What We Cover
We cover everything that MassHealth Standard and Medicare plans cover. And on top of that, you pay nothing for these covered services as long as you follow our rules for getting care.
Services you can get at no cost to you
- Doctor’s visits
- Prescription and over-the-counter drugs
- Mental health services
- Vision care
- Skilled nursing facilities
- Hearing services
- Home health care
- Inpatient hospital care
- Durable medical equipment such as wheelchairs, walkers, oxygen tanks
- Short-term respite care
Plus, get free member extras to give your health a boost.
- Healthy Rewards Card – Get $45 every three months to buy non-prescription drug store items.
- Enhanced Vision Benefit - Get $300 to use towards paying for better quality glasses or prescription sunglasses
- Acupuncture – Get up to $500 for services not related to pain or nausea
- Weight Watchers® – Get one 13-week membership per year (includes Online Plus and meetings
- Fitness Reimbursement – Up to $150 each year
A complete list of covered services is located in your Summary of Benefits.
Some Services Require Approval Before You Can Get Them
You may need approval before getting certain care - Some services such as procedures, medications, or visits to doctors outside our network require approval from us before you can get them. This is sometimes called “prior authorization”. Covered services that need advanced approval are marked in your Summary of Benefits document in bold.
Need a service that is not listed? You can request that we cover a benefit that we don't typically cover. Learn how to request services that are not covered
Limitations and restrictions may apply. Benefits, formulary, pharmacy network and provider network may change on January 1 of each year. You will receive notice when necessary. This information is not a complete description of benefits. For more information, contact the plan.
Last Updated 12/29/16