Blue Cross Blue Shield of Massachusetts covers more people in Massachusetts than any other health planA term that has different meanings depending upon the context. "Health plan" can be used to mean an HMO, a health benefits plan provided by an employer to its employees, or a health benefits plan offered to employers by an insurer or third party administrator. 
. 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.
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HMO
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PPO
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| Overview | You work with a primary doctor who arranges your care and gives you referrals for specialist or hospitalAn 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. care within a networkA group of health care providers under contract with a managed care company within a specific geographic area. . |
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. | |
| 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. Required |
Yes | No | Yes | No | No |
| Referrals Needed | Yes | No | Yes | No | No |
| 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. |
| May include Hospital Choice Cost Sharing | Yes | Yes | No | No | Yes |
| May include Value-Based Benefits | Yes | Yes | Yes | Yes | Yes |
Questions?
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 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. .
