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Celticare Health Plans

An Overview of Celticare Health Plans

Celticare Health Plans is a managed care organization that offers health insurance coverage to individuals and families across Massachusetts. Established in 2009, Celticare focuses on providing affordable, high-quality healthcare to its members. As a subsidiary of Centene Corporation, one of the largest managed care providers in the country, Celticare brings a wealth of experience and resources to the table.

Who Celticare Serves

Celticare Health Plans is designed for people who are eligible for Medicaid and Medicare. This includes low-income families, individuals with disabilities, and senior citizens. If you are looking for healthcare coverage and you qualify for either of these government-sponsored programs, Celticare may be a good option for you.

What Celticare Offers

Celticare Health Plans provides a broad range of healthcare services to its members. This includes preventive care, diagnostic services, hospitalizations, mental health treatment, and prescription drug coverage. Members also have access to a network of healthcare providers, including primary care physicians, specialists, hospitals, and clinics.

Celticare also offers additional services to help members manage their healthcare needs. For example, members can receive care coordination services to help navigate the healthcare system and find the resources they need. Additionally, Celticare provides wellness programs, such as smoking cessation programs and weight management programs, to help members maintain a healthy lifestyle.

Celticare’s Mission

Celticare’s mission is to improve the health of its members by providing access to high-quality, coordinated healthcare services. To achieve this mission, Celticare works closely with healthcare providers to ensure that members receive the care they need when they need it. They focus on promoting preventive care and managing chronic conditions to help members stay healthy and avoid expensive hospitalizations.

Celticare also places a strong emphasis on diversity and inclusion. They recognize that their members come from many different backgrounds and face unique challenges when it comes to healthcare. As such, they strive to provide culturally competent care that respects the needs and values of each individual.

The Benefits of Choosing Celticare Health Plans

There are many benefits to choosing Celticare Health Plans for your healthcare needs. Perhaps the most significant benefit is the affordability of the plans. Since Celticare serves people who are eligible for Medicaid and Medicare, the plans are designed to be accessible to those with limited financial resources. This means that members can receive high-quality healthcare services without having to worry about enormous medical bills.

Another major benefit of choosing Celticare is the network of healthcare providers that members have access to. Celticare has partnerships with numerous hospitals, clinics, and healthcare providers throughout Massachusetts, which means that members can receive care close to home. This can be especially important for people with mobility issues or those who live in areas with limited healthcare options.

Celticare Health Plans offers affordable, high-quality healthcare services to people who are eligible for Medicaid and Medicare. With a focus on preventive care and chronic disease management, Celticare is committed to improving the health of its members. By partnering with healthcare providers and offering additional services, such as care coordination and wellness programs, Celticare aims to provide a comprehensive healthcare experience to its members.

Benefits and Coverage of Celticare Health Plans

Celticare Health Plans offer a wide range of benefits and coverage to its members. This section will outline the various coverage options and benefits offered by Celticare Health Plans, including preventative care, hospitalizations, prescriptions, and more.

Preventative Care

Celticare Health Plans provides its members with preventative care services to help maintain good health and prevent illnesses. These services include annual checkups, cancer screenings, immunizations, and lab tests. Members can take advantage of preventative care services at little or no cost to them.


Hospitalizations can be a costly and stressful experience, which is why Celticare Health Plans offer comprehensive hospitalization coverage. Members can rest assured that they will receive quality care and support during their hospital stay, including coverage for room and board, tests, procedures, and postoperative care.

Prescription Coverage

Celticare Health Plans offer prescription drug coverage to help its members manage their medication costs. Members can benefit from mail-order services, home delivery, and generic medications, which can help to reduce the overall cost of prescription drugs.

Emergency Medical Care

Medical emergencies can happen when we least expect them, which is why Celticare Health Plans offer emergency medical care coverage. Members receive coverage for emergency room visits, ambulance services, and urgent care visits.

Behavioral Health Coverage

Celticare Health Plans recognizes the importance of addressing mental health and substance abuse disorders. Members can receive coverage for outpatient and inpatient services for mental health and substance abuse treatment.

Other Benefits

Celticare Health Plans also offer additional benefits and services to its members. Some of these benefits include care management programs, transportation assistance, interpreter services, and fitness memberships.

Celticare Health Plans provide comprehensive coverage and benefits to its members. By choosing Celticare Health Plans, members can have peace of mind knowing that they have access to a wide range of medical services and support.

Enrollment and Eligibility for Celticare Health Plans

Celticare Health Plans provide healthcare coverage to eligible individuals and families in Massachusetts. The company focuses on delivering innovative healthcare solutions and helping members achieve their health goals through comprehensive care coordination services and disease management programs. In this section, we will discuss the enrollment process, eligibility criteria, and potential enrollment deadlines for Celticare Health Plans.

Enrollment Process

The enrollment process for Celticare Health Plans is relatively simple and can be done either online or by phone. Before enrolling in a plan, it is recommended that individuals or families review the available options to determine which plan best suits their healthcare needs. It is essential to keep in mind that different plans may have varying costs, benefits, and provider networks.

Once a plan has been selected, the enrollment process can begin. Interested individuals can visit the Celticare website or call the sales team to enroll in a plan. During the enrollment process, individuals will be required to provide personal information, such as their name, address, date of birth, and social security number. Additionally, they will need to provide information on any previous medical conditions, current medications, and any relevant health history.

Eligibility Criteria

To be eligible for Celticare Health Plans, individuals must meet specific criteria. Firstly, they must be residents of Massachusetts and be a U.S. citizen, legal immigrant, or a non-citizen legally present in the U.S. They must also not be eligible for Medicaid or Medicare.

Additionally, eligibility is also based on income. Individuals with an income level of up to 400% of the Federal Poverty Level (FPL) may qualify for financial assistance through the Massachusetts Health Connector. This assistance can help lower the cost of healthcare premiums and out-of-pocket expenses.

Enrollment Deadlines

Enrollment in Celticare Health Plans may open at various times throughout the year. Individuals who are eligible for enrollment should pay attention to enrollment deadlines to ensure they do not miss out on coverage. The annual enrollment period for individuals who purchase their own coverage through the Massachusetts Health Connector runs from November 1st to January 23rd, with coverage effective on January 1st of the following year.

However, individuals who have experienced a qualifying life event, such as losing their job, getting married, or having a child, may also be eligible for a special enrollment period. This can occur at any time during the year and allows individuals to enroll in health coverage outside of the annual enrollment period.

Celticare Health Plans provide comprehensive healthcare coverage to eligible individuals and families in Massachusetts. The enrollment process is straightforward, with enrollment done online or by phone. To be eligible, individuals must meet specific criteria, including being a Massachusetts resident and meeting income requirements. Finally, individuals should be aware of enrollment deadlines to ensure they have access to the healthcare coverage they need.

Celticare Health Plans Provider Network

Celticare Health Plans offer a wide variety of healthcare services to their members, thanks to their expansive provider network. This network includes thousands of doctors, hospitals, and other medical professionals throughout Massachusetts, with many specialists within the network offering additional expertise and support to members. In this topic, we will explore the various aspects of the Celticare provider network, including coverage options, how to find an in-network provider, and more.

Coverage Options

While many medical providers are included in the Celticare provider network, not all services may be covered. It is important to review your specific plan and its covered services to ensure you make the most out of your benefits while avoiding out-of-pocket expenses. Celticare Health Plans include several types of coverage options, such as hospital stays, doctor visits, preventative care, prescription drugs, and emergency room services, among others. Members may also receive discounts on certain services, depending on their plan and eligibility requirements.

Finding an In-Network Provider

When searching for a medical provider, it’s essential to find an in-network provider that is covered under your specific plan. This will help you avoid unexpected medical bills and extra out-of-pocket costs that may occur when accessing out-of-network providers. The Celticare provider network is extensive, including thousands of providers throughout Massachusetts that offer preferred rates or other discounts to members. You can search for in-network providers on the Celticare website, or by calling the member services number listed on your insurance card.


Celticare Health Plans has a vast array of specialists within their network, providing members access to a diverse range of medical specialties. This network includes specialists such as cardiologists, endocrinologists, pulmonologists, oncologists, dermatologists, behavioral health professionals, and many others. To see a specialist, members typically need to obtain a referral from their primary care physician, depending on the particular plan.

Telehealth Options

Celticare Health Plans also offer telehealth options for members, allowing them to receive medical care through video and telephone consultations. Telehealth services enable members to access medical advice from the comfort of their own home, avoiding unnecessary travel to in-person appointments. Telehealth options are also an incredibly useful tool for those who live in remote or rural areas.

The Celticare Health Plans provider network has been designed to offer a broad range of medical services to members. With thousands of providers throughout Massachusetts, the network ensures that members can access high-quality medical care at reasonable rates. It is essential for members to familiarize themselves with the specifics of their plan, including coverage options and eligibility requirements, to get the most out of their benefits. Ultimately, the convenient and expansive Celticare network ensures that members receive the best possible care, with a diverse range of medical professionals available to meet their needs.

Member Resources

CeltiCare Health Plans is committed to providing its members with the resources they need to lead healthy, fulfilling lives. In addition to quality medical care, members have access to a wide variety of wellness programs, educational materials, and care coordination services to help them manage their health and well-being. Let’s take a closer look at some of these member resources.

Wellness Programs

At CeltiCare, we believe that preventive care is key to maintaining good health. That’s why we offer a range of wellness programs to help our members stay healthy and prevent serious health problems before they occur. Some of these programs include:

Disease management programs

Our disease management programs are designed to help members who are diagnosed with chronic conditions such as asthma, diabetes, and heart disease manage their symptoms and prevent complications. These programs provide personalized support and education to help members understand their condition, adhere to their treatment plan, and make healthy lifestyle choices.

Weight management programs

Maintaining a healthy weight is essential to preventing many chronic health conditions such as diabetes, heart disease, and cancer. Our weight management programs provide members with tools and resources to help them lose weight, including personalized meal plans, exercise programs, and ongoing coaching and support.

Tobacco cessation programs

Quitting smoking is one of the best things you can do for your health, and our tobacco cessation programs are here to help. Members who enroll in these programs receive personalized coaching and support to help them quit smoking and stay tobacco-free.

Educational materials

In addition to our wellness programs, CeltiCare members have access to a wealth of educational materials on a variety of health topics. Our online health library is full of resources on everything from healthy eating and exercise to disease prevention and management. Members can also attend free health seminars and workshops to learn more about specific health conditions and how to stay healthy.

Care coordination services

Managing your health can be complicated, especially if you have multiple chronic conditions or complex medical needs. That’s where our care coordination services come in. Our team of care managers works with members to develop personalized care plans to help them navigate the healthcare system and access the services they need. We also offer transportation assistance to help members get to their medical appointments.

CeltiCare Health Plans understands that good health is about more than just medical care. That’s why we offer a wide variety of member resources to help our members stay healthy, prevent illness, and manage chronic conditions. From wellness programs to care coordination services, we are committed to providing our members with the support they need to achieve their health goals.

Cost and Affordability

Affordability is a major concern when it comes to healthcare plans. Celticare Health Plans understand that health insurance should be accessible to everyone and have therefore designed their plans with affordability in mind. In this section, we’ll explore the various costs associated with Celticare, as well as potential cost-saving measures.

Monthly Premiums

One of the most significant costs associated with health insurance is the monthly premium. Celticare Health Plans offers a range of plans at varying price points to accommodate different budgets and healthcare needs. The premiums for these plans can vary depending on factors such as age, location, and the level of coverage chosen.

One of the ways that Celticare makes their plans more affordable is by offering subsidies to eligible enrollees. These subsidies can help offset the cost of monthly premiums and make healthcare coverage more accessible to those who may not otherwise be able to afford it.

Deductibles and Copays

In addition to monthly premiums, members of Celticare Health Plans may also be responsible for deductibles and copays. A deductible is the amount that a member must pay out of pocket before their insurance coverage kicks in. Copays, on the other hand, are a fixed dollar amount that must be paid at the time of service, such as a doctor’s visit or prescription.

Celticare offers plans with varying deductibles and copays, allowing members to choose a plan that fits their budget and healthcare needs.

Out-of-Pocket Maximums

Another potential cost associated with healthcare is the out-of-pocket maximum. This is the most a member will have to pay in a given year for covered services and is designed to prevent individuals from facing excessive medical bills. Once the out-of-pocket maximum is reached, the member will no longer be responsible for paying copays, deductibles, or coinsurance for covered services.

Celticare Health Plans offers plans with different out-of-pocket maximums, allowing members to choose a plan that works best for their budget and healthcare needs.

Cost-Saving Measures

To help make healthcare coverage more affordable, Celticare offers several cost-saving measures. For instance, members may be eligible for subsidies to reduce their monthly premiums, as well as discounts for using in-network providers.

Celticare also offers wellness programs and care coordination services that can help members manage their healthcare needs more efficiently. By staying on top of preventive care and managing chronic conditions, members can potentially avoid more expensive medical bills down the line.

Celticare Health Plans is committed to making healthcare coverage more accessible and affordable for everyone. By offering a range of plans at varying price points and providing cost-saving measures, Celticare is working to ensure that individuals can access the healthcare services they need without breaking the bank.


In conclusion, Celticare Health Plans provides a wide range of benefits and coverage options for its members. As an overview, this health insurance provider is focused on providing affordable healthcare insurance plans to low-income residents of Massachusetts. With a focus on preventative care, hospitalizations, prescriptions, and more, Celticare Health Plans offers a comprehensive selection of medical services for its members.

Enrollment and eligibility are relatively simple processes, and those who are eligible can benefit from a broad network of doctors and hospitals that are covered by the provider. Finding an in-network provider is also made simple through the provider’s network resources, ensuring that members can always find the care they need in their area.

Additionally, Celticare offers a robust suite of member resources, including wellness programs, educational materials, and care coordination services. These resources help members stay informed about their health and manage their care efficiently. The provider’s plans are designed to be affordable, offering various cost-saving measures like subsidies and discounts as well as competitive prices for deductibles, copays, and other out-of-pocket expenses.

In short, Celticare Health Plans not only provides essential medical services but also offers resources to help members manage their health proactively, ensuring that they remain healthy and informed throughout their lives. The provider goes beyond just offering coverage; it promotes healthy lifestyles and provides members with the necessary resources to achieve their health goals. With its comprehensive range of benefits and its commitment to affordability and member support, Celticare Health Plans is an excellent option for Massachusetts residents in need of comprehensive healthcare coverage.