2020 Compare 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
 Office Visits
 Prescriptions
30-day supply		 ER
Waived if admitted 		Hospitalization
Per admission
Platinum

Individual: $0*

Family: $0*

Medical: $3,000*

Pharmacy, & Pediatric Dental: $6,000*

PCP: $20

Specialist: $40

Tier 1: $10

Tier 2: $25

Tier 3: $50

 $150 per visit $500
Gold

Individual: $1,000* (Medical)

Family: $2,000* (Medical)

Medical: $5,000*

Pharmacy, & Pediatric Dental: $10,000*

PCP: $25

Specialist: $45

Tier 1: $20

Tier 2: $40

Tier 3: $60

 $150 per visit after deductible

 $500 after deductible
Low Gold

Individual: $2,000* (Medical)

Individual: $250* (Pharmacy)

 

Family: $4,000* (Medical) 

Family: $500 (Pharmacy)

Medical: $5,600*  

Pharmacy, & Pediatric Dental: $11,200*

PCP: $30

Specialist: $55

Tier 1: $25

Tier 2: $50 after deductible

Tier 3: $125 after deductible

  $350 per visit after deductible $750 after deductible
Silver A

Individual: $2,000

Family: $4,000*

Medical: $8,150* 

Pharmacy, & Pediatric Dental: $16,300*

PCP: $30

Specialist: $60

Tier 1: $30

Tier 2: $60

Tier 3: $100 after deductible

 $350 per visit after deductible $1000 after deductible
Silver A II

Individual: $2,000

Family: $4,000*

Medical: $8,150* 

Pharmacy, & Pediatric Dental: $16,300*

PCP: $30

Specialist: $60

Tier 1: $30

Tier 2: $60

Tier 3: $100 after deductible

 $350 per visit after deductible $1000 after deductible
Silver B

Individual: $3,000

Family: $6,000*

Medical: $7,900*

Pharmacy, & Pediatric Dental: $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% coinsurance after deductible
Bronze

Individual: $2,900

Family: $5,800*

Medical: $8,150*

Pharmacy, & Pediatric Dental: $16,300*

PCP: $30 after deductible

Specialist: $60 after deductible

Tier 1: $30

Tier 2: $60 after deductible

Tier 3: $125 after deductible

  $350 per visit after deductible $750 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.

$2,000/$4,000*

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%)

Copayment - 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 copayments, 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 or cancer screenings.

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

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