GET AFFORDABLE COVERAGE THAT MEETS YOUR NEEDS
To help make sure you get the coverage you need, we offer several plans through the Massachusetts Health Connector. There you’ll find the Summary of Benefits and Coverage (SBC) plus the coverage policy for each of these plans, which are available for both groups and individuals unless specified otherwise.
You can also use the Medication Lookup tool and Find a Doctor & Estimate Costs tool to see which prescriptions and providers are covered by each plan.
Platinum Plan
This plan has the highest monthly premiums but the lowest out-of-pocket costs for medical expenses.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| Standard Platinum: HMO Blue Premium | HMO Blue Premium SBC [PDF] | HMO Blue Premium Coverage Policy Document [PDF] |
Gold Plans
Gold plans generally have higher monthly premiums than Silver plans. These plans offer a good balance between lower out-of-pocket costs and a higher monthly premium.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| Standard High Gold: HMO Blue Value Deductible | HMO Blue Value Deductible SBC [PDF] | HMO Blue Value Deductible Coverage Policy Document [PDF] |
| Non-Standard Low Gold: HMO Blue Deductible with Copayment | HMO Blue Deductible with Copayment SBC [PDF] | HMO Blue Deductible with Copayment Coverage Policy Document [PDF] |
Silver Plans
These plans generally have higher monthly premiums than Bronze plans. You'll have moderate out-of-pocket costs when you receive medical care.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| Standard High Silver: HMO Blue Basic II | HMO Blue Basic II SBC [PDF] | HMO Blue Basic II Coverage Policy Document [PDF] |
| Standard High Silver: HMO Blue Basic* | HMO Blue Basic SBC [PDF] | HMO Blue Basic Coverage Policy Document [PDF] |
| Standard Low Silver: HMO Blue Saver* | HMO Blue Saver SBC [PDF] | HMO Blue Saver Coverage Policy Document [PDF] |
| Non-Standard Silver: Preferred Blue® PPO Saver with Copayment* | Preferred Blue PPO Saver with Copayment SBC [PDF] | Preferred Blue PPO Saver with Copayment Coverage Policy Document [PDF] |
* available for small groups only
Bronze Plan
This plan offers the lowest monthly premium. However, you pay higher out-of-pocket costs when you receive medical care.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| Standard High Bronze: HMO Blue Basic Deductible | HMO Blue Basic Deductible SBC [PDF] | HMO Blue Basic Deductible Coverage Policy Document [PDF] |
Catastrophic Plan
This plan is for individuals under 30. You're covered for medical care at a low monthly premium.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| HMO Blue Essential | HMO Blue Essential SBC [PDF] | HMO Blue Essential Coverage Policy Document [PDF] |
More Financial Help than Ever
Massachusetts expanded eligibility for the state-subsidized coverage program known as ConnectorCare, offering financial help to more people than ever before. Individuals with incomes of up to 500% of the Federal Poverty Level may now qualify for health coverage at a reduced cost. As a ConnectorCare carrier, we offer plan options for individuals seeking this coverage. See below for plan options:
Open enrollment at the Health Connector runs from November 1, 2024 to January 23, 2025. However, if you want coverage by January 1, 2025, you must apply, pick a plan, and make your first payment by December 23, 2024.
ConnectorCare plans also offer financial relief for prescription coverage. Learn more about medications that are covered at no cost to ConnectorCare members.
Use the Health Connector’s Get an Estimate calculator to see if you qualify for financial help, then apply at MAhealthconnector.org.
Prescription Coverage
Our list of covered medications is based on a tiered cost structure. When you fill a prescription, the amount you pay the pharmacy is determined by your medication's tier and your benefits. The amount you pay may also include your copayment, co-insurance, and deductibles. The pharmacist will tell you how much you owe at checkout. For more information about how our plans will cover your prescriptions, look them up using our Medication Lookup tool.
With the Medication Lookup tool, you can:
- Look up any medication to see if it's covered by a plan
- Find safe and effective covered alternatives for medications not covered by a plan
- Search for low-cost generic alternatives, specialty medications, and medications that have $0 copays
Learn about your pharmacy program
Medications covered at no cost for ConnectorCare plans
Pediatric Dental Benefits
All the health plans above include dental coverage for members up to the end of the month in which they turn 19. Learn more:
Find a Doctor & Estimate Costs
Pick the provider who's right for you, using our Find a Doctor & Estimate Costs tool. In minutes, you can:
- Find doctors, dentists, hospitals, and other health care providers
- Get cost estimates for about 1,600 common medical procedures
- Read and write reviews about doctors
Visit Find a Doctor & Estimate Costs
Did You Know?
90% of your premium dollars goes toward medical care. To learn more, see the
Platinum Plan
This plan has the highest monthly premiums but the lowest out-of-pocket costs for medical expenses.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| Standard Platinum: HMO Blue Premium | HMO Blue Premium SBC [PDF] | HMO Blue Premium Coverage Policy Document [PDF] |
Gold Plans
Gold plans generally have higher monthly premiums than Silver plans. These plans offer a good balance between lower out-of-pocket costs and a higher monthly premium.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| Standard High Gold: HMO Blue Copayment | HMO Blue Copayment SBC [PDF] | HMO Blue Copayment Coverage Policy Document [PDF] |
| Non-Standard Low Gold: HMO Blue Deductible with Copayment | HMO Blue Deductible with Copayment SBC [PDF] | HMO Blue Deductible with Copayment Coverage Policy Document [PDF] |
Silver Plans
These plans generally have higher monthly premiums than Bronze plans. You'll have moderate out-of-pocket costs when you receive medical care.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| Standard High Silver: HMO Blue Basic II | HMO Blue Basic II SBC [PDF] | HMO Blue Basic II Coverage Policy Document [PDF] |
| Standard High Silver: HMO Blue Basic* | HMO Blue Basic SBC [PDF] | HMO Blue Basic Coverage Policy Document [PDF] |
| Standard Low Silver: HMO Blue Saver* | HMO Blue Saver SBC [PDF] | HMO Blue Saver Coverage Policy Document [PDF] |
| Non-Standard Silver: Preferred Blue® PPO Saver with Copayment* | Preferred Blue PPO Saver with Copayment SBC [PDF] | Preferred Blue PPO Saver with Copayment Coverage Policy Document [PDF] |
* available for small groups only
Bronze Plan
This plan offers the lowest monthly premium. However, you pay higher out-of-pocket costs when you receive medical care.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| Standard High Bronze: HMO Blue Basic Deductible | HMO Blue Basic Deductible SBC [PDF] | HMO Blue Basic Deductible Coverage Policy Document [PDF] |
Catastrophic Plan
This plan is for individuals under 30. You're covered for medical care at a low monthly premium.
| Plan Type | Summary of Benefits and Coverage | Coverage Policy Document |
|---|---|---|
| HMO Blue Essential | HMO Blue Essential SBC [PDF] | HMO Blue Essential Coverage Policy Document [PDF] |
More Financial Help than Ever
Massachusetts expanded eligibility for the state-subsidized coverage program known as ConnectorCare, offering financial help to more people than ever before. Individuals with incomes of up to 500% of the Federal Poverty Level may now qualify for health coverage at a reduced cost. As a ConnectorCare carrier, we offer plan options for individuals seeking this coverage. See below for plan options:
Open enrollment at the Health Connector runs from November 1, 2024 to January 23, 2025. However, if you want coverage by January 1, 2025, you must apply, pick a plan, and make your first payment by December 23, 2024.
ConnectorCare plans also offer financial relief for prescription coverage. Learn more about medications that are covered at no cost to ConnectorCare members.
Use the Health Connector’s Get an Estimate calculator to see if you qualify for financial help, then apply at MAhealthconnector.org.
Prescription Coverage
Our list of covered medications is based on a tiered cost structure. When you fill a prescription, the amount you pay the pharmacy is determined by your medication's tier and your benefits. The amount you pay may also include your copayment, co-insurance, and deductibles. The pharmacist will tell you how much you owe at checkout. For more information about how our plans will cover your prescriptions, look them up using our Medication Lookup tool.
With the Medication Lookup tool, you can:
- Look up any medication to see if it's covered by a plan
- Find safe and effective covered alternatives for medications not covered by a plan
- Search for low-cost generic alternatives, specialty medications, and medications that have $0 copays
Learn about your pharmacy program
Medications covered at no cost for ConnectorCare plans
Pediatric Dental Benefits
All the health plans above include dental coverage for members up to the end of the month in which they turn 19. Learn more:
Find a Doctor & Estimate Costs
Pick the provider who's right for you, using our Find a Doctor & Estimate Costs tool. In minutes, you can:
- Find doctors, dentists, hospitals, and other health care providers
- Get cost estimates for about 1,600 common medical procedures
- Read and write reviews about doctors
Visit Find a Doctor & Estimate Costs
Did You Know?
90% of your premium dollars goes toward medical care. To learn more, see the