Choice Easy Tier HMO 2500 Plan Details for 2021- HealthPocket

Choice Easy Tier HMO 2500

$398.02/mo

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Zip Code02128
Applicant9/22/1986 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameChoice Easy Tier HMO 2500
Plan IDhhs-41304MA0081667
Plan Year2021
Insurance ProviderAllWays Health Partners
Metal LevelSilver
Plan TypeHMO
Deductible$0
Out-of-Pocket Maximum$0
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay after deductible
Specialist Visit$50 Copay after deductible
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$250 Copay after deductible

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs$60 Copay after deductible
Non-Preferred Brand Drugs$90 Copay after deductible
Specialty Drugs$225 Copay after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.allwayshealth.org
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.
Does this plan cover services outside plan service area?Yes - Urgent and Emergency only
Does this plan cover services outside the country?Yes - Urgent and Emergency only

Hospital services

Emergency Room Services$700 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$30 Copay after deductible
Mental/Behavioral Health Inpatient Services$500 Copay per Stay after deductible
Substance use disorder outpatient services$30 Copay after deductible
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, Pain Management, Pregnancy, Weight Loss Programs
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 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)
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
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
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsPreventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Weight Loss Programs
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Private-Duty Nursing
Long-Term/Custodial Nursing Home Care
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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.

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    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.com is a free information source. 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. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.