Compare 2021 Qualified Health Plans

To see which Qualified Health Plans you may qualify for, you need to first check your eligibility with the Massachusetts Health Connector. You can then choose your plan name below for more information.

Plan Name Annual deductible
Annual Max Out-of-Pocket
Medical, Pharmacy and Pediatric Dental
Office Visits Prescriptions
30-day supply
ER
Waived if admitted
Hospitalizations Per Admission
Platinum Individual:
$0
Family: $0*
Individual: $3,000
Family: $6,000*
PCP: $20
Specialist: $40
Tier 1: $10
Tier 2: $25
Tier 3: $50
$150 per visit $500
Gold Individual:
$0 (Medical)
Family: $0* (Medical)
Individual: $5,000
Family: $10,000*
PCP: $25
Specialist: $50
Tier 1: $25
Tier 2: $50
Tier 3: $75
$300 after deductible $750
Low Gold Individual:
$2,250 (includes Medical and Pharmacy)
Family: $4,500* (includes Medical and Pharmacy)
Individual: $5,800
Family: $11,600*
PCP: $25
Specialist: $50
Tier 1: $25
Tier 2: $50 after deductible
Tier 3: $125 after deductible
$250 after deductible $750 after deductible
Silver A Individual:
$2,000
Family: $4,000*
Individual: $8,550
Family: $17,100*
PCP: $25
Specialist: $50
Tier 1: $25
Tier 2: $50
Tier 3: $75 after deductible
$300 per visit after deductible $1,000 after deductible
Silver A II Individual:
$2,000
Family: $4,000*
Individual: $8,550
Family: $17,100*
PCP: $25
Specialist: $50
Tier 1: $25
Tier 2: $50
Tier 3: $75 after deductible
$300 per visit after deductible $1,000 after deductible
Silver B Individual:
$3,000
Family: $6,000*
Individual: $7,900
Family: $15,800*
PCP: $30
Specialist: $55
Tier 1: $30 copay
Tier 2: 35% coinsurance (all after deductible)
Tier 3: 35% coinsurance (all after deductible)
$500 per visit after deductible 30% coninsurance after deductible
Bronze Individual:
$3,600
Family: $7,200*
Individual: $7,000*
Family: $14,000*
PCP: $100 after deductible
Specialist: $150 after deductible
Tier 1: $30 after deductible
Tier 2: $150 after deductible
Tier 3: $225 after deductible
$1,750 per visit after deductible $2,000 after deductible

All preventive services are covered in full. Our plans meet the state mandate for health insurance coverage and offer a variety of cost-sharing options to employers.

*See plan document for more information.

Glossary

Coinsurance - Your share of certain covered services as a percentage of the service. For example if your plan's coinsurance is 10% for a covered service, and the service costs $100, you will pay $10. ($100 x 10%)

Copay- The set amount you pay for services such as prescription drugs or a doctor's office visit.

Deductible - The amount you have to pay for services before your plan starts to pay.

Annual Max Out-of-Pocket - The most you could pay during a coverage period (usually one year) for your share of covered services, which include copays, deductibles and coinsurance.

Premium - The amount you pay each month to get coverage.

Preventive Care - Care that helps you stay healthy, like flu shots and wellness visits or diabetes and cancer screenings.

Specialist - A doctor who has extra training in an area of medicine, such as cardiology, dermatology, or pediatrics.

 

*Please see the current year's Qualified Health Plan Evidence of Coverage and Schedule of Benefits for specific information on each plan, or additional information including which benefits, services and medications are covered or non-covered on our plan- and any restrictions or guidelines we must follow before providing them. You can find doctors and hospitals in our network here, see our privacy practices, and learn how we make sure you get the right care at the right time with our Utilization Management policy.