Understanding how Health Insurance works in Massachusetts

Health Insurance

Understanding how Medical Insurance works in Massachusetts

Massachusetts is well known for its innovation due to its historical significance and revolutionary spirit.
The American Industrial Revolution was also born in Massachusetts. That drive for improvement and ingenuity continues to this day, with residents receiving some of the best healthcare in the country.

What Exactly Is Health Insurance?
Health insurance is a contract in which an insurer agrees to pay some or all of a person’s medical expenses in exchange for a premium.

More specifically, health insurance typically pays for the insured’s surgical, medical, prescription drug, and occasionally dental expenses.

Health insurance can either reimburse the insured for medical expenses incurred as a result of illness or injury, or it can pay the care provider directly.


It is frequently included in employer benefit packages to entice quality employees, with premiums partially covered by the employer but frequently deducted from employee paychecks.

With certain exceptions for S corporation employees, the cost of health insurance premiums is deductible to the payer, and the benefits received are tax-free.

The Average Plan Cost Of Health Insurance Companies In Massachusetts
For health insurance, Massachusetts residents pay an average of $385 per month per person. There are some things you can do to help reduce this cost.

Insurance companies consider a number of factors when determining how much you’ll pay:

Age
Because older people have more health problems, you may pay more for health insurance when you’re 50 than when you’re 20 or 30.

Tobacco use
Smokers pay a higher premium for health insurance than nonsmokers. In Massachusetts, smoking accounts for slightly more than 13% of the population.

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If you smoke, there are numerous free and low-cost programs available to assist you in quitting. And if you don’t already smoke, don’t start. You will help to protect your health while also saving money on health insurance.

Body mass index (BMI)
A high BMI can be a risk factor for a number of preventable chronic conditions such as high blood pressure, diabetes, and heart disease. Reduce your BMI by exercising regularly and eating healthy foods.

Benefits Of Health  Insurance Plans

The five major benefits of purchasing a health care plan are as follows:

1. Indemnity for medical expenses
The primary goal of medical insurance is to ensure that you receive the best medical care possible without putting your finances at risk.

Health insurance plans protect you from high medical costs. It covers, among other things, hospitalization expenses, daycare procedures, domiciliary expenses, and ambulance charges. You can thus concentrate on your quick recovery rather than worrying about such high costs.

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2. Protection against critical illnesses
Critical illness insurance is now available from insurance companies as a standalone policy or as a rider.

A policy of this type covers life-threatening diseases such as kidney failure, bone marrow transplant, stroke, and limb loss, among others.

You are entitled to a lump sum payment if you are diagnosed with any of the critical illnesses on your policy’s predetermined list. This sum may be used to cover the costs of your illness-related treatment, daily expenses, and any other financial obligations.

3. Benefit from a cashless claim
Many insurance companies provide a cashless claim option. You will not have to make any out-of-pocket payments under this arrangement.

Your insurer and the hospital will negotiate the hospitalization costs. To be eligible for this benefit, you must be admitted to one of the insurer’s network hospitals. To use the cashless facility, fill out a pre-authorization form and show your health insurance card.

4. Additional protection in addition to your employer’s coverage
Many businesses provide group insurance to their employees. However, such policies are not tailored to the specific needs of each individual.

Furthermore, you may be left uninsured in the event of a job loss or change in employment. Purchase a health insurance policy on your own to protect yourself against such an occurrence.
Types Of Plans Health Insurance Companies In Massachusetts Offer
Here are some of the different types of plans health insurance companies in Massachusetts offer.

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Health Maintenance Organization

HMO plans include hospitalization, medical care, and preventive care. You are only covered if you receive your care from a provider in the HMO’s network (except in a case of emergency).

Most HMO plans require you to pay a copayment for each covered service. For example, you might pay $30 for an office visit and the HMO will cover the rest.

Plans with Preferred Providers (PPP)
Preferred provider plans typically include hospital, medical, and preventive care coverage. These plans include a network of preferred providers that you can use, but they also include coverage for services provided by non-network providers. PPPs will cover a greater portion of the cost if you use a network provider.

After copays and deductibles, the plan pays 100% of a network provider’s service but only 80% of an out-of-network (OON) provider’s service.

It is important to note that if you choose to go OON while enrolled in a PPP, your provider may balance bill you for the entire cost of the procedure.

Major Medical Plans/Indemnity Insurance
Major medical plans typically cover hospital and medical expenses incurred as a result of an accident or illness.

Some may also include preventive care and office visits. These plans typically pay a percentage of your covered expenses.

For example, suppose the plan pays for 80% of your hospital stay and you pay the remaining 20%. You are covered by any licensed health provider under these plans.

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