HMO Blue $1,000 Deductible

Individual Health Insurance (Obamacare)

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HMO Blue $1,000 Deductible

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Monthly Cost

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Benefits & Coverage

Plan Name
HMO Blue $1,000 Deductible
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Metal Level
Gold
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$30 Copay
Specialist Visit
$45 Copay
Laboratory Outpatient and Professional Services
$20 Copay after deductible
X-rays and Diagnostic Imaging
$20 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
$9300 per group

Prescription drug coverage

Generic Drugs
$20 Copay
Preferred Brand Drugs
$30 Copay
Non-Preferred Brand Drugs
$50 Copay
Specialty Drugs
$30 Copay

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 professional provider specialists except for OB/GYN and Chiropractor
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
$150 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
$500 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
$500 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$30 Copay
Mental/Behavioral Health Inpatient Services
$500 Copay per Stay after deductible
Substance use disorder outpatient services
$30 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 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 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
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
More Limited Benefits
Preventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Weight Loss Programs
Outpatient Rehabilitation Services
Habilitation Services
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded Benefits
Acupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Dental Check-Up for Children
Routine Foot Care
Accidental Dental

What To Know

  • This is an ACA (Obamacare) compliant health plan.

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Gold plan frequently asked questions (FAQ)

  • 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.

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