2018 & 2019 Health Plan Comparison Tool

If you are enrolled in a 2018 Health Connector health or dental plan and will renew your coverage for 2019, this tool can help you compare 2018 and 2019 plan benefits and costs, side-by-side.

Compare Health Plans
Compare Dental Plans

All Health Connector health plans include pediatric dental benefits. For benefit details, please see each plan’s Summary of Benefits and Coverage.

Definitions (click on a term below to learn more)

A health insurance plan that is no longer available for purchase by new members but are continued for renewing members only.
The Health Connector’s plans are in different levels that includes metallic tier coverage named after metals Platinum, Gold, Silver and Bronze. There is also Catastrophic level coverage.

What is the difference between Platinum, Gold, Silver and Bronze health plans?

The Health Connector’s plans are in tiers (levels) named after metals. The metallic tiers are Platinum, Gold, Silver and Bronze. The tiers make it easier for you to compare the plans.

Here’s how it works:

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

What is Catastrophic coverage?

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.

The Health Connector offers standardized plans within each metallic tier (level). Standardized health plans have a set of 21 major benefits with the same out-of-pocket costs, to make it easier for members to compare the plans. Non-standardized plans can have varying out-of-pocket costs for all benefits and are also offered within each metallic tier.

How are standardized plans the same as each other?

Within each metallic tier, the cost sharing (out-of-pocket costs) for standardized benefits are the same. Benefits that are standardized are listed in the chart below:

Plan Feature/ Service
A check mark () indicates this benefit is subject to the annual deductible. Bold indicates changes from 2018.
Platinum High Gold *New* Low Gold High Silver Bronze #1 Bronze #2 (HSA-compatible)
Annual Deductible–Combined $0 N/A N/A $2,000 $2,750 $3,300
$0 N/A N/A $4,000 $5,500 $6,600
Annual Deductible –Medical N/A $1,000 $2,000 N/A N/A N/A
N/A $2,000 $4,000 N/A N/A N/A
Annual Deductible –Prescription Drugs N/A $0 $250 N/A N/A N/A
N/A $0 $500 N/A N/A N/A
Annual Out-of-Pocket Maximum $3,000 $5,000 $5,500 $7,900 $7,900 $6,700
$6,000 $10,000 $11,000 $15,800 $15,800 $13,400
Primary Care Provider (PCP) Office Visits $20 $25 $30 $30 $25 $25
Specialist Office Visits $40 $45 $50 $55 $50 $50
Emergency Room $150 $150 $350 $300 $250 $250
Urgent Care $40 $45 $50 $55 $50 $50
Inpatient Hospitalization $500 $500 $750 $1,000 $750 $750
Skilled Nursing Facility $500 $500 $750 $1,000 $750 $750
Durable Medical Equipment 20% 20% 20% 20% 20% 20%
Rehabilitative Occupational and Rehabilitative Physical Therapy $40 $45 $50 $55 $50 $50
Laboratory Outpatient and Professional Services $0 $25 $50 $50 $50 $50
X-rays and Diagnostic Imaging $0 $25 $50 $50 $50 $50
High-Cost Imaging $150 $200 $250 $500 $500 $500
Outpatient Surgery: Ambulatory Surgery Center $250 $250 $500 $500 $500 $500
Outpatient Surgery: Physician/Surgical Services $0 $0 $0 $0 $0 $0
Prescription Drug Retail Tier 1 $10 $20 $25 $25 $25 $25
Retail Tier 2 $25 $40 $50 $50 $50 $50
Retail Tier 3 $50 $60 $100 $75 $100 $100
Mail Tier 1 $20 $40 $50 $50 $50 $50
Mail Tier 2 $50 $80 $100 $100 $100 $100
Mail Tier 3 $150 $180 $300 $225 $300 $300
Federal Actuarial Value Calculator 88.82% 80.34% 76.11% 71.97% 64.99% 64.98%

How are standardized plans different from each other?

  • Plan names. Names of standardized plans vary by the insurer (insurance company) that offers the plan. On the next page is a list of the insurers and their standardized plan names.
  • Provider networks. The health care providers (such as doctors and hospitals) may be different in each plan’s network. Go to ProviderDirectory.MAhealthconnector.org to see which plans have the providers you want.
  • Costs for other services. There are other covered services in addition to the ones listed in this tool. Be sure to check each plan’s Summary of Benefits and Coverage (SBC) for more details.
The total amount you must pay in a plan year before your plan will pay for part or all of your services. Some services may not have a deductible. They may be free or just have a co-pay, even though you haven’t met the deductible yet.
The most you pay in one year for health care services. Once you pay this, your plan pays for all of your covered services for the rest of the year. You still need to pay your premium each month.
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 you pay depends on the total cost of the service.
A fixed price you pay when you get certain health care services. Not all services require a co-pay.
A visit to the doctor who gives you health care and services, such as referrals to specialists. If you enroll in an HMO or EPO, you will need to choose a PCP.
A visit to a provider who is a specialist in a specific area of medicine (for example a cardiologist, dermatologist, or allergist).  Some plans may require a referral from a primary care physician for specialist visits.
Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.
Visit to a hospital emergency services department to get treatment for a life-threatening condition.  Covers all services performed in an emergency room including the hospital facility, physician charges, and all additional services.
Health care that you get when you’re admitted as an inpatient to a health care facility, like a hospital or skilled nursing facility.
Laboratory services include diagnostic tests and services that help health care providers understand a condition.
Covers the professional components of X-rays, ultrasounds, and other types of imaging—including the office and outpatient charges—that help health care providers understand a condition.
Covers the professional components of high-tech imaging like MRIs, CT scans, PET scans, and nuclear cardiac imaging—including the office and outpatient charges—that help health care providers understand a condition.
Surgery that does not require an overnight stay in a hospital.
A prescription drug that has the same active-ingredient formula as a brand-name drug. The Food and Drug Administration (FDA) rates these drugs to be as safe and effective as brand-name drugs. Generic drugs are usually the least expensive.
A prescription drug that your plan will cover more of the cost of than a non-preferred brand drug.  The co-payments for preferred brand drugs are usually higher than generic drugs, but less expensive than non-preferred brand drugs.
A non-preferred brand drug typically has alternative generic or preferred brand drug.  They are usually more expensive than preferred drugs or generic drugs.