How Medical Insurance Works


Blue Cross Blue Shield of Massachusetts covers more people in Massachusetts than any other health plan . And we've been rated time and again as a top five health plan nationwide.

Each type of insurance plan we offer has different rules and coverage. The chart below provides an overview of our most popular types of plans. All of our medical plans cover preventive care with no out–of–pocket costs. Click on a plan type for more detailed information.

Overview You work with a primary doctor who arranges your care and gives you referrals for specialist or hospital care within a network . You work with a primary doctor for most of your care. You can also choose to see other providers at a higher cost. Primary doctors and hospitals in the network are grouped into three levels (also called tiers). You decide what to pay out of your pocket based on the provider you choose for care. You choose the doctors you want to see with no referrals both inside and outside our nationwide network. Doctors and hospitals are grouped into a limited network based on their cost of care. You save by only using network providers when getting medical care.
Primary Care Provider (PCP) Required Yes No Yes No No Yes
Referrals Needed Yes No Yes No No Yes
Out-of-Network Options N/A N/A  N/A Option to seek care out-of-network at higher cost. Option to seek care out-of-network at higher cost. Access to Emergency Care and Urgent Care at no additional cost.
May include Hospital Choice Cost Sharing Yes Yes No No Yes No
May include Value-Based Benefits Yes Yes Yes Yes Yes Yes

If you have questions about your plan choices and are currently a member, call Member Service at the number on the front of your ID card .