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The Summary of Benefits and Evidence of Coverage plan documents include important information about your cost sharing and the services covered by your Medicare Advantage plan from Mass General Brigham Health Plan.

You can find your plan documents on the Mass General Brigham Health Plan member portal. You can create an account on the portal after your health plan effective date. The member portal is the best place to find all your plan documents and benefit information that’s specific to your plan. 

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You can search our online Provider Directory to find doctors, specialists, and other providers in the Mass General Brigham Health Plan network. As a Medicare Advantage member, your plan also includes coverage for non-emergency or routine care from any Medicare-participating provider anywhere in the U.S.

Out-of-network care and services may cost you more than in-network. You can check your in- and out-of-network cost sharing for providers in your plan’s Summary of Benefits. Instructions for how to find this document are located above. Your Care Guide can help you understand your cost sharing and find an in-network provider if you would like to switch.

Your Evidence of Coverage includes a list of covered services and their associated cost sharing. Instructions for how to find this document are located above. If you have questions about a specific service and its cost, your Care Guide can help review your plan documents and understand what your cost sharing will be.

If you receive a bill or pay for services that you think we should pay for, you may need to ask us for reimbursement. After your health plan effective date, you can submit a claim (also known as a reimbursement request) online through the Mass General Brigham Health Plan member portal. Your Care Guide can help you get started on the member portal after your effective date and can walk you through submitting a reimbursement.

You can search our online Formulary to find drugs covered by your plan and which of the five cost sharing tiers they belong to. The amount you pay depends on the drug’s tier and what stage of the benefit you have reached. You can find more information about these tiers and stages in your plan’s Summary of Benefits. Instructions for how to find this document are located above. Your Care Guide can also help you search for medications and help you understand what your cost sharing will be.

If you need help with the cost of your medications, you may be eligible for certain state and federal programs that reduce your monthly prescription drug premium or co-pays. You can find out more about these programs on our Prescription drug coverage page. Your Care Guide is also available to help you learn more about the low-income subsidy and pharmaceutical assistance programs.

You can visit our Benefits and savings page to learn about the benefits included with your plan and find an in-network provider for these services. Your plan’s Summary of Benefits includes specific coverage details for each of these benefits. Instructions for how to find this document are located above. Your Care Guide can help you find a provider and understand what your cost sharing will be for dental, vision, and hearing services.

As a Medicare Advantage member, you are covered anywhere for emergency and urgent care. This includes the hospitals and centers in your community and any place around the world. 

"Medically necessary" describes services or supplies that:

• Are needed for the diagnosis or treatment of your medical condition
• Are provided for the diagnosis, direct care, and treatment of your medical condition
• Meet the standards of good medical practice in the local area
• Aren’t mainly for the convenience of you or your doctor

Medical necessity criteria supports the summary of benefits and evidence of coverage for your Medicare Advantage plans from Mass General Brigham Health Plan.