Mass General Brigham Advantage Signature (PPO) plan information
Get to know 2025 benefit information for our Medicare Advantage Signature PPO plan.
2025 Plan information
Explore key 2025 benefit information for Mass General Brigham Advantage Signature (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!
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 | $299 per month |
| Primary Care (In/Out) | $0 / $0 copay |
| Specialist (In/Out) | $0 / $0 copay |
| Emergency room (In/Out) | $0 copay |
| Urgent care (In/Out) | $0 copay |
| Ambulance (In/Out) | $0 copay |
| Inpatient hospital stays (In/Out) | $0 copay / $0 copay |
| Outpatient hospital (In/Out) | $0 copay / $0 copay |
|
Outpatient physical, occupational, and speech therapy (In/Out) |
$0 copay / $0 copay |
| Cardiac rehabilitation (In/Out) | $0 / $0 copay |
| Comprehensive dental services allowance / preventative services | $3,0000 / $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 per year |
| Transportation allowance (Flexible Benefit Card) | $120 every 3 months |
| Over-the-counter purchases (Flexible Benefit Card) | $130 every 3 months |
| Out-of-pocket maximum (In + Out combined) | $0 / $0 |
| 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 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. | |
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October 1-March 31
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April 1-September 30
8 AM-8 PM ET, Mon-Fri
