HMO Blue Basic II
Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. · 2027 plan year
Silver
- Ind. deductible
- $2,000
- Family deductible
- $4,000
- Ind. OOP max
- $11,650
- Family OOP max
- $23,300
Compare with other Silver plans in MA
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. plans in MA
Monthly premiums by age
Rating Area 1 — the lowest-priced of the 7 areas this plan covers. Premiums differ by area.
| Age | Individual |
|---|---|
| Under 15 | $490 |
| 21 | $772 |
| 30 | $840 |
| 40 | $909 |
| 50 | $1,136 |
| 60 | $1,543 |
| 64 and over | $1,543 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $30.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Urgent Care Centers or Facilities | $60.00 |
| Emergency Room Services | $500.00 Copay after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | $1000.00 Copay per Stay after deductible |
| Outpatient Surgery Physician/Surgical Services | No Charge after deductible |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $30.00 |
| Non-Preferred Brand Drugs | $90.00 Copay after deductible |
| Off Label Prescription Drugs | $90.00 Copay after deductible |
| Preferred Brand Drugs | $60.00 Copay after deductible |
| Specialty Drugs | $60.00 Copay after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $1000.00 Copay per Stay after deductible |
| Mental/Behavioral Health Outpatient Services | $30.00 |
Other
| Benefit | In-network |
|---|---|
| Transplant | $1000.00 Copay after deductible |
| Treatment for Temporomandibular Joint Disorders | $60.00 |
| Weight Loss Programs | No charge |
| Well Baby Visits and Care | No charge |
| Abortion for Which Public Funding is Prohibited | No charge |
| Acupuncture | $60.00 |
| Allergy Testing | $60.00 |
| Bariatric Surgery | $1000.00 Copay after deductible |
| Bone Marrow Transplants for Treatment of Breast Cancer | $1000.00 Copay after deductible |
| Cardiac Rehabilitation | $60.00 |
| Chemotherapy | No Charge after deductible |
| Chiropractic Care | $60.00 |
| Clinical Trials | $1000.00 Copay after deductible |
| Congenital Anomaly, including Cleft Lip/Palate | $1000.00 Copay after deductible |
| Contraceptive Services | No charge |
| Delivery and All Inpatient Services for Maternity Care | $1000.00 Copay after deductible |
| Diabetes Care Management | $60.00 |
| Diabetes Education | $60.00 |
| Dialysis | No Charge after deductible |
| Durable Medical Equipment | 20.00% Coinsurance after deductible |
| Early Intervention Services | No charge |
| Emergency Transportation/Ambulance | No Charge after deductible |
| Eye Glasses for Children | 35.00% Coinsurance after deductible |
| Habilitation Services | $60.00 |
| Hearing Aids | No charge |
| Home Health Care Services | 3.00% Coinsurance after deductible |
| Hormone Replacement Therapy (HRT) | $60.00 |
| Hospice Services | No Charge after deductible |
| Human Leukocyte Antigen Testing | $50.00 Copay after deductible |
| Hypodermic Syringes or Needles | $60.00 Copay after deductible |
| Imaging (CT/PET Scans, MRIs) | $350.00 Copay after deductible |
| Infertility Treatment | $500.00 Copay after deductible |
| Infusion Therapy | 3.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | No Charge after deductible |
| Laboratory Outpatient and Professional Services | $50.00 Copay after deductible |
| Nutrition/Formulas | No Charge after deductible |
| Nutritional Counseling | $60.00 |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $30.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $500.00 Copay after deductible |
| Outpatient Rehabilitation Services | $60.00 |
| Prenatal and Postnatal Care | No charge |
| Prosthetic Devices | 20.00% Coinsurance after deductible |
| Radiation | No Charge after deductible |
| Reconstructive Surgery | $1000.00 Copay after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $60.00 |
| Rehabilitative Speech Therapy | $60.00 |
| Routine Eye Exam (Adult) | No charge |
| Routine Eye Exam for Children | No charge |
| Skilled Nursing Facility | $1000.00 Copay per Stay after deductible |
| Substance Abuse Disorder Inpatient Services | $1000.00 Copay per Stay after deductible |
| Substance Abuse Disorder Outpatient Services | $30.00 |
| X-rays and Diagnostic Imaging | $60.00 Copay after deductible |
Service area
This plan covers 1 geographic area.
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