioritize your needs and preferences
  • Serve as your primary point of contact when you need care

The Community Resource Coordinator helps you coordinate community services such as home care services and adult day programs.

The Geriatric Support Services Coordinator (GSSC) is a local representative from your elder agency that arranges home care services, when needed.

Getting Care

We cover your medical treatments and services as long as:

  • They are covered benefits (a complete list of covered benefits is in Chapter 4 of your Evidence of Coverage, also known as your Member Handbook)
  • The services and treatments are considered medically necessary
  • You have a primary care provider (PCP) who is overseeing your care
  • You receive care from a network provider (some exceptions apply)

Some benefits and services require prior authorization from us before you get them. Learn more about prior authorization.

The first step to getting the right care is choosing the right PCP. Senior Whole Health has an expansive network of providers with expertise in many different specialty areas.

What is a primary care provider (PCP) and why do I need one?

Your primary care provider is the doctor, physician’s assistant or nurse practitioner you’ll see for annual checkups and all your day-to-day health needs. Your PCP will get to know you and become familiar with your health history.
It’s important to visit your PCP within 60 days after you in enroll in Senior Whole Health. When your PCP gets to know you when you’re well, they’re better able to treat you when you aren’t.

Your PCP will also refer you to specialists or other providers when needed.

How do I choose a primary care provider (PCP)?

It’s important to find the right PCP for you. Look for someone who can meet your individual needs—someone who speaks your language or has a wheelchair accessible exam room.

We make it easy to find high quality health care for seniors in Massachusetts. Use our Find a Provider search tool.  You can search for providers by name, specialty or distance; find out if they’re accepting new patients, what languages they speak and what hospitals they’re affiliated with.

The Senior Whole Health provider directory lists all the primary care and specialty doctors, hospitals, nursing homes, behavioral health providers, pharmacies and other care and service providers in our network.

Prescription Drugs

As a member of Senior Whole Health, you get prescription drugs and other pharmacy benefits with no copays and no deductibles. Your drugs are covered when you show your member ID card at a network pharmacy whenever you get your prescriptions filled. Learn more about your pharmacy and prescription drug benefits here. 

Extra programs and benefits

Healthy You Card Program 
Senior Whole Health members can now have the added convenience of ordering their OTC medications, health and wellness related items, first-aid supplies, and other qualifying items online using their $100 per quarter allowance. Learn more 

Medication Therapy Management Program
This program helps you understand and manage your prescription drugs when you have chronic conditions that require at least 7 long-term drugs. Learn more.