Network Health Together co-payments
Use this chart to find services and co-payments.gif "Click for Definition")
for Network Health Together®, our MassHealth plan:
Network Health Together
|
Service
|
Co-payment*
|
Outpatient Medical Care
|
Community health center visits
|
No co-payment
(PCP/specialty)
|
Office visits
|
No co-payment
(PCP/specialty)
|
Outpatient surgery
(hospital/ambulatory surgery centers)
|
No co-payment
|
X-rays/labs
|
No co-payment
|
Abortion services
|
No co-payment
|
Inpatient Medical Care
|
Room and board
(includes deliveries/surgery/X-rays/labs)
|
No co-payment
|
Prescription Drugs
|
Medication via pharmacy (1-month supply)
|
|
|
$0 for kids
$0 - $3.65 for ages 19+
|
|
|
$0 for kids
$0 - $3.65 for ages 19+
|
Emergency Care
|
Emergency care
|
No co-payment
|
Inpatient Mental Health and Substance Abuse
|
Inpatient mental health and substance abuse services
|
No co-payment
|
Outpatient Mental Health and Substance Abuse
|
Outpatient mental health and substance abuse services
|
No co-payment
|
Rehabilitation Services
|
Cardiac rehabilitation
|
No co-payment
|
Home health care
|
No co-payment
|
Extended inpatient care (100 total days per benefit year):
|
|
|
No co-payment
|
|
|
No co-payment
|
Short-term outpatient rehabilitation
(physical, occupational, and speech therapies)
|
No co-payment
|
Other Benefits
|
Ambulance
|
No co-payment
|
Dental
[preventive/radiography/diagnostic (exams and X-rays)/extractions/
emergency care/oral surgery]
|
No co-payment
|
DME/supplies/prosthetics/oxygen and respiratory therapy equipment
|
No co-payment
|
Hospice
|
No co-payment
|
Routine vision (exam and glasses every 24 months)
|
No co-payment
|
Wellness (family planning/nutrition)
|
No co-payment
|
Maximum Yearly Out-of-Pocket Expenses
|
Pharmacy
|
$200
|