Shouldn't your health plan be a "help plan?"
One of the most important benefits of any medical plan is getting assistance and advice.
So no matter which plan you have, we make sure it comes with the helpful tools of MyBlue, and the helpful people of Team Blue.
Together, they make Massachusetts’ most trusted medical plans more powerful than ever.
- You’re a Massachusetts resident between the ages of 18 and 29.
- Your annual household income is less than $49,960.
If you meet these qualifications and want to buy HMO Blue Essential, click here to get started or read on to learn more about the plan. If your annual income is less than $49,960, you may qualify for a subsidy to help pay for your insurance. Visit Health Connector Plans to learn more.
Additional information regarding Medicare Creditable Coverage can be found here.
Here’s what you get for around $290 a month:
- Pay $0 out-of-pocket for preventive care, routine physicals, OB/GYN, well child visits, routine hearing and vision exams, and family planning. There’s no copay or deductible.
- Pay no more than $35 per visit for your first three sick-care or non-preventive office visits. For additional visits, you are responsible until the deductible is met.
- No additional charge for emergency room, inpatient hospital care, or outpatient surgery after you pay your deductible.
- Pay nothing for Tier 1 birth control and, after you pay your deductible, pay nothing for all covered prescriptions.
- Enjoy savings on fitness reimbursements and discounts on holistic services.
The deductible is $8,200 for individuals and $16,400 for families. Check out the Summary of Benefits & Coverage to learn more.
Co-insurance and copayments
With this plan, you are covered for routine preventive care and services at no cost. You also get three medical office visits each year for either a $35 copayment or 50% co-insurance (you pay half the cost of the visit), whichever is less. You don’t pay toward your deductible for a medical office visit until after these three visits.
Your out-of-pocket maximum is the most you pay per plan year for covered health expenses, before the plan pays 100% of covered expenses for the rest of that year. This plan's out-of-pocket maximum is of $8,200 for individuals and $16,400 per family.
Your deductible is the amount you pay before your insurance pays any of the costs for most services. After you pay your deductible, you’ll pay nothing for covered services for the rest of the year. (Note: Your monthly premium payments don't count toward your deductible). This plan's deductible is $8,200 for individuals and $16,400 per family.
Get started by finding a primary care provider. Keep in mind, the provider must be in Massachusetts. Once you’ve enrolled in this health plan, use the Find a Doctor tool to get started.
If you need a specialist, your primary care provider will refer you to one. You must have a referral for your specialist care to be covered.
What about emergencies? Go to the nearest medical facility or call 911. Once you’ve met your deductible for the year, there’s no charge for emergency care.
What if my doctor’s office is closed? You have two great options:
- Call our 24/7 Nurse Line toll-free at 1-888-247-BLUE (2583) to speak with a registered nurse, right when you need to, day or night, at no charge.
- If you have an illness or injury that needs immediate attention, but isn't life-threatening, go to an urgent care center.
Want to learn more? Explore your care options
Yes! Your medical plan coverage includes a separate dental policy, covering pediatric essential dental benefits for members until the end of the calendar month in which they turn age 19, as required by federal law.
Your dental deductible is $50 per member (no more than $150 for three or more members enrolled under the same family membership). You must meet a plan-year deductible for certain covered dental services.
Your out-of-pocket maximum is $350 per member (no more than $700 for two or more members enrolled under the same family membership). The out-of-pocket maximum is the most that you could expect to pay covered dental services during a plan year (for the deductible and co-insurance).
Plans that fit you, not the other way around
One great plan deserves another
Combine one or more of these options with your medical plan, and let Team Blue bring a unified approach to your care.