Which benefits are required under Massachusetts Minimum Creditable Coverage?
For most plans, the 2025 Minimum Creditable Coverage standards include:
- Coverage for a comprehensive set of services (e.g. doctor's visits, hospital admissions, day surgery, emergency services, mental health and substance abuse, and prescription drug coverage).
- Doctor visits for preventive care, without cost-sharing.
- A cap on annual deductibles of $2,950 for an individual and $5,900 for a family.
- For plans with up-front deductibles or co-insurance on core services, an annual maximum on out-of-pocket spending of no more than $9,200 for an individual and $18,400 for a family.
- No caps on total benefits for a particular illness or for a single year.
- No policy that covers only a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges.
- For policies that have a separate prescription drug deductible, it cannot exceed $360 for an individual or $720 for a family.
- All services must be provided to all of those covered (for example, a plan that covers dependents must extend maternity services to them).
- No cap on prescription drug benefits.
