Standard High Gold: Complete HMO 1000 20/45
Mass General Brigham Health Plan, Inc · 2027 plan year
Gold
- Ind. deductible
- $1,000
- Family deductible
- $2,000
- Ind. OOP max
- $7,500
- Family OOP max
- $15,000
Compare with other Gold plans in MA
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Mass General Brigham Health Plan, 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 | $576 |
| 21 | $907 |
| 30 | $987 |
| 40 | $1,068 |
| 50 | $1,335 |
| 60 | $1,813 |
| 64 and over | $1,813 |
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 | $20.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $45.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $250.00 Copay after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | $500.00 Copay per Stay after deductible |
| Outpatient Surgery Physician/Surgical Services | No Charge after deductible |
| Urgent Care Centers or Facilities | $45.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $25.00 |
| Non-Preferred Brand Drugs | $75.00 Copay after deductible |
| Preferred Brand Drugs | $45.00 |
| Specialty Drugs | $75.00 Copay after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $500.00 Copay per Stay after deductible |
| Mental/Behavioral Health Outpatient Services | $20.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | No charge |
| Accidental Dental | $250.00 Copay after deductible |
| Allergy Testing | $35.00 Copay after deductible |
| Bariatric Surgery | $500.00 Copay after deductible |
| Basic Dental Care - Child | 25.00% Coinsurance after deductible |
| Chemotherapy | $75.00 |
| Chiropractic Care | $20.00 |
| Delivery and All Inpatient Services for Maternity Care | $500.00 Copay after deductible |
| Dental Check-Up for Children | No charge |
| Diabetes Education | $45.00 |
| Dialysis | No charge |
| Durable Medical Equipment | 20.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | No Charge after deductible |
| Eye Glasses for Children | No charge |
| Habilitation Services | $45.00 |
| Hearing Aids | No charge |
| Home Health Care Services | No charge |
| Hospice Services | No charge |
| Imaging (CT/PET Scans, MRIs) | $200.00 Copay after deductible |
| Infertility Treatment | $45.00 |
| Infusion Therapy | No charge |
| Inpatient Physician and Surgical Services | No Charge after deductible |
| Laboratory Outpatient and Professional Services | $25.00 Copay after deductible |
| Major Dental Care - Child | 50.00% Coinsurance after deductible |
| Nutritional Counseling | $45.00 |
| Orthodontia - Child | 50.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $20.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $400.00 Copay after deductible |
| Outpatient Rehabilitation Services | $45.00 |
| Prenatal and Postnatal Care | No charge |
| Prosthetic Devices | 20.00% Coinsurance after deductible |
| Radiation | $75.00 |
| Reconstructive Surgery | $500.00 Copay after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $45.00 |
| Rehabilitative Speech Therapy | $45.00 |
| Routine Eye Exam (Adult) | $45.00 |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $45.00 |
| Skilled Nursing Facility | $500.00 Copay per Stay after deductible |
| Substance Abuse Disorder Inpatient Services | $500.00 Copay per Stay after deductible |
| Substance Abuse Disorder Outpatient Services | $20.00 |
| Transplant | $500.00 Copay after deductible |
| Treatment for Temporomandibular Joint Disorders | $45.00 |
| Weight Loss Programs | No charge |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $35.00 Copay after deductible |
Service area
This plan covers 1 geographic area.
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