Compare 2022 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* Family: $0* |
Individual: $5,000* Family: $10,000* |
PCP: $25 Specialist: $50 |
Tier 1: $25 Tier 2: $50 Tier 3: $75 |
$300 per visit | $750 |
Low Gold | Individual: $2,250* Family: $4,500* |
Individual: $5,800* Family: $11,600* |
PCP: $25 Specialist: $50 |
Tier 1: $25 Tier 2: $50 after deductible Tier 3: $125 after deductible |
$250 per visit after deductible | $750 after deductible |
Silver A | Individual: $2,000 Family: $4,000* |
Individual: $8,700* Family: $17,400* |
PCP: $25 Specialist: $50 |
Tier 1: $25 Tier 2: $50 Tier 3: $70 after deductible |
$300 per visit after deductible | $750 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.
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