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Updated on August 9, 2022

MassHealth Insurance For Addiction Treatment

What is Massachusetts Medicaid (MassHealth)?

MassHealth is the name of Massachusetts’s state Medicaid program. Both Medicaid in Massachusetts and the Children’s Health Insurance Program (CHIP) are a part of MassHealth.

Qualified participants can receive coverage for:

  • Prescriptions
  • Doctor visits
  • Hospital stays
  • Addiction treatment

The program includes an Accountable Care Organization (ACO). This network of doctors, hospitals, and healthcare providers accept MassHealth benefits. However, not all plans are ACO plans.

MassHealth offers 4 health plan choices:

  • Accountable Care Partnership Plan
  • Managed Care Organization (MCO)
  • Primary Care ACO
  • Primary Care Clinician (PCC) Plan

MassHealth is an affordable option for people who can’t purchase health insurance coverage from private providers. This type of insurance has many of the same benefits as private plans but at a more affordable price. 

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Does MassHealth Cover Rehab for Drugs and Alcohol?

Yes. In most cases, MassHealth covers drug and alcohol addiction treatment. Coverage includes a variety of care options for addiction, detox, and mental health. 

People with MassHealth coverage can get professional treatment advice from their medical provider regarding addiction recovery and relapse prevention.

They’re also eligible for mental health and substance abuse treatment services from qualified addiction practitioners.

MassHealth offers addiction treatment services similar to other medical insurance providers. Coverage cost and treatment services are usually far less under MassHealth insurance than with private health insurance. 

Types of Rehab Services MassHealth Covers

MassHealth’s behavioral health benefits include both addiction and mental health services, including:

  • Inpatient rehab
  • Residential rehab
  • Outpatient rehab
  • Prescription medication
  • Counseling

Specifically, these programs include:

  • 12-step programs
  • Cognitive behavioral therapy (CBT)
  • Family therapy and counseling
  • Individual and group therapy
  • Intensive outpatient programs (IOPs)
  • Medication-assisted treatment (MAT)       
  • Medically supervised detox programs

Provided services are comparable to the benefits people receive when using private insurance coverage. The primary difference is the cost of coverage. 

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Who Qualifies for MassHealth Coverage? 

Not everyone qualifies for MassHealth Coverage. To qualify, you must be any 1 or more of the following:

  • A parent with children under age 19
  • An adult caretaker relative with children under age 19
  • 19 years old or younger
  • An adult aged 21 to 64
  • Pregnant
  • Disabled
  • HIV-positive
  • A breast or cervical cancer patient

How to Apply

There are several ways to apply for MassHealth coverage, including:

How Much Does MassHealth Insurance Cost? 

Not all participants in the MassHealth program pay insurance premiums. However, some people with income limits above 100 percent of the federal poverty level pay a small monthly premium. This amount is determined by income and other financial factors, including personal assets and household size.

The state offers a premium assistance program. Many MassHealth members can apply to receive financial assistance to help pay their premiums.

Participants in the program occasionally have co-pays for medical services. These are rarely more than $10.

There are no co-pays for inpatient treatment for substance use disorder (SUD). There might not be co-payments for medication-assisted therapy (MAT), including treatment with Vivitrol and Suboxone.

Additionally, program participants under the age of 19 don’t have co-pays for any services. 

Coverage includes all or part of a participant’s health care expenses. 

Alternative Coverage Options

Some people pair MassHealth coverage with other health insurance plans. This can increase the number of covered services available and reduce the overall cost of medical care.

Keep in mind: you must have a Modified Adjusted Gross Income (MAGI) in the low to medium range to qualify for MassHealth. This applies whether or not MassHealth is your only insurance plan.

Call to find out how much your insurance will cover
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