- Division of Insurance
All fully insured health plans offered in Massachusetts cover mental health and substance use disorder benefits in addition to physical/medical health benefits. However, for some people, understanding their benefits, limitations and costs can be confusing, and this challenge can be even more difficult if they or a loved one is experiencing a mental health crisis.
This Mental Health Awareness Month, the Division of Insurance is reminding residents about their mental health and substance use disorder benefits and how to access care:
- Carriers are required to cover, with no cost sharing, an annual behavioral health wellness examination (like your annual physical). Additional information about the content of a wellness examination can be found in Division Bulletin 2024-02.
- Carriers must follow Mental Health Parity rules including that copayments and cost-sharing for behavioral health care are no more than for medical care. This means that the insurance company cannot charge you a higher co-payment just because you or a covered family member have a mental health visit or place limits on your visits that don’t exist for physical health benefits.
- If you need a mental health provider and cannot find one in your health plan’s provider directory, the insurance company is required to assist you in finding a mental health provider. Carriers are also in the process of updating provider directories before 2026 so that they are accurate and up-to-date.
- Massachusetts law also requires that health insurance carriers cover opioid alternatives for pain management, including non-medication treatment modalities such as acupuncture or occupational therapy.
The Division of Insurance licenses insurance carriers approved to sell insured health plans to Massachusetts-residing individuals. Consumers can purchase comprehensive health plans by contacting a licensed insurance carrier, through a licensed broker, or by going through the Health Connector, the Commonwealth’s official health insurance exchange or “marketplace” at www.MAhealthconnector.org. Plan members should review their Summary of Benefits and Coverage and Certificate of Coverage documents or call the number on the back of their health insurance card if they have questions about their coverage and cost sharing.
If you or someone you care about is struggling with mental health or substance use, the Behavioral Health Help Line is a service of the Commonwealth of Massachusetts, operated by the Massachusetts Behavioral Health Partnership (MBHP). For 24/7 Supports, please call or text 833-773-2445. You can also visit https://www.masshelpline.com/ to live chat. This line is for crisis supports as well as resource and mental health service inquiries.
