COVID-19 Coverage in Massachusetts
Last updated July 16, 2021
Tufts Health Plan continues to evaluate COVID-19 policies with the state emergency and other regulations in mind. For our Massachusetts members, some policy changes will be reinstated, effective August 7, 2021, unless otherwise extended by state orders.
Unless otherwise noted, all policies are effective beginning with dates of service on or after March 6, 2020. These policies have been put in place in connection with the COVID-19 pandemic and are not intended to be permanent changes. For any policy without an end date listed or for which it states "until further notice," we will aim to provide at least four week notice in advance of any termination of the policy. We encourage our members to call the number on their ID cards with any questions related to their health benefits.
Coverage and cost
There are no out-of-pocket costs for medically necessary COVID-19 testing and vaccinations until further notice.
- If you are pregnant, testing is also covered at no cost for expectant parents if it is required prior to admittance to a delivery facility. Each parent must be a Tufts Health Plan member to be covered.
- Consistent with Federal and State guidance COVID-19 tests will only be covered or reimbursed if they are medically necessary, as determined by a health care provider, in accordance with current CDC and state public health department guidelines. COVID-19 tests that are not ordered or referred by a provider are not covered benefits. Testing will not be covered solely for general workplace health and safety, public health surveillance or for other purposes not primarily intended for a member’s individual COVID-19 diagnosis or treatment.
- Members are covered for urgent and/or emergency services only when traveling outside of the 50 United States. Coronavirus tests are only covered or reimbursed if they are medically necessary. Diagnostic coronavirus testing required as a condition of travel inside or outside of the United States is not covered.
- Members are covered without cost share for COVID-19 antibody testing when testing is determined by a primary care physician (PCP) or other treating provider to be medically necessary in accordance with current CDC and state public health department guidelines, which are being continuously updated.
- At-home COVID-19 PCR (polymerase chain reaction) tests are covered when your physician or attending provider orders them or gives you a referral. Tufts Health Plan will not cover or reimburse you for these tests when you order them yourself, including when you order using an online self-completed questionnaire.
- We are waiving member cost shares - including copayments, coinsurance, and deductibles for medically necessary coronavirus in-person treatment. This coverage applies at in-network providers, urgent care center, emergency rooms and other facilities, and at out-of-network providers in the event a member cannot easily find an in-network provider to provide timely services.
- These cost-sharing changes will also apply to members of our self-funded groups that have not opted-out.
- If you receive non-COVID related treatment or services from a provider or facility, you may need to pay cost sharing, depending on your plan type.
Prescription drug coverage
The following pharmacy policies are in effect until August 7, 2021:
- Early refill of prescription medication without waiting to finish 80% of the day supply from your last dispensed prescription.
- Refill for up to a 90-day supply to the extent consistent with clinical guidelines, except for controlled substances (subject to CMS rules).
- 90-day supply of maintenance medicines (excluding controlled substances), you can ask your pharmacist to dispense a 90-day supply, if you have that supply remaining on your prescription. You will need to contact your prescriber for a new prescription if you do not have a 90-day supply remaining, or if you would like to have a 90-day supply delivered by mail order.