2019 Standard High Gold: Tufts Health Direct Gold 1000 Plan Details - HealthPocket

Standard High Gold: Tufts Health Direct Gold 1000

$387.98/mo

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Zip Code02128
Applicant5/25/1984 Male
Coverage Start5/26/2019
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameStandard High Gold: Tufts Health Direct Gold 1000
Plan IDhhs-59763MA0040011
Plan Year2019
Insurance ProviderTufts Health Plan
Metal LevelGold
Plan TypeHMO
Deductible$1,000
Out-of-Pocket Maximum$5,000
Personal Score

Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$25 Copay
Specialist Visit$45 Copay
Laboratory Outpatient and Professional Services$25 Copay after deductible
X-rays and Diagnostic Imaging$25 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$200 Copay after deductible
Deductible - Family$2000 per group
Out-of-Pocket Maximum - Family$10000 per group

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs$40 Copay
Non-Preferred Brand Drugs$60 Copay
Specialty Drugs$60 Copay

Access to doctors and hospitals

Provider directory URLhttp://www.tuftshealthplan.com
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - Emergency care only
Does this plan cover services outside the country?Yes - Emergency care only

Hospital services

Emergency Room Services$150 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$500 Copay per Stay after deductible
Inpatient Physician and Surgical ServicesNot Applicable
Emergency Transportation or Ambulance ServiceNot Applicable

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care$500 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$25 Copay
Mental/Behavioral Health Inpatient Services$500 Copay per Stay after deductible
Substance use disorder outpatient services$25 Copay
Substance use disorder inpatient services$500 Copay per Stay after deductible

Medical Management Programs

Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Acupuncture
Bariatric Surgery
Infertility Treatment
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
More Limited BenefitsPreventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Weight Loss Programs
Outpatient Rehabilitation Services
Dental Check-Up for Children
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded BenefitsCosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
PremiumPlan NameDeductible
from $541
HMO Blue Select $1,000 Deductible with Copayment
$1,000.00Select
from $568
HMO 1000 with Coinsurance - Flex
$1,000.00Select
from $585
HMO Blue New England $1,000 Deductible with Copayment
$1,000.00Select
from $605
HMO Blue Select $1,000 Deductible
$1,000.00Select
from $616
HMO 1000 - Flex
$1,000.00Select
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Charles, Williams
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Mirjana, Kostich
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Heba, Haddad
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Kelly, Trussell
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Adrianna, D'aurora
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East Boston Physical Therapy Center, Inc.
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Marissa, Gonzalez
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Maureen, Young
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Caroline, Del Rey
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Aliza, Llovet
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Erin, Slowe
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Gustavo, Borda Sanchez
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Jackie Fantes, MD
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  • Phone Number
    (617) 569-5800
  • Office Locations
    10 Gove St
    East Boston, MA 02128
10 Gove St East Boston MA, 02128
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)