FAQ: Getting your care at MIT Medical with the MIT High Deductible Health Plan (HDHP)

Yes. Patients with any MIT-sponsored health plan, including the MIT HDHP, can get their care at MIT Medical. 

Yes, if you are covered by the MIT HDHP, you can keep your current MIT Medical PCP or choose an MIT Medical PCP for the first time. While the plan doesn’t require patients to select a PCP, we strongly recommend that all of our patients select a PCP — one clinician who can coordinate your care. If you already have an MIT Medical PCP, you don’t need to do anything more. 

It depends on the service. Urgent Care, Eye Service, and Radiology are available to all benefits-eligible members of the MIT community. Other services, like OB/Gyn, require that you have a PCP at MIT Medical, or that a PCP who is coordinating your care refers you to the service. If you are on the MIT HDHP and do not have a PCP at MIT Medical, you will still need referrals from an MIT clinician to use some services at MIT Medical. 

It depends on the services you receive and whether or not you have already met your deductible for the year. MIT Medical clinicians and front-desk staff cannot provide cost estimates. To get an estimate of charges you can expect for services at MIT Medical, visit myfindadoctor.bluecrossma.com. Note: you must create a Blue Cross Blue Shield account to use the cost-estimation tool. If you have already met your deductible, you will have no out-of-pocket costs for services at MIT Medical, except at the pharmacy. 

If you are referred outside of MIT Medical for services, you will be required to pay toward your deductible, or, if you have already met your deductible for the year, you will be billed 10 percent coinsurance. 

No. You will receive a bill in the mail from Blue Cross Blue Shield (BCBS) after you receive your care. If you have questions about the invoice, you will need to ask BCBS. You will pay nothing at the time of your visit. 

A deductible is set amount of money you must pay out of pocket before insurance benefits begin. A copay is a fixed amount of money you pay for a specific type of visit. The MIT HDHP has a deductible, while MIT Choice and the MIT Traditional Plan have copays. 

You will pay 10 percent of the cost for any services you receive until you reach your out-of-pocket maximum. This fee is known as “coinsurance.” However, coinsurance is waived for services you receive at MIT Medical once you have fully met your deductible.

An out-of-pocket maximum is the total amount you will pay out of pocket, per year, for health care, excluding premiums. The out-of-pocket maximum includes your deductible. In 2018, the out-of-pocket maximum will be $3,000 for employee-only coverage. For employee + spouse/domestic partner, employee and child (ren), or family coverage, the out-of-pocket maximum will be $6,000.

Yes. However MIT Medical clinicians and front-desk staff cannot provide cost estimates for services provided at MIT Medical. To get an estimate of the charges you can expect for a specific service, visit myfindadoctor.bluecrossma.com. Note: you must create a Blue Cross Blue Shield (BCBS) account to use the cost-estimation tool.  

Once you reach your out-of-pocket maximum, all non-preventive services will be covered 100 percent by your health plan.