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:
- 2025 Summary of Benefits (PDF)
- 2025 Evidence of Coverage (PDF) - Coming soon!
- Annual Notice of Changes for 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 |
| 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 |
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:
- 2024 Summary of Benefits (PDF) Updated 10/01/2023
- 2024 Evidence of Coverage (PDF) Updated 10/11/2023
- Annual Notice of Changes for 2024 Updated 10/12/2023
| 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
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April 1-September 30
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