2025 plan offerings
Get details on benefits, cost sharing and more in our 2025 Massachusetts product guide.
HMO Flex and HMO HSA Flex
Choose a primary care provider (PCP) from Harvard Pilgrim’s HMO – Flex network. The Flex benefit helps you save money with lower cost sharing on general lab services and outpatient surgery.
Plan details:
- PCP required
- Referrals to most kinds of specialists required
- Must receive care for covered services from providers in the HMO – Flex provider directory (exceptions include medical emergencies)
- Includes Core MA 3-Tier prescription drug coverage or Core MA 5-Tier prescription drug coverage
Focus HMO and Focus HMO HSA
These plans feature our select Focus Network – MA HMO, which includes thousands of leading health professionals and hospitals across Massachusetts.1 Focus HMO plans may help you save money with lower premiums than our full-network plans.
Plan details:
- PCP required
- Referrals to most kinds of Focus Easy Access specialists required
- Must receive care for covered services from Easy Access providers in our Focus Network – MA HMO provider directory (exceptions include medical emergencies)
- Includes Core MA 5-Tier prescription drug coverage
PPO Access Flex and PPO Access HSA Flex
Choose to receive care for covered services from providers inside or outside our extensive network. The Flex benefit helps you save money with lower cost sharing on general lab services and outpatient surgery.
Plan details:
- PCP encouraged but not required
- Referrals not required
- In-network coverage and lower cost sharing when you receive care for covered services from participating providers
- Out-of-network coverage and higher cost sharing when you receive care for covered services from non-participating providers
- Find participating doctors and hospitals in the PPO Access – Flex provider directory
- Includes Core MA 3-Tier prescription drug coverage or Core MA 5-Tier prescription drug coverage
Get details on benefits, cost sharing and more in our 2024 Massachusetts product guide.
HMO Flex and HMO HSA Flex
Choose a primary care provider (PCP) from Harvard Pilgrim’s HMO – Flex network. The Flex benefit helps you save money with lower cost sharing on general lab services and outpatient surgery.
Plan details:
- PCP required
- Referrals to most kinds of specialists required
- Must receive care for covered services from providers in the HMO – Flex provider directory (exceptions include medical emergencies)
- Includes Value 3-Tier prescription drug coverage or Value 5-Tier prescription drug coverage
Focus HMO and Focus HMO HSA
These plans feature our select Focus Network – MA HMO, which includes thousands of leading health professionals and hospitals across Massachusetts.1 Focus HMO plans may help you save money with lower premiums than our full-network plans.
Plan details:
- PCP required
- Referrals to most kinds of Focus Easy Access specialists required
- Must receive care for covered services from Easy Access providers in our Focus Network – MA HMO provider directory (exceptions include medical emergencies)
- Includes Value 5-Tier prescription drug coverage
PPO Flex and PPO HSA Flex
Choose to receive care for covered services from providers inside or outside of our extensive network. The Flex benefit helps you save money with lower cost sharing on general lab services and outpatient surgery.
Plan details:
- PCP encouraged but not required
- Referrals not required
- In-network coverage and lower cost sharing when you receive care for covered services from participating providers
- Out-of-network coverage and higher cost sharing when you receive care for covered services from non-participating providers
- Find participating doctors and hospitals in the PPO – Flex provider directory
- Includes Value 3-Tier prescription drug coverage or Value 5-Tier prescription drug coverage
Footnote(s)
1
These plans provide access to a limited provider network that’s smaller than Harvard Pilgrim’s full provider network. You’ll have coverage only from providers in this specific plan network.