Medical Insurance Personalized to Your Individual Needs (2024)

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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.

Medical Insurance Personalized to Your Individual Needs (1)Medical Insurance Personalized to Your Individual Needs (2)

Buy your own insurance

Choosing a health plan should be easy for everyone. Find an option that’s right for you.

Finding Financial Support

This year, more financial help for health insurance premiums is available to more people than ever before. See how qualified members who enroll through the Massachusetts Health Connector can get the help they need.

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Medical Insurance Personalized to Your Individual Needs (3)Medical Insurance Personalized to Your Individual Needs (4)

Leave nothing on the table

Don’t miss out on your rightful reimbursem*nts, prescription savings, discounts, and benefits. See them all when you sign in to MyBlue.

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Medical Insurance Personalized to Your Individual Needs (5)Medical Insurance Personalized to Your Individual Needs (6)

Student Blue

As a student, you're always on the go. With Blue Cross, you can live your life knowing that we've got you covered when you need us.

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Medical Insurance Personalized to Your Individual Needs (7)Medical Insurance Personalized to Your Individual Needs (8)

About to leave your parents’ plan? Don’t have an employer plan yet? Then HMO Blue Essential might be the plan for you. Read on to learn more, or call Team Blue at 1-800-422-3545 to sign up, ask questions, or learn about other plan options.

How do I qualify?

  • 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 foundhere.

What’s included?

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 additionalcharge 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 reimbursem*nts 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.

Can you explain my costs?

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.

Out-of-pocket maximum
Yourout-of-pocket maximumis 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.

Deductible
Yourdeductibleis 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.

How do I choose my doctors?

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 areferral 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

Is dental coverage an option?

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

Access doctorsanywhere

We have a nationwide network of the best doctors, hospitals, and specialists. Plus an easy tool to find them.

Find a doctor

Your planin your hand

Get an instant snapshot of your benefits, medications, balances, and deductible. All in one place, all on your device.

Learn more

Medical Insurance Personalized to Your Individual Needs (9)Medical Insurance Personalized to Your Individual Needs (10)

The best health insurance is the kind you understand

A little knowledge is a lot of empowerment. Here’s where you can brush up on all the health insurance basics.

Read on

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.

Dental Blue®

Receive regular dental checkups and more from one of the largest networks in the country.

Learn more

Blue 20/20 vision plan

Take a look at savings on routine eye exams, eyeglasses, contacts, and more.

Learn more

Pharmacy benefits

Enjoy savings on prescriptions through the mail service pharmacy, and get delivery to your door!

See Pharmacy Coverage

Medical Insurance Personalized to Your Individual Needs (2024)

FAQs

What does having insurance do for an individual? ›

Health insurance can help protect you from the high costs of illness or injury. It also helps you get regular health care, such as exams, preventive care and vaccines. But health insurance can cost a lot. And it can be hard to choose the best insurance.

What is an individual health insurance policy required to contain? ›

Final answer: An individual health insurance policy is required to contain a payment of claims provision, which outlines how and when claims will be paid by the insurer.

Can you add anyone you want to your health insurance? ›

Typically, medical plans will only allow you to add dependent family members, such as your spouse or children, to your plan. However, there are a few exceptions to this rule. One option is domestic partnership coverage.

What is a person covered with an individual health plan? ›

Individual health insurance is for anyone who doesn't have access to employer-sponsored or government-run health coverage.

How do individuals benefit from having health insurance? ›

Health insurance provides important financial protection in case you have a serious accident or sickness. People without health coverage are exposed to these costs. This can sometimes lead people without coverage into deep debt or even into bankruptcy.

Is health insurance really necessary? ›

There are a couple of things that can happen if you don't have health insurance: You may be more likely to avoid getting recommended preventive care. You may be responsible for paying the full cost of any medical care if you happen to get sick, injured, or develop a chronic illness.

What are the three basic types of health insurance for an individual? ›

There are many types of health coverage such as PPOs, EPOs and HMOs. Each one is a little different.

What are the 3 typical requirements in an insurance policy? ›

The Conditions

Common conditions in a policy include the requirement to file a proof of loss with the company, to protect property after a loss, and to cooperate during the company's investigation or defense of a liability lawsuit.

What are the three types of insurance everyone should have? ›

6 Types of Insurance You Need at Every Life Stage
  • Life insurance. Life insurance comes in two forms — whole and term — both of which provide similar benefits. ...
  • Renters/homeowners insurance. ...
  • Long-term disability insurance. ...
  • Long-term care insurance. ...
  • Critical illness insurance. ...
  • Travel insurance.

Can I add my girlfriend to my health insurance if we live together? ›

If you and your partner live together and meet your state's requirements, you may be able to add them to your health insurance plan. But, as mentioned, your state or city's law must recognize domestic partnerships. For example, California and Nevada recognize domestic partnerships.

Can I add someone I'm not related to to my insurance? ›

In most cases, one insurance policy covers all drivers in a single household. This also applies to friends who all live together under the same roof. So, assuming all of your friends live at the same address, you can add more than one friend to your car insurance policy.

Can you put a non-dependent on your health insurance? ›

HealthCare.gov states that non-dependent children should not be included in your household when you apply for coverage, but on the same page it clarifies that you should include them if you want to add them to your policy.

What is the difference between a PPO and a HMO? ›

Choosing between an HMO or a PPO health plan doesn't have to be complicated. The main differences between the two are the size of the healthcare provider network, the flexibility of coverage or payment assistance for doctors in network vs out of network, and the monthly payment.

Which is better, group insurance or individual insurance? ›

Choosing group health insurance can offer several advantages, including: Lower Premiums: Group health insurance plans often have lower premiums compared to individual plans because the risk is spread across a larger pool of participants, including contributions from employers.

What are four individual health insurance policies that are regulated by individual states? ›

What are four individual health insurance policies that are regulated by individual states? Private Health Insurance, Group Health Insurance, Employer Group Health Insurance, and Individual Health Insurance.

What are the benefits of an individual life insurance policy? ›

Buying life insurance protects your spouse and children from the potentially devastating financial losses that could result if something happened to you. It provides financial security, helps to pay off debts, helps to pay living expenses, and helps to pay any medical or final expenses.

Why is it important to have insurance? ›

Insurance isn't just about planning for life's worst-case scenarios. Insurance is your financial plan's safety net – having the right insurance at the right amount protects you and your family from unforeseen events and provides a baseline financial cushion.

What is the purpose of person insurance? ›

Key person insurance is a type of business insurance designed to help a company recover from the financial loss caused by the death of an owner, partner, or essential employee. Key person insurance provides financial protection by giving businesses the time to find and train replacements for key employees.

What are the benefits of insurance to individuals and to society? ›

Insurance helps society by protecting its wealth. By life insurance, the insurance company helps the community by protecting its wealth, and general insurance covers society's properties from fire, natural calamities, etc.

References

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