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Health Care Coverage Information

Information on Coverages and Benefits

Table of Contents

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.  

Carriers' Alternatives to Treat Pain

Lists of Available Coverages

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.

Dedicated Provider Network Telephone Numbers

Consumer Resources on Coverages

Consumer Alert:

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.

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