Lists of Available Coverages
Find information on available plan options and purchasing insurance as an individual or for/part of a group.
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.
PACT Act - Carrier List of Medications for Chronic Conditions as of July 1, 2025
Massachusetts law requires that health insurance carriers cover one identified generic drug and one identified brand-name drug to treat certain chronic disease. Review the chart found here for information regarding your health insurer’s identified drugs to treat certain chronic diseases.
PACT Act - Carrier List of Medications for Chronic Conditions as of July 1, 2025
Carriers’ Policies on Naloxone
2025 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.
Opioid Antagonist Carrier Facility Codes
Massachusetts law requires that health insurance carriers provide coverage and reimbursement for an opioid antagonist (Narcan) used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in which the opioid antagonist was prescribed or ordered. The attached list clarifies the codes that health care facilities should use when billing carriers for the opioid antagonist prescription.
Consumer Resources on Coverages
Below find various question and answer documents to help understand coverages.
Q&A Chapter 140 of the Acts of 2024 Fertility Preservation Benefits – Fertility Preservation Benefits
Q&A Chapter 285 of the Acts of 2024 Opioid Antagonists Frequently Asked Questions About Chapter 285 of the Acts of 2024 and Coverage for Pain Management
Q&A Chapter 342 of the Acts of 2024 Coverage for Certain Prescription Drugs to Treat Certain Chronic Conditions Frequently Asked Questions About Chapter 342 of the Acts of 2024 and Coverage for Certain Prescription Drugs to Treat Certain Chronic Conditions
Q&A Chapter 186 of the Acts of 2024 Maternal Health Law The Division of Insurance developed this document to explain insurance carriers’ obligations and consumer rights and protections under the new maternal health law.
Division of Insurance QA Abortion and Abortion-Related Service The Division of Insurance developed a Q&A to help explain Massachusetts laws regarding insurance coverage for abortion and abortion-related care.
Federal No Surprises Act Resources and Consumer Disclosures The Division of Insurance developed this document to explain insurance carriers’ obligations and consumer rights and protections under the new law.
Massachusetts ACCESS Law Common Questions and Answers (Q&A) 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.
Shop Smart to Avoid Health Insurance Scams Learn more about the benefits that health insurance plans in Massachusetts must cover:
Mandatory Benefits Guide 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.
Answers to Frequently Asked Questions about Summary of Payments Documents
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
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".