Best Massachusetts Health Insurance

Jump straight to it: The best way to get nationwide and Massachusetts covering health insurance is with Blue Cross and Blue Shield.

With its great historical significance and 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. But if you're looking for the best cheap health insurance MA, we can help you figure out the best plan.

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. 

Quick Look: Best Massachusetts Health Insurance

• Best Overall: TUFTS Health Plan
• Best for Nationwide Coverage: Blue Cross and Blue Shield of Massachusetts
• Best for Value for Money: Fallon Community Health Plan
• Best for Individual and Family Plans: Harvard Pilgrim Health Care, Inc

Best Massachusetts (MA) Health Insurance Providers

The best Massachusetts health insurance 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. Best Overall: 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. Best for Nationwide Coverage: 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. Best for Value for Money: 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. Best for Individual and Family Plans: 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. 

Key Open Enrollment Dates for Coverage in Massachusetts

• Open enrollment has typically been from November 1 to January 23 annually
• For individuals, you must enroll before December 15
• Some states have longer enrollment periods

Note: Massachusetts has its own MA State Marketplace known as Massachusetts Health Connector. As a MA resident, this is how you'll apply for marketplace coverage during open enrollment.

How Does Health Insurance Work?

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. This payment is typically made monthly, and the premium cost can vary depending on factors such as age, location, and the type of plan chosen.

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%. 

Keep in mind that insurance companies may list these payments as “claims” that are, as yet, unpaid. Other times, your provider may ask you to make payment on those claims before they provide further services. If you have trouble making those payments, reach out to your provider for support or a payment plan.

Types of Health Coverage Available in Massachusetts

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. 

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. 

What Does Health Insurance in MA 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
• Hospitalization
• Wellness checks
• Pediatric care

What Does Health Insurance in MA 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
• LASIK
• 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. 

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. 

Frequently Asked Questions