Mass General Brigham Health Plan

What Mass General Brigham Health Plan does

Mass General Brigham Health Plan is a Massachusetts-based health insurance carrier and subsidiary of Mass General Brigham, offering commercial, Medicare Advantage, and Medicaid (MassHealth ACO) plans to employers, individuals, and government-program members. It sells HMO (Complete HMO), PPO Plus, EPO (Complete Access EPO), and tiered-network (Choice Easy Tier) products across small-group (1–4 and 5–50 employees) and large-group (51+ employees) segments, plus individual and family plans through the Massachusetts Health Connector. The company also administers Mass General Brigham Advantage Medicare plans and is launching dual-eligible Special Needs Plans (One Care and Senior Care Options) in January 2026.

Revenue is generated primarily through recurring monthly premiums across commercial, Medicare, and MassHealth lines of business, with pharmacy benefits managed via Optum Rx. The technology stack centers on a Member Portal and mobile app, a Provider Portal for eligibility/authorization, a Broker Portal for distribution, and the new mPulse-powered interactive Wellness Hub. Behavioral health is delivered through Lyra Health and Optum's Live and Work Well platform; specialty drug prior authorizations run through Prime Therapeutics; sleep management through CareCentrix; and molecular/genetic testing through EviCore. National PPO access is enabled via the UnitedHealthcare Options network (1.6M+ providers).

The go-to-market is sales-led and multi-channel: direct employer sales with account executives, a broker portal with competitive compensation, intermediary partnerships (HSA Insurance, SBSB) for very small groups, marketplace distribution through the Massachusetts Health Connector, and CMS/MassHealth enrollment channels for government lines. The company reports serving approximately 700,000 members in the Massachusetts individual and small-group market, competes on average 10%+ HMO premium savings versus peer Massachusetts carriers, and is expanding its digital wellness, women's health (Pelvic Health Initiative), and D-SNP portfolios under a parent-system brand anchored by Massachusetts General Hospital and Brigham and Women's Hospital.

Name

Mass General Brigham Health Plan

Legal name

Mass General Brigham Health Plan, Inc.

Website

https://www.massgeneralbrighamhealthplan.org

Company type

Private

Operating status

Operating

Headcount range

251–500 employees

Short description

Mass General Brigham Health Plan is a Massachusetts-licensed health insurance subsidiary of Mass General Brigham, offering commercial HMO/PPO/EPO plans, Medicare Advantage, and MassHealth ACO coverage to ~700,000 employer and individual members across MA, NH, and RI.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Group HMO Plans (FSAIAFAK)

akta.pro secondary industries

Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH), MA Prescription Drug Plans (MA-PD) (HLAEACAF), MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI), MA Care Coordination & Utilization Management (UM) Programs (HLAEACAK), Public Sector & Government Employer Group Health Plans (FSAIAFAF), Medicare Advantage (MA) Plans (FSAIAGAA), Specialty Medicaid Managed Care (e.g., HIV/AIDS, SMI/SED) (HLAEAEAG)

Keywords

• Health insurance plans
• Medicare Advantage plans
• Employer group coverage
• Managed care plans
• Medicaid managed care

Headquarters

HQ city

Somerville

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Commercial Health Insurance Premiums: Mass General Brigham Health Plan generates primary revenue through premium payments from employer-sponsored health insurance plans (small group 1-4, 5-50 employees, and large group 51+ employees) and individual/family plans purchased through the Massachusetts Health Connector or intermediary partners. Premiums are collected on a monthly basis and cover comprehensive medical, pharmacy, and behavioral health benefits.
2. Medicare Advantage Premiums: The company offers Medicare Advantage plans (Mass General Brigham Advantage) generating premium revenue from CMS and Medicare-eligible members for bundled Part A, B, and D coverage including dental, vision, and hearing benefits.
3. MassHealth/Medicaid Premiums: Revenue from providing coverage to MassHealth members through Mass General Brigham ACO, including coverage for Mass General Brigham One Care (D-SNP for ages 21-64 with both MassHealth and Medicare) and SCO Senior Care Options (D-SNP for ages 65+ with both MassHealth and Medicare).
4. Pharmacy Benefit Management: Pharmacy benefits are managed through Optum Rx partnership. Revenue is incorporated into premium pricing with cost-sharing mechanisms for prescription drugs across 3-tier, 4-tier, and 6-tier pharmacy programs.

Pricing tiers

Go-to-market motion1 record

Distribution channels6 records

Marketing channels7 records

Core offering

Mass General Brigham Health Plan is a Massachusetts-licensed health insurance company offering commercial, Medicare Advantage, and MassHealth (Medicaid) health plans to individuals, families, and employer groups. It provides HMO, PPO Plus, and EPO plan designs along with specialized products such as One Care (D-SNP) and Senior Care Options (SCO), integrating coverage with the Mass General Brigham provider network.

Product overview

Mass General Brigham Health Plan is a health insurance company offering a comprehensive portfolio of health plans for individuals, families, and employers across Massachusetts. The product portfolio includes three main plan architecture types: HMO (Complete HMO), PPO Plus (Complete PPO Plus), and EPO (Complete Access EPO) plans, each with Choice Easy Tier variants for tiered cost-sharing. These core plans are supplemented by Care Complement benefits for cost-sharing waivers and a 6-tier pharmacy program managed by Optum Rx. The company serves multiple segments: commercial employer groups (1-4, 5-50, and 51+ employees), individuals and families through the Massachusetts Health Connector, Medicare populations via Medicare Advantage plans including One Care (ages 21-64) and Senior Care Options (ages 65+), and MassHealth members through Mass General Brigham ACO. An interactive wellness hub launched March 2026 provides members with digital health resources and personalized support. The company also offers digital service platforms including a Member Portal, Provider Portal, and Broker Portal for plan management and healthcare coordination.

Differentiator

Problem solved

Functional benefit

Brands

• Care Complement: Benefit program providing access to more affordable care options by removing cost sharing for certain services, therapies, and medications including physical therapy, acupuncture, chiropractic visits, and select prescription medications
• Mass General Brigham Advantage
• Medicare Balance
• LiteSwitch
• Complete Access EPO
• Complete PPO Plus
• Choice Easy Tier

Products and services

• Complete HMO

Quantifiable outcome

• Average 10%+ savings on HMO plans versus peer Massachusetts carriers
• +2 more outcomes

Named customers1 record

Segments5 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration11 records

Feature4 records

Partnerships

Nine partnerships are on record, tiered core and minor.

• mPulsecoreTechnology or Integration · 18 March 2026Mass General Brigham Health Plan partnered with mPulse to launch an interactive wellness hub providing digital health resources, mental health support, coaching, and chronic condition management through an omni-channel design with personalized guidance. The hub is accessible via the Member Portal and offers services including mental health resources, coaching, and chronic condition management.
• Optum RxcoreTechnology or IntegrationOptum Rx manages pharmacy benefits for Mass General Brigham Health Plan members. Members can fill prescriptions at any pharmacy in the national network including CVS, Walgreens, Rite Aid, and independent pharmacies. Optum Rx also manages behavioral health benefits with Live and Work Well portal providing resources, virtual therapy, and provider search.
• UnitedHealthcarecoreTechnology or IntegrationArrangement with UnitedHealthcare allows Mass General Brigham Health Plan members to access UnitedHealthcare Options PPO network outside Massachusetts and New Hampshire. The PPO Plus plans include access to over 1.6 million providers and 5,600 hospitals nationwide through this network arrangement.
• Prime TherapeuticscoreTechnology or IntegrationPrime Therapeutics reviews medical specialty drugs that require prior authorization. Providers can submit requests through the Provider portal or GatewayPA.com. Prime Therapeutics handles specialty medication prior authorizations including drugs like Abecma, Amtagvi, Breyanzi, Carvykti, and other gene therapies.
• Lyra HealthcoreTechnology or IntegrationLyra Health provides mental health support for many Mass General Brigham Health Plan members. Services include personalized care recommendations, virtual or in-person appointments with therapists and health coaches often within 1-3 days, and family support including children and adolescents. Available through member portal login.
• Delta DentalminorChannel Partner/ Reseller/ DistributorDelta Dental provides dental network access for Mass General Brigham Health Plan members. Search for Massachusetts dentists through Delta Dental MA EPO network and dentists outside Massachusetts through PPO network.
• EyeMedminorChannel Partner/ Reseller/ DistributorEyeMed provides vision discount network for Mass General Brigham Health Plan members with access to independent providers and top retail providers including LensCrafters, Pearle Vision, and Target Optical. Includes discounts on standard plastic lenses, frames, lens options, contact lens materials, and laser vision correction.
• HSA InsuranceminorChannel Partner/ Reseller/ DistributorHSA Insurance is a preferred intermediary partner for Mass General Brigham Health Plan small business (1-4 employees) plans. Offers personalized service and guidance choosing a plan. Shoppers can buy insurance through HSA Insurance with direct quoting available at hsainsurance.com.
• Small Business Service Bureau, Inc (SBSB)minorChannel Partner/ Reseller/ DistributorSmall Business Service Bureau, Inc (SBSB) is a preferred intermediary partner for Mass General Brigham Health Plan small business (1-4 employees) plans. Offers personalized service and guidance choosing a plan. Shoppers can buy insurance through SBSB with direct quoting available.

Scale indicators5 records

Recent moves6 records

Expansion highlights6 records

Broad incumbents

• UnitedHealthcare: Largest U.S. health insurer; offers Medicare Advantage, employer, and individual plans in Massachusetts and is also MGBHP's PPO Plus network partner (UnitedHealthcare Options PPO). Provides both competitive overlap and infrastructure dependence.
• Humana: National health insurer with strong Medicare Advantage focus including D-SNP offerings; competes for MA market share in Massachusetts and offers comparable commercial group products through employer channels.
• Molina Healthcare: Government-sponsored health plan specialist focused on Medicaid and Medicare, including D-SNPs; relevant comparable for MGBHP's MassHealth ACO and upcoming One Care / SCO D-SNP product launches.
• Kaiser Permanente: Vertically integrated payer-provider health plan operating in select regions; the closest U.S. analogue to MGBHP's provider-payer integration thesis via Mass General Brigham, though geographically non-overlapping with Massachusetts.
• Aetna (CVS Health): National health insurer offering commercial, Medicare Advantage, and Medicaid plans across the U.S.; competes for Massachusetts employer and MA business and brings vertically integrated PBM/retail capabilities via CVS Health.
• Cigna Group: National health services company offering employer-sponsored and individual health plans plus Medicare Advantage; competes for Massachusetts large-group business and shares the multi-state, broker-led distribution model.

Direct peers

• Blue Cross Blue Shield of Massachusetts: Largest health plan in Massachusetts offering HMO, PPO, Medicare Advantage, and Medicaid products to the same employer, individual, and Medicare segments as Mass General Brigham Health Plan. Direct head-to-head competitor in the merged market.
• Tufts Health Plan (Point32Health): Massachusetts-based plan offering commercial HMO/PPO, Medicare Advantage, and Medicaid (Tufts Health Together) products that directly overlap MGBHP's Complete HMO, Medicare Advantage, and MassHealth ACO lines.
• Harvard Pilgrim Health Care (Point32Health): New England-based HMO/PPO health plan now part of Point32Health; competes directly with MGBHP across commercial group, individual, and Medicare Advantage lines in Massachusetts and NH.
• Fallon Health: Massachusetts-based nonprofit health plan offering commercial, Medicare Advantage ( Fallon NaviCare), and SCO (Senior Care Options) products — directly competitive with MGBHP's MA HMO-POS and upcoming SCO D-SNP.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/channel/UChkuvuY5gEoHRMhA3maf2cA
• Facebookfacebook.com/MGBHealthPlan
• LinkedInlinkedin.com/company/mgbhealthplan
• Instagraminstagram.com/mgbhealthplan
• Xx.com/MGBHealthPlan

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Mass General Brigham Health Plan