HMO Blue New England $5,000 Deductible Plan Details for 2021- HealthPocket

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Zip Code	02128 (edit)
Applicant	6/28/1987 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	HMO Blue New England $5,000 Deductible
Plan ID	hhs-42690MA1290086
Plan Year	2021
Insurance Provider	Blue Cross Blue Shield of Massachusetts
Metal Level	Silver
Plan Type	HMO
Deductible	$5,000
Out-of-Pocket Maximum	$8,350
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$40 Copay
Specialist Visit	$65 Copay
Laboratory Outpatient and Professional Services	$60 Copay after deductible
X-rays and Diagnostic Imaging	$75 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	$500 Copay after deductible
Deductible - Family	$10000 per group
Out-of-Pocket Maximum - Family	$16700 per group

Prescription drug coverage
Generic Drugs	$45 Copay
Preferred Brand Drugs	$150 Copay
Non-Preferred Brand Drugs	$225 Copay
Specialty Drugs	50.00% Coinsurance

Access to doctors and hospitals
Provider directory URL	http://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)	$1000 Copay per Stay after deductible
Inpatient Physician and Surgical Services	Not Applicable
Emergency Transportation or Ambulance Service	Not Applicable

Maternity
Prenatal and Postnatal Care	Not Applicable
Delivery and all inpatient services for maternity care	$1000 Copay after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	$40 Copay
Mental/Behavioral Health Inpatient Services	$1000 Copay per Stay after deductible
Substance use disorder outpatient services	$40 Copay
Substance use disorder inpatient services	$1000 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 Children	Included
Eye Glasses for Children	Included
Routine Eye Exam for Adults	Included

Child Dental Coverage
Child Dental Coverage - Routine Dental Care	Not Covered
Child Dental Coverage - Basic Dental Care	Not Covered
Child Dental Coverage - Orthodontia	Not Covered
Child Dental Coverage - Major Dental Care	Not Covered

Adult Dental Coverage
Adult Dental Coverage - Routine Dental Care	Not Covered
Adult Dental Coverage - Basic Dental Care	Not Covered
Adult Dental Coverage - Orthodontia	Not Covered
Adult Dental Coverage - Major Dental Care	Not Covered

Exclusions and Limitations
More Included Benefits	Other 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 Benefits	Preventive 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 Benefits	[object Object]

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Premium	Plan Name	Deductible
from $1,138	HMO 5000 - Flex	$5,000.00	Select
from $372	Select Advantage HMO 5000	$5,000.00	Select
from $394	Complete HMO 5000 35/45 10% with Care Complement	$5,000.00	Select
from $408	Direct Care Bronze Deductible 5000 Low	$5,000.00	Select
from $413	PPO HSA 5000 - Flex	$5,000.00	Select

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Jackie Fantes, MD

Phone Number
(617) 569-5800
Office Locations
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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HMO Blue New England $5,000 Deductible

Apply For This Plan

Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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HMO Blue New England $5,000 Deductible

Apply For This Plan

Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

Similar Plans

Physician Finder

Related Articles

Related Searches

Silver plan frequently asked questions (FAQ)

What Is the Silver Plan?

How are Silver Plans different than other Obamacare health plans?

How much does a Silver Plan cost?

When Can I Enroll in a Silver Plan?

Apply For This Plan

Health Plans Found

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