CHOOSE THE CARE THAT'S
RIGHT FOR YOU
If your medical plan has the Hospital Choice Cost Sharing feature, what you pay for certain services depends on where you choose to get care. Knowing how it works can help you avoid unexpected costs.
HOW HOSPITAL CHOICE COST SHARING WORKS
Your cost share is what you pay out of pocket for things like copayments and co-insurance, and depends on the factors below.* These factors can help you determine the most cost-effective options for your care.
Facility
Your cost for certain services will vary, based on the hospital or facility where you choose to receive care.
Services
Hospital Choice Cost Sharing only applies to certain services, listed below.
Provider affiliation
Choose health care providers who are affiliated with lower cost share facilities.
TYPES OF SERVICES AFFECTED BY HOSPITAL CHOICE COST SHARING**
|
Categories of service |
Examples |
|---|---|
|
Outpatient diagnostic lab services |
Blood tests, strep test |
|
Outpatient diagnostic X-rays and other imaging tests |
Ultrasounds, non-routine mammograms |
|
Outpatient diagnostic high-tech radiology |
CT scans, MRIs, PET scans, nuclear cardiac imaging |
|
Inpatient care |
Maternity care, joint replacement |
|
Outpatient day surgery |
Arthroscopic knee surgery, hernia repair |
|
Outpatient physical, occupational, and speech therapy |
N/A |
Freestanding labs and imaging centers
- Facilities like Quest Diagnostics always provide care at a lower cost share. They are a convenient, budget-friendly alternative for service like lab work, MRIs, and outpatient surgery.
Emergency care
- Emergency room (ER) visits require an ER copay. In an emergency, always go directly to your nearest ER or call 911. Your copay is waived if you're admitted to the hospital or there for an observation stay. The amount you'll pay for emergency care is the same regardless of hospital location.
HOW TO AVOID UNEXPECTED COSTS
Use our Find a Doctor & Estimate Costs tool
Sign in to MyBlue and find your provider using the Find a Doctor tool. Then click Hospital Affiliation to see if higher-cost or lower-cost Hospital Choice Cost Sharing applies to your provider’s facility.
Call your provider
To help make a cost-effective decision, call your provider’s office and ask which facilities they’re affiliated with.
* Massachusetts law allows qualifying members with a serious health condition, like cancer or cystic fibrosis, to continue receiving care at certain higher-cost facilities and pay a lower cost for up to one year. This benefit only applies in certain situations and is based on how you purchase your health insurance coverage.
** Your actual costs and plan design may be different from the examples provided here. To see your actual out-of-pocket costs, be sure to check your plan benefits documents.