All of the health plans you can choose through the Health Connector offer these health benefits:

• Outpatient care – Treatment you get without being admitted to a hospital
• Inpatient care – Treatment you get in the hospital
• Emergency room – Treatment you get in an emergency room
• Prenatal and postnatal care – Care before and after your baby is born
• Mental health and substance use disorder services – This includes behavioral health treatment, counseling, and psychotherapy
• Prescription drugs – These are medications prescribed by your physician that you take at home
• Services and items to help you recover if you are injured, or have a disability or chronic condition – This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more
• Lab tests – These include tests such as blood work or Pap smears
• Preventive services – Services to help keep you healthy, like counseling, screenings, and vaccines
• Pediatric services – Services for children, including vision care

Differences between plans include:

• Which health insurance company offers the plan
• Provider networks (the doctors, hospitals, and other providers in the plan)
• Costs, including monthly premium, and out-of-pocket costs like co-pays and deductible

In Questions to help you get started, you wrote the names of doctors and hospitals you want in the plan you choose. Before you enroll in a plan, use our online tools at PlanFinder.MAhealthconnector.org to make sure the providers you want and the prescription drugs you need are in the plan’s network. You can also call the insurance company directly for this information.

When you search or call an insurance company to ask about a provider, be sure to give the plan’s full name. For example, say: “Fallon Health Select Care Platinum Connector” and not just “Fallon Health.”

There are five kinds of costs in health plans:

• Premium: This is the cost you pay each month, whether or not you use health care services. You will pay your monthly premium bill to the Health Connector. The premium is always due by the 23rd of the month.
• Deductible: This is the total cost you must pay in a plan year before your plan will pay for part or all of your services.
• Co-pay: This is the cost you pay at the time you get certain health care services. Usually, you start to pay co-pays after you meet your deductible.
• Co-insurance: If a health care service has co-insurance, you pay a percentage (part) of the cost for that service. Usually, you start to pay co-insurance after you meet your deductible. It is not a fixed cost like a co-pay. The amount depends on the total cost of the service.
• Maximum out-of-pocket (MOOP) cost: This is the most you pay in one year for health care services. Once you have paid this amount, your plan pays for all of your covered services for the rest for the year.

Here’s how it works:

• Platinum and Gold plans have the highest premiums (monthly cost) but the lowest costs (deductibles and co-pays) when you get health care services.
• Silver plans have premiums that are usually lower than Gold plans but have higher costs when you get health care services.
• Bronze plans have the lowest premiums but the highest costs when you get health care services.

Catastrophic plans are only available to certain people. To qualify, you must be less than 30 years old or have a qualifying hardship exemption from the federal government. Catastrophic plans only cover you in a major health event. They have very high deductibles. You must pay for almost all of your health care until you reach the deductible. If you enroll in a Catastrophic plan you will not be able to get help paying for your coverage, even if you would otherwise qualify. To learn more, go to MAhealthconnector.org/catastrophic-plans.

To choose a tier, think about how often you use health care services. You may want to pay less each month and pay more when you get care. Or you may want to pay more each month and pay less when you get care.

A Platinum or Gold plan may be best for you if:

• You have a chronic condition (like diabetes) or think you will use a lot of health care services (like going to the doctor, getting a prescription filled, or having an operation).
• You would rather pay a higher premium each month so you pay less in co-pays and co-insurance when you use health care services.

A Silver plan may be best for you if:

• You use some health care services and don’t want to pay very high out-of-pocket costs when you get care.

A Bronze plan may be best for you if:

• You do not use many health care services, except for preventive care.
• You would rather pay less for your premium each month and pay more when you use health care services.
• You can afford to pay a high deductible and high out-of-pocket costs if you need care.

A Health Savings Account (HSA) is a way to set aside money before taxes, to use for certain medical costs. All Bronze and Catastrophic plans available through the Health Connector are “HSA compatible,” which means that you may be able to set up an HSA if you are enrolled in one of those plans. You can usually set up an HSA at a financial institution, like a bank. To learn more about HSAs, go to MAhealthconnector.org/hsa.

Once you choose a metallic tier (Platinum, Gold, Silver or Bronze) it will be easier to compare your plan choices. If you are shopping for a plan at MAhealthconnector.org, you can choose up to three plans to compare online.

A Limited or Smaller Network is a plan with fewer providers and lower premiums than other plans offered by the same insurer (insurance company). When you shop for plans online, you will see “Network Note” appear if you are looking at one of these plans. It may be a good choice for you if it has the providers you want. Before you enroll, use the Find a Provider tool to see if your providers are in the plan.