How Medical Insurance Works
Blue Cross Blue Shield of Massachusetts covers more people in Massachusetts than any other health plan. And we've been rated time and again as a top five health plan nationwide.
HMO - You work with a primary doctor who arranges your care and gives you referrals for specialist or hospital care within a network.
PPO - You choose the doctors you want to see with no referrals both inside and outside our nationwide network.
Access Blue - You work with a primary doctor for most of your care. You can also choose to see other providers at a higher cost.
Blue Options HMO - Primary doctors and hospitals in the network are grouped into three levels (also called tiers). You decide what to pay out of your pocket based on the provider you choose for care.
Blue Options PPO - Primary doctors and hospitals in the network are grouped into three levels (also called tiers). You decide what to pay out of your pocket based on the provider you choose for care. Option to seek care out-of-network at higher cost.
Blue Select HMO - Doctors and hospitals are grouped into a limited network based on their cost of care. You save by only using network providers when getting medical care.
Each type of insurance plan we offer has different rules and coverage. The chart below provides an overview of our most popular types of plans. All of our medical plans cover preventive care with no out–of–pocket costs. Click on a plan type for more detailed information.
| Plan Type | Primary Care Provider Required | Referrals Needed | May include Hospital Choice Cost Sharing | May include Value-Based Benefits |
|---|---|---|---|---|
| HMO | Yes | Yes | Yes | Yes |
| PPO | No | No | Yes | Yes |
| Access Blue | No | No | Yes | Yes |
| Blue Options HMO | Yes | Yes | No | Yes |
| Blue Options PPO | No | No | No | Yes |
| Blue Select HMO | Yes | Yes | No | Yes |
| Out-of-Network Options | |
|---|---|
| HMO | N/A |
| PPO | Option to seek care out-of-network at higher cost. |
| Access Blue | N/A |
| Blue Options HMO | N/A |
| Blue Options PPO | Option to seek care out-of-network at higher cost. |
| Blue Select HMO | Access to Emergency Care and Urgent Care at no additional cost. |
HMO
|
Primary Care Provider Required Yes |
|
Referrals Needed Yes |
|
May include Hospital Choice Cost Sharing Yes |
|
May include Value-Based Benefits Yes |
|
Out-of-Network Options Yes |
PPO
|
Primary Care Provider Required No |
|
Referrals Needed No |
|
May include Hospital Choice Cost Sharing Yes |
|
May include Value-Based Benefits Yes |
|
Out-of-Network Options Option to seek care out-of-network at higher cost. |
Access Blue
|
Primary Care Provider Required No |
|
Referrals Needed No |
|
May include Hospital Choice Cost Sharing Yes |
|
May include Value-Based Benefits Yes |
|
Out-of-Network Options N/A |
Blue Options HMO
|
Primary Care Provider Required Yes |
|
Referrals Needed Yes |
|
May include Hospital Choice Cost Sharing No |
|
May include Value-Based Benefits Yes |
|
Out-of-Network Options N/A |
Blue Options PPO
|
Primary Care Provider Required No |
|
Referrals Needed No |
|
May include Hospital Choice Cost Sharing No |
|
May include Value-Based Benefits Yes |
|
Out-of-Network Options Option to seek care out-of-network at higher cost. |
Blue Select HMO
|
Primary Care Provider Required Yes |
|
Referrals Needed Yes |
|
May include Hospital Choice Cost Sharing No |
|
May include Value-Based Benefits Yes |
|
Out-of-Network Options Access to Emergency Care and Urgent Care at no additional cost. |
Questions?
If you have questions about your plan choices and are currently a member, call Member Service at the number on the front of your ID card.