MA H4333

Requires health insurers to count third-party payments (such as manufacturer copay assistance or charitable assistance) toward an enrollee's deductible, copayment, coinsurance, and out-of-pocket maximum

Mandates that all cost sharing reductions made on behalf of an enrollee be applied in full at the time of service toward the enrollee's cost sharing obligations

Requires insurers to count expenditures for all covered essential health benefits toward the annual out-of-pocket maximum under federal law

Includes special provisions for HSA-qualified high-deductible health plans to maintain federal tax compliance, applying requirements only after the minimum IRS deductible is met (except for preventive care)

Applies to health plans entered into, amended, extended, or renewed on or after January 1, 2026