As you navigate treatment and recovery, you have rights and protections with your health care and health insurance. Health insurance can be hard to navigate, but state and private health insurance policies cover a variety of services for people with opioid use disorder (OUD). The Mental Health Parity and Addiction Equity Act, for example, requires health insurers provide the same level of benefits for OUD treatment and services than they do for physical health care. And for those without health insurance, Overdose Education and Naloxone Distribution (OEND) sites offer many clinical services for people in recovery for free, and they won’t take any insurance information.
- If you are working, you may be offered health insurance as a benefit through your employer. If your employer doesn’t offer a health insurance benefit, you can find a health insurance plan through the Massachusetts Health Connector. The plans offered through the Health Connector by different carriers meet state and national coverage standards, and you can compare plans and see costs to find the plan that will work best for you.
- Types of plans: The most common types of health insurance plans in Massachusetts are Health Maintenance Organization plans (HMOs), Preferred Provider Plans (PPPs), and Indemnity Plans.
- HMOs cover hospital, medical, and preventive care within a network of providers. Care that you get from a provider outside of the provider network is not covered. You usually pay a portion of the cost of each service (called a co-pay) and the HMO pays the rest of the cost.
- Like HMOs, PPPs usually cover hospital, medical, and preventive care within a network of providers. In a PPP, you can also get care from providers outside of the network and the PPP will still pay a portion of the cost, but it may be a smaller amount.
- Indemnity Plans cover hospital and medical expenses for an accident or illness. Some also cover preventive care. These plans will pay a part of the cost and you are responsible for the rest.
- MassHealth: If you meet certain income requirements, you may be eligible for MassHealth. MassHealth is a Medicaid program paid for by state and federal taxes. There are different types of coverage available through MassHealth based on your age, living and family situation, disability status, and certain health information.
- Copays: There is no copay for substance use disorder (SUD) treatment covered by MassHealth
- Medicare: Medicare is the federal health insurance plan for people age 65 or older and people with certain disabilities or health conditions. Both original Medicare and Medicare Advantage provide coverage for SUD, ranging from screening to inpatient and outpatient treatment by a Medicare-approved provider. However, a person who receives treatment must still pay deductibles, copayments, and coinsurance.
- Other subsidized plans (ConnectorCare): You may be able to get a ConnectorCare plan if you: have a household income at 300% of the Federal Poverty Level or lower; you don’t qualify for MassHealth, Medicare, or other public health insurance programs; and you meet other eligibility requirements. ConnectorCare plans offer comprehensive coverage and have low monthly premiums, low out-of-pocket costs, and no deductibles.
- No insurance: If you do not have health insurance, you can still receive treatment in Massachusetts. There are some programs funded by the state that offer free treatment to people without insurance. You can learn more about state-funded services and how to find them by calling the Helpline at 800-327-5050 or on the Helpline website. When you search for services on the Helpline website, you can choose “Only show BSAS-funded programs” to see free treatment options.
Rights, Protections, and Tips for Advocacy
- The Massachusetts Mental Health Parity Law makes it illegal for insurers to put smaller annual or lifetime limits on coverage of care for mental health and substance use disorders than on physical disorders.
- Under this act, patients are allowed 14 days of inpatient care and $500 worth of outpatient benefits. When a person gets treatment for mental health and substance use disorders, the patient has the right to more coverage.
- Your right to fill your prescription for medication for opioid use disorder (MOUD) at a pharmacy is protected, but people may still experience discrimination in pharmacy settings. A pharmacist can refuse to fill your prescription because it is against their religion or the pharmacist believes the prescription is not appropriate. If that happens, you have a right to ask for a pharmacist who will fill your subscription. You cannot be denied your medication if the pharmacist serving you will not fill it.
- Know what else to look for when it comes to discrimination in pharmacy settings. Here are some examples:
- A pharmacy worker refusing to fill your prescription and refusing to refer you to someone who will. A pharmacist may have the right to refuse to fill your prescription if it is against their religion, or they believe the prescription is not appropriate, but they must find another pharmacist or technician who will fill your prescription.
- Pharmacists asking you who the medication is for or asking why you were prescribed MOUD. The pharmacist may ask if you have any questions about your prescription, but not any personal probing questions.
- Receiving a lower dose or fewer pills than what your doctor prescribed. If you believe the pharmacist gave you less than you were prescribed, you can ask to see what your doctor prescribed you.
- Saying anything negative about the medication you are prescribed and telling you a different form of MOUD is better. You know what treatment works best for you.
- If you are a loved one picking up a prescription for someone on MOUD, and the pharmacist refuses to give it to you. The pharmacist does not need written or oral notice by the patient before picking up and does not need any additional documentation or identification.
- You have a right to health care and certain protections even if you are undocumented.
- You have the right to health care regardless of your immigration or health insurance status. Healthcare providers, including emergency rooms, can give you care without asking for your immigration, citizenship, or insurance status.
- Applying for government subsidized health insurance will not affect your immigration status. But you will be asked to disclose your immigration status to apply for health insurance.
- Immigration and Customs Enforcement (ICE) usually cannot detain (take) you at hospitals or at other places that provide care, and your health information is protected information no matter what your immigration status is.
Resources for Health Care
- Learn more about how to get treatment without health insurance on the Helpline website.
- Find health insurance on the MA Health Connector website.
- Find out if you are eligible for MassHealth.