Health Care Coverage Information

Information on Coverages and Benefits

Table of Contents

PACT Act - Carrier List of Medications for Chronic Conditions as of July 1, 2025

PACT Act - Carrier List of Medications for Chronic Conditions as of July 1, 2025

Q&A Chapter 342 of the Acts of 2024 Coverage for Certain Prescription Drugs to Treat Certain Chronic Conditions

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.

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.  

Carriers' Alternatives to Treat Pain

Opioid Antagonist Carrier Facility Codes

Opioid Antagonist Carrier Facility Codes

Q&A Chapter 285 of the Acts of 2024 Opioid Antagonists

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.

Lists of Available Coverages

Find information on available plan options and purchasing insurance as an individual or for/part of a group.

Health Products and Plans

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:

Frequently Asked Questions About Chapter 285 of the Acts of 2024 and Coverage for Pain Management

Frequently Asked Questions About Chapter 342 of the Acts of 2024 and Coverage for Certain Prescription Drugs to Treat Certain Chronic Conditions

The Division of Insurance developed the following to explain insurance carriers’ obligations and consumer rights and protections under the new maternal health law.

The Division of Insurance developed a Q&A to help explain Massachusetts laws regarding insurance coverage for abortion and abortion-related care. 

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

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