Carriers’ Policies on Naloxone
2020 Carriers' Alternatives to Use of Opioids to Treat Pain
Massachusetts law requires that health insurance carriers cover a variety of pain treatment alternatives to be available for their members in lieu of an opioid prescription. Review the chart found here for information regarding your health insurer’s alternative services and medicines. Information about pain management and alternatives to opioids is also available on your health insurer’s website.
Lists of Available Coverages
Find information on available plan options and purchasing insurance as an individual or for/part of a group.
Keeping Coverage after Leaving Employment
State and federal laws allow employees to be a part of a previous employer's health plan after separation of employment, often referred to as "COBRA".
Dedicated Provider Network Telephone Numbers
Bulletin 2018-06 requires Health Carriers to have dedicated staff available to help Members, where necessary, with setting up appointments with providers available to treat certain services.
The attached chart identifies each of Massachusetts Health Carriers’ dedicated phone lines to call for help accessing both non-behavioral and behavioral health care services.
Consumer Resources on Coverages
Consumer Alert:
The Division of Insurance developed the following to explain insurance carriers’ obligations and consumer rights and protections under the new law.
The Division of Insurance developed a Q&A to help insurance companies, providers, pharmacists, and consumers understand the contraceptive access rights provided under the ACCESS law.
Learn more about the benefits that health insurance plans in Massachusetts must cover:
All health care payers in the state must use a common summary of payments form so that consumers can easily understand their responsibility, if any, for payment of any portion of a health care provider claim.
Estimating What Your Health Care May Cost
Knowing the cost of a treatment or procedure can help consumers make informed decisions about their health care. Chapter 224 of the Acts of 2012 requires that health insurance carriers provide individualized information regarding the estimated or maximum allowed charge for a proposed service as well as the estimated amount a member may be responsible to pay out-of-pocket. These estimates are to be based on information available to the member's insurance company at the time the consumer requests the estimate.
A chart found here details the current phone numbers and website addresses for each company's cost estimator program.
Medicare and Medigap Coverage
Rate Review
HealthCare.gov Rate Review Portal
Consumers in Massachusetts may go to ratereview.healthcare.gov to view easy-to-access, consumer-friendly disclosure information explaining proposed increases that are 10 percent or higher than last year’s rates. Further background information can be found here: Rate Review Data. Consumers will see a summary of the key factors driving rate increases and an explanation provided by insurance companies for why the proposed increase is needed.
If you would like to submit a comment on a proposed rate increase, please send an email to HCAB.mailbox@state.ma.us.