Helping Tufts Health Together (MassHealth) Members During the Coronavirus (COVID-19) Outbreak

Until further notice:

• COVID-19 vaccines that the FDA has approved or authorized for emergency use are covered in full. There will be no cost to members. For more information, visit our COVID-19 Symptoms and Testing webpage.
• Tufts Health Together plan members are fully covered to receive medically necessary testing and in-person treatment for COVID-19 from any health care provider within our provider network and with out-of-network providers if a member has trouble accessing such services in-network.
  • If you have received a bill for a service that you believe was related to seeking care for COVID-19 but was considered not related to COVID-19, please contact us at 888-257-1985 (TTY: 711)
• Tufts Health Together members are fully covered to receive telehealth services from network providers. Telehealth is the term for checking in or receiving health care from a provider by phone or another technology virtually. Contact your provider to see if this option is available.

If you have questions about your coverage, call member services at 888-257-1985 (TTY: 711).

We cover in-person PCR (polymerase chain reaction), antigen and antibody laboratory testing consistent with federal and state guidance at no cost to our members. These tests must be medically necessary, as determined by a health care provider, in accordance with current CDC and state public health department guidelines.

COVID-19 PCR tests that are laboratory processed and either conducted in person or at home must be prescribed by a provider to be covered benefits. We will not cover or reimburse you for these tests when you order them yourself, including when you order using an online self-completed questionnaire. Testing is not covered solely for general workplace health and safety, public health surveillance or for other purposes not related to a member’s individual COVID-19 diagnosis or treatment. Diagnostic coronavirus testing required as a condition of travel inside or outside of the United States is not covered.

Diagnostic testing required by your provider for surgical or other medical procedures is medically necessary and covered, including if you are pregnant or an expectant parent and testing is required prior to admittance to a delivery facility.

Updates to our current COVID-19 testing policies will be published to this site as they become available.

The FDA has authorized the following two oral antiviral medications under emergency use authorization (EUA) for the treatment of certain cases of COVID-19. When prescribed and dispensed under the requirements of the EUA, one course of therapy at a time can be provided at no charge to the member. Prescriber and pharmacy access is currently extremely limited; speak to your health care provider if you test positive for COVID-19 and believe you qualify for treatment.

• Pfizer’s PAXLOVID™ (nirmatrelvir/ritonavir)
• Merck’s molnupiravi

• Members do not need a referral or prior authorization to get medically necessary testing or treatment related to COVID-19 in-network or out-of-network.
• Tufts Health Together members should continue to see providers in their network whenever possible. Members do not need a referral from their primary care provider to see in-network specialists.
• A referral or prior authorization is required for most out-of-network services that are not related to COVID-19. Members do not need a referral to see out-of-network providers for certain covered services, such as emergency and urgent care, outpatient behavioral health and primary care.

These changes apply to our managed care organization (MCO) and accountable care organization (ACO) MassHealth plans.

During the COVID-19 pandemic, it’s still important for children to get their immunizations. Make sure you protect your kids from preventable diseases. Measles, mumps and whooping cough are some of the illnesses we can prevent through vaccines. They are serious risks for young children even now. Providers’ offices are taking steps to see kids in a safe and controlled way when they need an in-office visit.

Call your child’s primary care provider. Make a plan to keep your child on schedule for his or her immunizations safely. Well visits and immunizations are covered at no cost to members. Members who get their immunizations by their second birthday may qualify for a $25 gift card reward!

Members can refill up to a 90-day supply (excluding controlled substances), if that supply is remaining on the prescription.

Please note: Most members ages 21 and older still have to pay a small copayment for covered prescription drugs.

Your provider may offer check-ins by phone or video chat. Contact your provider to see if this option is available. Virtual check-ins and telehealth enable members to make inquiries regarding symptoms or treatment for COVID-19 or other health issues without going to medical offices where the risk of coming in contact with COVID-19 may be higher. Virtual check-ins with network providers are covered in full.

If you don’t have reliable phone or internet service or you’re having trouble paying for the service you have, you may qualify for help through the federal Lifeline program. Learn more.

If you have questions about coronavirus or any health issue, call our free 24/7 NurseLine at 888-697-6546 to speak to a registered nurse.