HMO Blue New England $4,500 Deductible Plan Details for 2021- HealthPocket

HMO Blue New England $4,500 Deductible

$414.20/mo

Apply For This Plan

Zip Code02128
Applicant11/24/1985 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameHMO Blue New England $4,500 Deductible
Plan IDhhs-42690MA1290081
Plan Year2020
Insurance ProviderBlue Cross Blue Shield of Massachusetts
Metal LevelSilver
Plan TypeHMO
Deductible$4,500
Out-of-Pocket Maximum$8,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$40 Copay
Specialist Visit$55 Copay
Laboratory Outpatient and Professional Services$60 Copay after deductible
X-rays and Diagnostic Imaging$100 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$300 Copay after deductible
Deductible - Family$9000 per group
Out-of-Pocket Maximum - Family$16000 per group

Prescription drug coverage

Generic Drugs$45 Copay
Preferred Brand Drugs$150 Copay
Non-Preferred Brand Drugs$225 Copay
Specialty Drugs$150 Copay

Access to doctors and hospitals

Provider directory URLhttp://www.bluecrossma.com/wps/portal/members/using-my-plan/doctors-hospitals/findadoctor/
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All specialists except OB/GYN providers
Does this plan cover services outside plan service area?Yes - Emergency and Urgent Care Services only
Does this plan cover services outside the country?Yes - Emergency and Urgent Care Services only

Hospital services

Emergency Room Services$500 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$40 Copay
Mental/Behavioral Health Inpatient Services$500 Copay per Stay after deductible
Substance use disorder outpatient services$40 Copay
Substance use disorder inpatient services$500 Copay per Stay after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy
Does this plan offer a wellness program?Included

Vision Coverage

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

Child Dental Coverage

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

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)
Bariatric Surgery
Infertility Treatment
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Diabetes Care Management
Abortion for Which Public Funding is Prohibited
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
Bone Marrow Transplants for Treatment of Breast Cancer
Cardiac Rehabilitation
Clinical Trials
Congenital Anomaly, including Cleft Lip/Palate
Contraceptive Services
Early Intervention Services
Hormone Replacement Therapy (HRT)
Human Leukocyte Antigen Testing
Hypodermic Syringes or Needles
Nutrition/Formulas
Off Label Prescription Drugs
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsPreventive Care/Screening/Immunization
Skilled Nursing Facility
Acupuncture
Hearing Aids
Weight Loss Programs
Outpatient Rehabilitation Services
Habilitation Services
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded BenefitsCosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Dental Check-Up for Children
Routine Foot Care
Accidental Dental
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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 Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver 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 Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver 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 the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.

  • When Can I Enroll in a Silver 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, or an individual and family 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 part of the Benefytt Technologies, Inc. family of companies.