Mass General Brigham Advantage Premier (PPO) plan information

Get to know 2025 benefit information for our Medicare Advantage Premier PPO plan.

2025 Plan information

Explore key 2025 benefit information for Mass General Brigham Advantage Premier (PPO).

You’ll find a summary of cost sharing for commonly used benefits in the table, or you can explore plan documents for detailed information:

plan-premier-2025

Did you know?

Our Medicare Advantage Premier PPO plan is best for people who regularly visit the doctor. Your premium is slightly higher, but your copays for common services are much lower. 

Monthly plan premium $140 per month
Primary Care (In/Out) $0 / $10 copay
Specialist (In/Out) $25 / $40 copay
Emergency room (In/Out) $90 copay
Urgent care (In/Out) $30 copay
Ambulance (In/Out) $200 copay
Inpatient hospital stays (In/Out) $150 days 1-3; $0 days 4-90 / 20% coinsurance
Outpatient hospital (In/Out) $0-125 copay / 20% coinsurance

Outpatient physical, occupational, and speech therapy (In/Out)

$20 / $40 copay
Cardiac rehabilitation (In/Out) $0 / $0 copay
Comprehensive dental services allowance / preventative services $2,500 / $0 copay
Hearing aids / routine hearing exam $699-$999 copay per hearing aid per year / $0 copay
Eyewear allowance / routine eye exam $300 per year / $0 copay
Fitness, weight loss, and prescription hearing aid allowance (Flexible Benefit Card) $450
Transportation allowance (Flexible Benefit Card) $120 every 3 months
Over-the-counter purchases $120 every 3 months
Out-of-pocket maximum (In + Out combined) $3,150 / $5,450
This is the most you pay for covered medical services in a calendar year (does not include Part D drug costs). If you reach the maximum amount, Mass General Brigham Health Plan pays 100% of the cost of covered services, including part B drugs, through December 31.

Initial coverage: When your coverage begins, you pay your cost share for covered prescription drugs. Your cost for a 30-day supply from a participating retail pharmacy is below. Or save money using the CVS Caremark Mail Service Pharmacy. Get a three-month supply of many medications with a copay for only two. Refer to the Mass General Brigham
Health Plan Formulary for details.

Tier 1: $0 copay

Tier 2: $5 copay

Tier 3: $47 copay

Tier 4: $100 copay

Tier 5: $33% coinsurance

Catastrophic coverage: Beginning in 2025, if your out-of-pocket cost for Part D drugs reaches $2,000, you reach the Catastrophic Coverage Stage and pay nothing for covered Part D drugs. You may have cost sharing for drugs that are covered under our enhanced benefit.
 Please note: Drugs purchased outside the U.S. are not Medicare approved and are not covered.

2024 Plan information

Explore key 2024 benefit information for Mass General Brigham Advantage Premier (PPO).

You’ll find a summary of cost sharing for commonly used benefits in the table, or you can explore plan documents for detailed information:

plan-premier-2025
Monthly plan premium $140 per month
Primary Care (In/Out) $0 / $10 copay
Specialist (In/Out) $20 / $40 copay
Emergency room (In/Out) $90 copay
Urgent care (In/Out) $30 copay
Ambulance (In/Out) $200 copay
Inpatient hospital stays (In/Out) $125 days 1-3, $0 days 4 and beyond / 20% coinsurance
Outpatient hospital (In/Out) $0-125 copay / 20% coinsurance

Outpatient physical, occupational, and speech therapy (In/Out)

$20 / $40 copay
Cardiac rehabilitation (In/Out) $0 / $0 copay
Comprehensive dental services allowance / preventative services $2,500 / $0 copay
Hearing aids / routine hearing exam $699-$999 copay per hearing hair per year / $0 copay
Eyewear allowance / routine eye exam $300 per year / $0 copay
Over-the-counter purchases $120 every 3 months
Out-of-pocket maximum (In + Out combined) $3,150 / $5,450
This is the most you pay for covered medical services in a calendar year, not including Part D drug costs. If you reach the maximum, your health plan pays for 100% of covered services, including Part B drugs, through the end of the year.
Initial coverage: When your coverage begins, you pay your cost share for covered prescription drugs. Your cost for a 30-day supply from a participating retail pharmacy is below. Or save money using the CVS Caremark Mail Service Pharmacy. A three-month supply of many prescriptions is available for
only two co-pays. Refer to the Mass General Brigham Health Plan Formulary for details.

Tier 1: $0 copay

Tier 2: $3 copay

Tier 3: $37 copay

Tier 4: $100 copay

Tier 5: $33% coinsurance

Coverage gap: If your total drug costs in 2024 reach $5,030, your cost for prescription drugs changes. You pay:

25% for generic drugs and 25% for contracted brands
Catastrophic coverage: Beginning in 2024, if you reach the Catastrophic Coverage Stage, you pay nothing for covered Part D drugs. You may have cost sharing for excluded drugs that are covered under our enhanced benefit.

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Need more information about our plans? Contact a Medicare Advisor

Our dedicated Medicare Advisors are here to help. They can answer any questions about our plans including copays, coverage, and benefits.  

Set up a consultation or call now 855-486-3097 (TTY 711)

October 1-March 31
8 AM-8 PM ET, Mon-Sun

April 1-September 30
8 AM-8 PM ET, Mon-Fri

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