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 $80 every three months to buy non-prescription drug store items.
  • Enhanced Vision Benefit - Get $200 to use towards paying for prescription glasses or prescription sunglasses
  • Acupuncture – Get up to $500 for services not related to pain or nausea
  • Weight Watchers® – Get up to $150 reimbursement per year towards a Weight Watchers program (includes Online Plus and meetings)
  • Fitness Reimbursement – 25% off health club memberships or fitness classes 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 12/31/17