With its great historical significance and its revolutionary spirit, Massachusetts is well known for its innovation. Massachusetts is also the birthplace of the American Industrial Revolution. That drive toward improvement and ingenuity extends until today, where residents benefit from some of the best healthcare in the nation.
We’ve reviewed and compared the best Massachusetts health insurance providers to help you make a decision with confidence. Here are the companies that have earned our highest recommendations.
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The Best Massachusetts Health Insurance:
- Best Overall & Most Affordable: TUFTS Health Plan
- Best for Claims: BCBS of Massachusetts
- Best Customer Service: Fallon Community Health Plan
- Best for Low Deductibles: Harvard Pilgrim Healthcare
- The Best Massachusetts Health Insurance:
- What is Health Insurance?
- Average Cost of Health Insurance in Massachusetts
- Types of Health Coverage
- What Does Health Insurance Cover?
- What Does Health Insurance Not Cover?
- Best Health Insurance Providers in Massachusetts
- Innovation in Healthcare Close to Home
- Frequently Asked Questions
What is Health Insurance?
Health insurance helps to protect you financially from the cost of injury and illness treatment by doctors, hospitals and specialists. If you’re curious about how to get health insurance, there are several ways. You can go through your employer if insurance is offered at your workplace, or you can go through a state exchange. Individual and family insurance plans are also available.
Considering that illness or injury can strike anyone at any time and drain your savings, it’s a smart idea to have health insurance to help manage some of the financial costs. As you compare insurance plans, you’ll come across different terms. It’s a good idea to become familiar with what they mean so that you’ll know what portion of your health insurance costs you’re responsible for.
- Premium: A fee that’s paid each month to your insurance company to keep your policy active and valid.
- Deductible: You pay a deductible out of pocket before your insurance coverage takes over. Deductible amounts vary and it’s possible to have a low deductible plan, but you’ll pay more per month in premiums, and vice versa.
- Copay: This is a small and generally inexpensive flat fee paid to your doctor or for prescription drugs. Your copay does not count toward your deductible.
- Coinsurance: This is a percentage that’s shared between you and the insurance company. For any given treatment, surgery or other covered procedure, you pay a certain percentage and the insurance pays the other. Common coinsurance amounts are 80/20 and 70/30 — your insurance pays 80% or 70% respectively, and you pay 20% or 30%.
Average Cost of Health Insurance in Massachusetts
Massachusetts residents pay an average of $385 per month, per person for health insurance. There are certain things that you can do to help lower this cost. When evaluating how much you’ll pay, insurance companies look at a variety of factors:
- Body mass index (BMI): A high BMI can be a precursor to several preventable chronic conditions like high blood pressure, diabetes or heart disease. Take steps to lower your BMI by exercising regularly and eating healthy foods.
- Tobacco use: Smokers pay more for health insurance than their non-smoking counterparts. A little over 13% of people in Massachusetts are smokers. If you smoke, there are plenty of free and low-cost programs to help you quit. And if you do not smoke, don’t start. You’ll help protect your health as well as save money on health insurance.
- Age: Older people tend to have more health conditions, so you may pay more for health insurance when you’re 50 versus when you’re 20 or 30.
Types of Health Coverage
There are several varieties of health insurance available in Massachusetts. Each one has a different approach to how they help keep costs low while providing you with quality care:
- Health maintenance organizations (HMOs): HMOs are designed to save you money by creating a predetermined network of doctors, hospitals and specialists. You’ll have a primary care physician who will be in charge of most of your care. You’ll need a referral from your primary care physician to see a specialist, and that specialist should also be part of the HMO network. If you see a doctor, go to a hospital or see a specialist outside of the HMO network, you may be responsible for the full cost of the bill.
- Preferred provider organizations (PPOs): With a PPO, there’s more paperwork involved but you’ll have greater freedom to see the doctor you want or go to the hospital you prefer. You also don’t need a referral to see a specialist. You’ll pay more for treatment if you go outside of the PPO network, but unlike with HMOs, you likely won’t pay the full cost. You’ll need to file a claim with the PPO to be reimbursed.
- Point of service (POS) plan: POS plans give you the greatest degree of freedom to see the doctor or go to the hospital you want. You also don’t need a referral to see a specialist. With a POS plan, you’ll pay the full cost of service up front and you’ll be reimbursed by the POS plan. Like with other types of plans, you’ll pay more if you see a doctor outside of the POS network.
What Does Health Insurance Cover?
Health insurance doesn’t only cover the majority of treatments for illnesses or injuries. It can also cover additional types of care. The details vary by plan, but generally include some or all of the following:
- Newborn and maternity care
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Mental health care
- Ambulance services
- Emergency services
- Wellness checks
- Pediatric care
What Does Health Insurance Not Cover?
Although the list above looks fairly comprehensive when it comes to health coverage, there are some things that most health insurance companies don’t cover by default. These may include:
- Elective or cosmetic procedures
- Long-term nursing home care
- Infertility treatments
- Alternative therapies
- Dental, vision and hearing
With regard to dental, vision and hearing, some health insurance companies offer additional coverage for these particular types of care.
Best Health Insurance Providers in Massachusetts
The best health insurance in Massachusetts depends heavily on your budget as well as what your healthcare needs are. Do you have a specific doctor or specialist that you’d like to see? If so, then it’s a good idea to conduct a search through the providers below in order to get a quote and see if the healthcare provider you want accepts that brand of health insurance.
1. TUFTS Health Plan
One of the few companies to receive a perfect rating from the National Center for Quality Assurance, which independently rates private health insurance companies, the quality of care from the Tufts health plan is rated highly by its customers in terms of the quality of care as well as the rapidness of response to getting an appointment and getting claims taken care of quickly.
Tufts offers a variety of health plans, with the associated health maintenance organization being the HMO variety.
2. Blue Cross and Blue Shield of Massachusetts
Offering HMO and PPO plans, Blue Cross and Blue Shield of Massachusetts is well known as a full-service health insurance provider offering a wide range of plans to fit a variety of needs and budgets.
A comprehensive online search network of doctors and hospitals makes it easy to see if your preferred healthcare practitioner accepts BCBS health insurance before you sign up.
Getting a quote is also easy and straightforward, and you have a variety of options to further customize your health insurance needs both for yourself and your family.
3. Fallon Community Health Plan
Available as both an HMO and POS plan, members of the Fallon Community Health Plan have a wide range of options.
Depending on your household type and your income level, you may qualify for a subsidy to help pay for your insurance. Prices for many common healthcare needs are also very affordable.
Certain prescriptions are available for as little as $5, while there’s a $10 copay for office visits with your primary care provider. If you need lab services like blood tests, there’s also a $0 copay, helping you save money while staying healthy.
4. Harvard Pilgrim Health Care, Inc.
Harvard Pilgrim Health Care and Tufts will soon merge organizations. Although they currently operate separately, it’s worth noting that they’ll be in the process of unifying these major health operations to better serve Massachusetts.
With Harvard Pilgrim health plans, members get a $0 copay annual physical exam and flu shot, as well as discounts and reimbursements for health and wellness services, including gym memberships.
Chiropractic and acupuncture visits are also available, making this a well-rounded plan if you’re looking for health insurance that rewards you for taking the initiative toward leading a healthier lifestyle.
Innovation in Healthcare Close to Home
With so many innovative and comprehensive health care solutions to choose from, finding reliable, affordable health insurance in Massachusetts is now easier than ever.
Get quotes from each of the providers featured here so that you can better understand your health coverage options and choose the best plan that fits your needs and the needs of your family. Since quotes can vary among providers, it’s a good idea to get the full picture of what your options include so you can make the best choice for your needs and budget.