Access to care and coverage
Mass General Brigham Health Plan is committed to ensuring timely access to critical health care services for COVID-19 that our members may need during this public health emergency.
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We have put in place coverage policies for COVID-19 vaccines, testing and treatment, based on public health recommendations and industry guidelines that are informed by the best data and medical evidence available.
To expedite access to critical health care services for COVID-19 in accordance with guidelines from state and federal agencies, our coverage criteria--which may be updated in response to an evolving situation--includes:
- Removing cost-sharing (copayments, deductibles, or coinsurance) for medically necessary outpatient and inpatient COVID-19 testing and treatment at in-network or out-of-network providers, urgent care centers, emergency departments, hospitals, and other facilities for the duration of the public health emergency.
Note: Employers that are self-insured may have different cost sharing for these services. Please visit the Mass General Brigham Health Plan Member portal or call the Customer Service number on the back of your member ID card if you have questions about your plan.
Mass General Brigham Health Plan will cover the administration of COVID-19 vaccines at no cost to our members. The COVID-19 vaccines that are being administered have received Emergency Use Authorization (EUA) or full approval from the Food and Drug Administration (FDA).
Learn about the safety and effectiveness of the vaccines, the truth behind several common vaccine myths, and where you can schedule a vaccine appointment in our guide to common COVID-19 vaccine questions.
Testing is an important way to prevent the spread of COVID-19. Mass General Brigham Health Plan has ensured timely access to critical health care services for our members throughout the pandemic and remains committed to providing a variety of options to make COVID-19 testing available. Visit our FAQs on testing to learn more about these options and our coverage policies.
Frequently asked questions
When can I get the COVID-19 vaccine?
People ages 6 months and older who live, work, or study in Massachusetts are eligible to receive a COVID-19 vaccine. People ages 6 months through 17 can receive the Pfizer or Moderna vaccine and people age 18 and older can receive any vaccine. You can find a vaccine location near you on Mass.gov/covid-19-vaccine.
The CDC also recommends a booster shot for individuals age 12 and older. Individuals who are 12-17 years old can get a Pfizer booster. Individuals 18 and older can get any booster. Additionally, individuals ages 50 or older can now get a second booster at least 4 months after their first booster. For the latest guidance on booster shots and eligibility, please visit Mass.gov.
Where can I receive my COVID-19 vaccine?
To see the latest COVID-19 vaccination sites and schedule an appointment please visit Vaxfinder.mass.gov. Walk-in or same-day appointments are also available at local pharmacies such as CVS, Walmart, and Walgreens.
For members who require in-home vaccinations because they are unable to leave their home to get to a vaccination site, please visit the state’s COVID-19 Homebound Vaccination Program page at Mass.gov/covidvaccine.
Before your appointment, find out the latest clinical guidelines and what to expect ahead of your vaccination at the CDC website.
Can children get the COVID-19 vaccine?
Yes, children 6 months and older who live or go to school in Massachusetts are now eligible to get the COVID-19 vaccine. Children ages 6 months to 17 can receive the Pfizer or Moderna vaccine. The latest information and guidance on COVID-19 vaccinations for children and youth can be found on the following Mass.gov pages:
Appointments for children at sites across the Commonwealth can be found on VaxFinder.mass.gov. Please note that some locations listed may only vaccinate certain ages so you should read the site details to learn more. For medical questions about vaccinating your child, we encourage you to contact your child’s health care provider. You can also learn more about the latest guidance on the COVID-19 vaccine for children and teens from the CDC.
Will I have to pay for the COVID-19 vaccine?
Mass General Brigham Health Plan will cover the administration of COVID-19 vaccines at no cost to our members.
The COVID-19 vaccines that are being administered have received Emergency Use Authorization (EUA) or full approval from the Food and Drug Administration (FDA). EUA is a designation issued by the FDA to facilitate the availability and use of medical actions, including vaccines, during public health emergencies.
Is the COVID-19 vaccine safe?
The COVID-19 vaccines that are being administered have proven to be extremely effective. Clinical trials were conducted to evaluate the safety of these vaccines, with thousands of participants across gender, age, race, and ethnicity. Visit the CDC to learn more about the safety and benefits of the COVID-19 vaccines.
Can we stop wearing masks and social distancing after getting vaccinated?
The CDC has shared guidance on how to protect yourself and others for people who are fully vaccinated.
When should I get a COVID-19 booster shot?
The CDC also recommends a booster shot for individuals ages 5 and older. Updated “bivalent” COVID-19 booster vaccines from Moderna and Pfizer are now available for individuals 12 and older. Bivalent vaccines protect against two different viruses, or two strains of the same virus, meaning they target the original COVID-19 strain and the newer omicron variant. You are eligible for this updated booster if you have completed a primary vaccination series with one of the COVID-19 vaccines and if at least 2 months have passed since the last dose of your primary vaccine series or any booster dose. Individuals who are 5-17 years old can continue to get the original Pfizer booster.
For the latest guidance on booster shots, eligibility, and vaccine locations, please visit Mass.gov.
Are COVID-19 tests covered by Mass General Brigham Health Plan?
Yes, Mass General Brigham Health Plan covers all medically necessary COVID-19 testing for the duration of the public health emergency.
We also offer access to at-home COVID-19 tests at no cost to members. More information is below.
How do I access at-home tests through Mass General Brigham Health Plan?
Beginning January 15, 2022, members of Mass General Brigham Health Plan have access to up to 8 FDA-approved at-home COVID-19 tests per member per month in accordance with federal guidance. This policy will remain in effect for the duration of the federal public health emergency.
- Commercial members* can obtain these tests at the pharmacy counter of all participating retail pharmacies at no cost at the time of purchase. We offer members thousands of participating pharmacies nationwide, including CVS Pharmacy®, independent pharmacies, and chains like Walgreens® and Rite Aid®. There are several online ordering options through CVS Pharmacy®. Many pharmacies also offer delivery or shipping direct to homes. Commercial members who pay out-of-pocket can also submit for reimbursement through Caremark.com. Please note that reimbursements will be up to $12 per individual test ($24 for box of 2 tests). Remember to save a copy of your receipt.
- My Care Family members can obtain these tests at all participating Massachusetts retail pharmacies at no cost at the time of purchase. My Care Family members should visit the pharmacy counter for more information on obtaining a MassHealth covered test at no cost.
*Employers whose pharmacy benefit is not covered through Mass General Brigham Health Plan may have different processes in place for their members. Please consult with your pharmacy benefits manager.
As a reminder, visit At-Home OTC COVID-19 Diagnostic Tests | FDA for the latest on at-home COVID-19 test expiration dates.
Where can I get a COVID-19 test?
COVID-19 testing sites are located across the state. These sites include rapid antigen tests and PCR tests. Visit Get Tested MA on Mass.gov for the latest guidance on COVID-19 testing and to find a testing location near you.
COVID-19 care and coverage
Who do I contact with questions about my COVID-19-related health care and coverage?
If you have questions about insurance coverage for COVID-19, please call the number on the back of your ID card for a prompt that will take you to a dedicated phone line. For medical questions about testing, treatment, or vaccines, we recommend that you contact your doctor or another health care professional.
My Care Family coverage policies are aligned with the most up-to-date guidelines from MassHealth. For more information on MassHealth, you can visit Mass.gov.
Do I have access to telemedicine services?
Mass General Brigham Health Plan commercial members have access to On Demand telemedicine services for virtual urgent care. If you are a Mass General Brigham Health Plan member, you can log in to the Member portal for instructions to get started.
For My Care Family members, telemedicine services are covered when medically necessary and clinically appropriate and to access out-of-network providers for the initial COVID-19 test or treatment when no in-network providers are available, in accordance with MassHealth guidance.
What are my options if I no longer have health insurance coverage through my employer?
The Massachusetts Health Connector offers coverage resources and support to uninsured residents. Learn more at MAhealthconnector.org
Please note that individuals are encouraged to update their income information through the Health Connector website to see if they’re eligible for MassHealth benefits or additional support.
Are there resources available to support my mental health and well-being during this time?
Mental health is a key part of our overall well-being—and Mass General Brigham Health Plan here to help. Visit our mental health resources page to find useful resources to help you get the support you need.
For more information
Visit our COVID-19 Resource Center to find resources for employers and our provider FAQ.
Where can I get updates on COVID-19?
The best source for credible news on COVID-19 is the CDC. You can check their website to find the latest updates and recommendations, including resources like:
- Frequently asked questions
- Information about the disease
- Guidance for businesses and employers
- Preventing COVID-19 spread in communities
The Massachusetts Department of Public Health is also a helpful resource for more of the latest updates.
Our Customer Service team is here to answer any of your questions Monday through Friday, 8:00 AM to 6:00 PM and Thursdays 8:00 AM to 8:00 PM.