Focus HMO 1500 Plan Details for 2021- HealthPocket

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Zip Code02128
Applicant5/28/1987 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameFocus HMO 1500
Plan IDhhs-36046MA0760070
Plan Year2021
Insurance ProviderHarvard Pilgrim
Metal LevelGold
Plan TypeHMO
Deductible$1,500
Out-of-Pocket Maximum$7,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$25 Copay
Specialist Visit$50 Copay
Laboratory Outpatient and Professional Services$45 Copay after deductible
X-rays and Diagnostic Imaging$45 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$300 Copay after deductible
Deductible - Family$3000 per group
Out-of-Pocket Maximum - Family$14000 per group

Prescription drug coverage

Generic Drugs$5 Copay
Preferred Brand Drugs$60 Copay
Non-Preferred Brand Drugs$100 Copay
Specialty Drugs20.00% Coinsurance

Access to doctors and hospitals

Provider directory URLhttp://www.providerlookuponline.com/Harvardpilgrim/po7/Search.aspx
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - A Referral is Needed for all Specialist except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.
Does this plan cover services outside plan service area?Not Covered
Does this plan cover services outside the country?Not Covered

Hospital services

Emergency Room Services$300 Copay
Inpatient Hospital Services (e.g., Hospital Stay)$250 Copay per Stay after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Emergency Transportation or Ambulance ServiceNo Charge after deductible

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity care$250 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$25 Copay
Mental/Behavioral Health Inpatient Services$250 Copay per Stay after deductible
Substance use disorder outpatient services$25 Copay
Substance use disorder inpatient services$250 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, Low Back Pain, 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 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)
Preventive Care/Screening/Immunization
Acupuncture
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
Diabetes Care Management
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
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
Childbirth Classes
Fitness Club Reimbursement
Low Protein Foods
Retail Health Clinics
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Inherited Metabolic Disorders - PKU
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Weight Loss Programs
Outpatient Rehabilitation Services
Habilitation Services
Inpatient Rehabilitation Services
Rehabilitative Occupational and Rehabilitative Physical Therapy
Treatment for Temporomandibular Joint Disorders
Wigs
More Excluded BenefitsCosmetic Surgery
Private-Duty Nursing
Dental Check-Up for Children
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $1,518Preferred Blue PPO $1,500 Deductible$1,500.00Select
from $470Select Advantage HMO 1500$1,500.00Select
from $503Your Choice HMO 1500$1,500.00Select
from $527Focus HMO 1500$1,500.00Select
from $557Advantage HMO 1500 (90%)$1,500.00Select
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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.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.