Mass General Brigham Advantage Secure (HMO-POS) plan information
Get to know 2025 benefit information for our Medicare Advantage HMO plan.
2025 Plan information
Explore key 2025 benefit information for Mass General Brigham Advantage Secure (HMO-POS).
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 HMO plan doesn't require referrals from your primary care provider.
| Monthly plan premium | $52 per month |
| Primary Care (In/Out) | $0 / $20 copay |
| Specialist (In/Out) | $45 / $50 copay |
| Emergency room (In/Out) | $105 copay |
| Urgent care (In/Out) | $50 copay |
| Ambulance (In/Out) | $200 copay |
| Inpatient hospital stays (In/Out) | $250 days 1-5, $0 days 6-90 / 30% coinsurance |
| Outpatient hospital (In/Out) | $0-200 copay / 30% coinsurance |
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Outpatient physical, occupational, and speech therapy (In/Out) |
$15 / $50 copay |
| Cardiac rehabilitation (In/Out) | $0 / $0 copay |
| Comprehensive dental services allowance / preventative services | $2,000 / $0 copay |
| Hearing aids / routine hearing exam | $699-$999 copay per hearing hair per year / $0 copay |
| Eyewear allowance / routine eye exam | $250 per year / $0 copay |
| Fitness, weight loss, and prescription hearing aid allowance (Flexible Benefit Card) | $450 per year |
| Transportation allowance (Flexible Benefit Card) | $120 every 3 months |
| Over-the-counter purchases (Flexible Benefit Card) | $95 every 3 months |
| Out-of-pocket maximum (In + Out combined) | $3,350 / $7,000 |
| 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. | |
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Initial coverage: When your coverage begins, you pay your cost share for covered |
Tier 1: $0 copay Tier 2: $5 copay Tier 3: $47 copay Tier 4: $100 copay Tier 5: $33% coinsurance
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| 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. |
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| Please note: Drugs purchased outside the U.S. are not Medicare approved and are not covered. |
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2024 Plan information
Explore key 2024 benefit information for Mass General Brigham Advantage Secure (HMO-POS).
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 | $52 per month |
| Primary Care (In/Out) | $0 / $20 copay |
| Specialist (In/Out) | $40 / $50 copay |
| Emergency room (In/Out) | $105 copay |
| Urgent care (In/Out) | $50 copay |
| Ambulance (In/Out) | $200 copay |
| Inpatient hospital stays (In/Out) | $230 days 1-5; $0 days 6-90 / 30% coinsurance |
| Outpatient hospital (In/Out) | $0-200 copay / 30% coinsurance |
|
Outpatient physical, occupational, and speech therapy (In/Out) |
$15 / $50 copay |
| Cardiac rehabilitation (In/Out) | $0 / $0 copay |
| Comprehensive dental services allowance / preventative services | $2,000 / $0 copay |
| Hearing aids / routine hearing exam | $699-$999 copay per hearing hair per year / $0 copay |
| Eyewear allowance / routine eye exam | $250 per year / $0 copay |
| Over-the-counter purchases | $95 every 3 months |
| Out-of-pocket maximum (In + Out combined) | $3,350 / $7,000 |
| 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. | |
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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 |
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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 |
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| Catastrophic Coverage: Beginning in 2024, if you reach the Catastrophic Coverage Stage, you pay nothing for Part D drugs. You may have cost sharing for excluded drugs that are covered under our enhanced benefit. |
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| Please note: Drugs purchased outside the U.S. are not Medicare approved and are not covered. | ||
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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.
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October 1-March 31
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April 1-September 30
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