Our HMOAn organization that arranges a wide spectrum of health care services which commonly include hospital care, physicians' services and many other kinds of health care services with an emphasis on preventive care. 
plans offer reliable coverage and access to the best doctors and hospitalsAn institution whose primary function is to provide diagnostic and therapeutic inpatient services, for a variety of surgical and non-surgical medical conditions. In addition, most hospitals provide outpatient services, including emergency care. in Massachusetts. No matter which HMO plan you choose, it will have these features:
- You choose a primary care provider (PCP)A provider, usually a family or general practitioner, internist, or pediatrician, who provides a broad range of routine medical services and refers patients to specialists, hospitals, and other providers as necessary. Under some benefits plans, a referral by the primary care provider is required to obtain services from other providers. Each covered family member chooses his or her own PCP from the network's providers. from your plan networkA group of health care providers under contract with a managed care company within a specific geographic area.
- Your PCP oversees your care and refersIf a PCP determines that an individual requires specialized care, the PCP may "refer" that person to an appropriate specialist. A referral is often required by a managed care plan before the plan will cover certain services. you to specialists
- Your care is covered when your doctors and hospitals are members of your plan network
Generally, our HMO plans cover these types of care:
- Inpatient and outpatient medical care
- Mental health/substance use
- Prescription drugA drug that has been approved by the Federal Food and Drug Administration as dispensable only with a licensed physician's prescription. benefits
- Preventive care covered with no out-of-pocket costs
To get the specifics of your plan, check your subscriber certificate or visit Member Central and click on the Using My Plan tab. Your member ID cardIdentification cards are provided to all participants for proper identification under their group health plan. ID card information helps providers verify patient eligibility for coverage. contains valuable information so it's important for you to card. Watch our Managed Care video to learn more about your health plan.
Depending on the plan you choose, you may be required to pay the following out of pocket before your insurance covers at 100 percent:
- DeductibleThe dollar amount that a member must pay for health care services before a health plan will cover eligible services. For example, if a member's deductible is $500, the member will pay that amount, out of pocket, before the health plan will cover any eligible services. —The amount you pay before your insurance begins picking up any of the costs for certain services. Deductibles are typically between $500 and $2,000.
- CopaymentThe amount that a plan member must pay the provider at the time of service. Also called a copay, this amount varies depending on the specifics of a given health plan contract. —The cost you're required to pay for certain services or prescription medications. Your copayments will vary depending on your plan and the type of service or medication you receive. Watch our Copayment video to learn more about copayments.
- Co-insuranceThe portion of eligible expenses that plan members are responsible for paying, most often after the deductible is met. Co-insurance is usually determined as a percentage of the total provider's actual charge, or the allowed amount. —A percentage of the cost a doctor or hospital charges that you're required to pay.
Note: If you have a plan with Hospital Choice Cost Sharing, you will have different out-of-pocket costs depending on the hospital where you choose to get care.
Have more questions? You can find definitions of other common medical terms or get answers to FAQs 24/7.
Your member ID card contains valuable information so it's important for you to know how to read your ID card.
When you select an HMO plan, you need to choose a primary care provider (PCP) to coordinate your care. Your PCP will refer you to other specialists in your HMO plan's network.
When you see out-of-network providers, you will pay the full cost of your care, except in cases of emergencies. To find a new provider online or check to see if your provider is part of your network, select from one of the options below:
Find a Doctor or Hospital in Massachusetts
Search for other providers
Watch our Primary Care Provider and Making the Most of Your Doctors Appointment videos to learn more about choosing the right doctor and making the most of your medical visits.
Hospital Choice Cost Sharing
If your plan includes Hospital Choice Cost Sharing, what you pay for certain services depends on the hospital where you choose to get care. Our Hospital Choice Cost Sharing page can help you understand the your costs and care options.
Quick Start Guides—An easy to follow introduction to HMO plans.
Deductible Education Sheets—See what medical care is subject to the deductible.
Get the Most Value From Your Plan—This downloadable guide provides six practical steps you can take to begin using your plan more effectively.
Claims Summary Demystified—A quick guide to your claims summary.
