A new Massachusetts law expands mandatory prosthetic coverage in ways that will affect your group health insurance premiums and member benefits.
Most gym and fitness studio owners in Massachusetts don't realize that a provision buried in a bill about limb loss—H5626, filed July 30, 2026—will directly change what their group health insurance plans must cover and how much those plans will cost.
Here's what happened: Massachusetts lawmakers added a requirement to H5626 (titled "To improve outcomes for persons with limb loss and limb difference") that mandates every health insurer, HMO, medical service corporation, and Medicaid managed care plan operating in the state must now cover activity-specific prosthetic and orthotic devices. That means prosthetics designed for running, swimming, bathing, workplace tasks, and other specific activities—not just basic mobility devices.
The law goes further. Insurers must also cover repair and replacement of these devices, and they cannot impose separate financial requirements (like higher copays or deductibles for prosthetics) or lifetime-use limits. In plain terms: once a member needs an activity-specific prosthetic, the insurer cannot cap how many times it can be replaced or repaired over the member's lifetime.
If your gym or studio offers group health coverage to employees, your plan's costs will rise. Insurers will build the cost of this expanded benefit into their premiums. The provision applies across all insurer types—commercial plans, HMOs, medical service corporations, and Medicaid managed care—so there's no way to avoid it by switching carriers.
The scope is broad. "Activity-specific" devices include those for sports, recreation, and occupational use. For a fitness business, this is relevant: members and employees with limb loss or limb difference can now access prosthetics designed to support the activities your facility offers, and those devices are fully covered without caps.
The law is codified in Section 3 (new subsection g) of H5626, found on page 3, lines 33–39. The same requirement is mirrored in Sections 4, 7, 10, 13, and 16, which apply the rule to different types of insurers operating in Massachusetts.
H5626 was filed July 30, 2026. Massachusetts law typically makes bills effective 90 days after enactment, though the bill does not state an explicit effective date. You should expect this provision to take effect in the fall of 2026, though you may want to confirm the exact date with your insurance broker or the Massachusetts Division of Insurance as the enactment date approaches.
Start planning now. Review your current group health plan documents and speak with your broker about how this will affect your renewal rates and member communications. If you have employees with limb loss or limb difference, this change expands their coverage in meaningful ways—and your plan will bear part of that cost.
Source: H5626, "To improve outcomes for persons with limb loss and limb difference," filed July 30, 2026, Commonwealth of Massachusetts.