SimpliveraCoverage Companion

HMO Blue Basic Deductible

Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. · 2027 plan year

Expanded BronzeHSA eligible
Ind. deductible
$3,000
Family deductible
$6,000
Ind. OOP max
$11,650
Family OOP max
$23,300

Other cost-sharing reduction variants for this plan:

Standard Bronze Off Exchange PlanStandard Bronze On Exchange PlanZero Cost Sharing Plan Variation

More Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. plans in MA

HMO Blue PremiumHMO Blue Value DeductibleHMO Blue Essential

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$30.00 Copay after deductible

Specialist

BenefitIn-network
Specialist Visit$65.00 Copay after deductible

Hospital

BenefitIn-network
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 ServicesNo Charge after deductible
Urgent Care Centers or Facilities$65.00 Copay after deductible

Pharmacy

BenefitIn-network
Generic Drugs$30.00
Non-Preferred Brand Drugs$100.00 Copay after deductible
Off Label Prescription Drugs$100.00 Copay after deductible
Preferred Brand Drugs$65.00 Copay after deductible
Specialty Drugs$65.00 Copay after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services$1000.00 Copay per Stay after deductible
Mental/Behavioral Health Outpatient Services$30.00 Copay after deductible

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNo charge
Acupuncture$65.00 Copay after deductible
Allergy Testing$65.00 Copay after deductible
Bariatric Surgery$1000.00 Copay after deductible
Bone Marrow Transplants for Treatment of Breast Cancer$1000.00 Copay after deductible
Cardiac Rehabilitation$65.00 Copay after deductible
ChemotherapyNo Charge after deductible
Chiropractic Care$65.00 Copay after deductible
Clinical Trials$1000.00 Copay after deductible
Congenital Anomaly, including Cleft Lip/Palate$1000.00 Copay after deductible
Contraceptive ServicesNo charge
Delivery and All Inpatient Services for Maternity Care$1000.00 Copay after deductible
Diabetes Care Management$65.00 Copay after deductible
Diabetes Education$65.00 Copay after deductible
DialysisNo Charge after deductible
Durable Medical Equipment20.00% Coinsurance after deductible
Early Intervention ServicesNo charge
Emergency Transportation/AmbulanceNo Charge after deductible
Eye Glasses for Children35.00% Coinsurance after deductible
Habilitation Services$65.00 Copay after deductible
Hearing AidsNo charge
Home Health Care ServicesNo Charge after deductible
Hormone Replacement Therapy (HRT)$65.00 Copay after deductible
Hospice ServicesNo Charge after deductible
Human Leukocyte Antigen Testing$50.00 Copay after deductible
Hypodermic Syringes or Needles$65.00 Copay after deductible
Imaging (CT/PET Scans, MRIs)$400.00 Copay after deductible
Infertility Treatment$500.00 Copay after deductible
Infusion TherapyNo Charge after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Laboratory Outpatient and Professional Services$50.00 Copay after deductible
Nutrition/FormulasNo Charge after deductible
Nutritional Counseling$65.00 Copay after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$30.00 Copay after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)$500.00 Copay after deductible
Outpatient Rehabilitation Services$65.00 Copay after deductible
Prenatal and Postnatal CareNo charge
Prosthetic Devices20.00% Coinsurance after deductible
RadiationNo Charge after deductible
Reconstructive Surgery$1000.00 Copay after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$65.00 Copay after deductible
Rehabilitative Speech Therapy$65.00 Copay after deductible
Routine Eye Exam (Adult)No charge
Routine Eye Exam for ChildrenNo 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 Copay after deductible
Transplant$1000.00 Copay after deductible
Treatment for Temporomandibular Joint Disorders$65.00 Copay after deductible
Weight Loss ProgramsNo charge
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging$100.00 Copay after deductible

Open enrollment coming up?

Get notified when it opens — we'll remind you so you don't miss your window.