It’s Time for Everyone to Feel Better.

• General Behavioral Health Coverage: For MassHealth members, there are no monthly bills or copayments for covered health services, and covered medications are free. A referral from a primary care provider (PCP) is generally not required for counseling services. Members also have access to a 24/7 NurseLine.  

• Coverage for Key Biotherapies: Spravato and TMS are typically covered for MassHealth ACO/MCO plans with prior authorization for TRD.  

• IV Ketamine Coverage: Generally not covered.  

Note: In-network providers are preferred for counseling services.

• General Behavioral Health Coverage: Behavioral health services for these plans are primarily covered through the Massachusetts Behavioral Health Partnership (MBHP) provider network. This includes a wide array of services such as outpatient and inpatient care, crisis intervention via Community Behavioral Health Centers (CBHCs) and Mobile Crisis Intervention (MCI), and various substance use disorder services. As of April 1, 2024, there are no copays for any MassHealth-covered service.  

• Coverage for Key Biotherapies: FDA-approved Spravato is covered for treatment-resistant depression (TRD) with prior authorization, documentation of failed antidepressants, and administration in a certified center. TMS is likely covered with prior authorization.  

• IV Ketamine Coverage: Generally not covered, as it is considered an off-label treatment.  

Note: MBHP serves as the central contact point for members to understand services and connect with support. MassHealth Fee-For-Service generally has a more limited network of behavioral health providers compared to Managed Care plans.

• General Behavioral Health Coverage: Health New England provides comprehensive behavioral health coverage for all members, including mental health, depression, and substance use disorder services. They offer specialized programs like Depression Case Management and access to virtual care through Teladoc. Some services may also be accessed through the Massachusetts Behavioral Health Partnership (MBHP).  

• Coverage for Key Biotherapies: Spravato and TMS are likely covered with prior authorization for a TRD diagnosis.  

• IV Ketamine Coverage: Generally not covered.

Note: Copayments for Teladoc services may vary by plan.

• General Behavioral Health Coverage: BMC HealthNet Plan offers extensive mental health resources and programs, including adult and pediatric outpatient psychiatry clinics. They explicitly mention a “Transcranial Magnetic Stimulation Clinic” for major depressive disorder. The plan adheres to the Massachusetts Mental Health Parity Law, ensuring equal coverage for mental and physical conditions.  

• Coverage for Key Biotherapies: Spravato is likely covered with prior authorization for TRD or acute suicidal ideation. TMS is explicitly mentioned and likely covered.  

• IV Ketamine Coverage: May offer partial coverage for “parts of treatment sessions,” but typically involves higher out-of-pocket costs.  

Note: Adheres to the Mental Health Parity Law.

• General Behavioral Health Coverage: Benefits include comprehensive counseling and treatment for various mental health issues such as substance use disorders, depression, eating disorders, suicidal thoughts, and ADHD. No referral from a PCP is required for outpatient services. The plan partners with Optum for behavioral health services, offering extensive online resources and virtual care options through Lyra. An annual mental health wellness exam is covered as preventive care.  

• Coverage for Key Biotherapies: Spravato is covered for TRD or MDD with suicidal ideation, subject to prior authorization, specific criteria, and the REMS program. TMS is generally covered.  

• IV Ketamine Coverage: Coverage varies and is generally not fully covered.  

Note: Behavioral health services are covered by Optum Behavioral. Prior authorization may be required, and Mass General Brigham Health Plan assists in coordinating these services. As of April 1, 2024, there are no copays for any MassHealth-covered service.

• General Behavioral Health Coverage: Point32Health reimburses contracted licensed behavioral health (BH) and substance use disorder (SUD) providers for medically necessary services across various settings. They emphasize the crucial connection between behavioral and physical health.  

• Coverage for Key Biotherapies: Spravato and TMS are likely covered with prior authorization for a TRD diagnosis.  

• IV Ketamine Coverage: Coverage is variable, often resulting in high out-of-pocket costs.  

Note: Prior authorization may be required for certain behavioral health and/or substance use disorder services. They provide a dedicated Behavioral Health Access Center for inquiries.

• General Behavioral Health Coverage: BCBS MA offers coverage for therapy services under both its PPO and HMO plans, including treatment for depression, anxiety, and substance use disorders. PPO plans offer greater flexibility with both in-network and out-of-network benefits and no PCP referral. HMO plans typically require in-network providers and a PCP referral. Both plans cover online therapy at the same rate as in-person visits.  

• Coverage for Key Biotherapies: FDA-approved Spravato is covered for treatment-resistant depression (TRD) or major depressive disorder (MDD) with acute suicidal ideation, subject to prior authorization and the REMS program. TMS is generally covered for MDD and OCD.  

• IV Ketamine Coverage: Generally not covered for psychiatric use and often results in high out-of-pocket costs. BCBS MA HMO explicitly states it does not cover ketamine and psychedelic treatments.  

Note: Coverage generally requires diagnosis-based therapy. HMO plans require a PCP referral before starting therapy.

• General Behavioral Health Coverage: Fallon Health provides coverage for behavioral health and substance use disorder services. They partner with Carelon Behavioral Health for the administration of behavioral health services and provider networks. The plan also offers Teladoc for virtual consultations. Fallon 365 Care operates as a MassHealth ACO Partnership Plan.  

• Coverage for Key Biotherapies: Spravato and TMS are likely covered with prior authorization for a TRD diagnosis.  

• IV Ketamine Coverage: May offer partial coverage, but typically involves high out-of-pocket costs.  

Note: Partners with Carelon Behavioral Health for behavioral health administration.

• General Behavioral Health Coverage: WellSense Essential & BILH ACO offers all standard MassHealth benefits, including comprehensive behavioral health services and no-cost annual screenings. They provide a large provider network with telehealth options.  

• Coverage for Key Biotherapies: Spravato and TMS are likely covered with prior authorization for a TRD diagnosis.  

• IV Ketamine Coverage: Generally not covered.  

Note: Members have access to primary care providers within the network.