Compare Medicare Advantage plans | Mass General Brigham Health Plan

	Advantage (PPO)	Advantage Secure (HMO-POS)	Advantage Premier (PPO)	Advantage Signature (PPO)
You pay	$0 per month	$52 per month	$140 per month	$299 per month

Primary Care (IN/OUT)	$0 / $20 copay	$0 / $20 copay	$0 / $10 copay	$0 / $0 copay
Specialist (IN/OUT)	$50 / $65 copay	$45 / $50 copay	$25 / $40 copay	$0 / $0 copay

Emergency room (In/Out)	$90	$105	$90	$0
Urgent care (In/Out)	$50	$50	$30	$0
Ambulance (In/Out)	$275	$200	$200	$0

Inpatient hospital stays (In/Out)	$350 days 1-5; $0 days 6-90 / 30% coinsurance	$250 days 1-5; $0 days 6-90 / 30% coinsurance	$150 days 1-3; $0 days 4-90 / 20% coinsurance	$0 copay / $0 copay
Outpatient hospital (In/Out)	$0-$300 copay / 40% coinsurance	$0-$200 copay / 30% coinsurance	$0-$125 copay / 20% coinsurance	$0 copay / $0 copay
Outpatient physical, occupational, and speech therapy (In/Out)	$40 copay / $65 copay	$15 copay / $50 copay	$20 copay / $40 copay	$0 copay / $0 copay
Cardiac rehabilitation (In/Out)	$0 copay / $65 copay	$0 copay / $0 copay	$0 copay / $0 copay	$0 copay / $0 copay

Comprehensive dental services allowance / preventative services	$1,500 / $0 copay	$2,000 / $0 copay	$2,500 / $0 copay	$3,000 / $0 copay
Hearing aids / routine eye exam	$699-$999 copay per hearing aid per year / $0 copay	$699-$999 copay per hearing aid per year / $0 copay	$699-$999 copay per hearing aid per year / $0 copay	$699-$999 copay per hearing aid per year / $0 copay
Eyewear allowance / routine eye exam	$200 per year / $0 copay	$250 per year / $0 copay	$300 per year / $0 copay	$300 per year / $0 copay
Fitness, weight loss, and prescription hearing aid allowance (Flexible Benefit Card)	$450 per year	$450 per year	$450 per year	$450 per year
Transportation allowance (Flexible Benefit Card)	$120 every 3 months	$120 every 3 months	$120 every 3 months	$120 every 3 months
Over-the-counter purchases (Flexible Benefit Card)	$85 every 3 months	$95 every 3 months	$120 every 3 months	$130 every 3 months

Out-of-pocket maximum (In / In + Out combined)	$5,500 / $9,550	$3,350 / $7,000	$3,150 / $5,450	$0 /$0
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.

	Advantage (PPO)	Advantage Secure (HMO-POS)	Advantage Premier (PPO)
You pay	$0 per month	$52 per month	$140 per month

Primary Care (IN/OUT)	$0 copay / $20 copay	$0 copay / $20 copay	$0 copay / $10 copay
Specialist (IN/OUT)	$45 copay / $65 copay	$40 copay / $50 copay	$20 copay / $40 copay

Emergency room (In/Out)	$90 copay	$105 copay	$90 copay
Urgent care (In/Out)	$50 copay	$50 copay	$30 copay
Ambulance (In/Out)	$275 copay	$200 copay	$200 copay

In-patient hospital stays (In/Out)	$335 days 1-5; $0 days 6-90 / 40% coinsurance	$230 days 1-5; $0 days 6-90 / 30% coinsurance	$125 days 1-3; $0 days 4 and beyond / 20% coinsurance
Outpatient hospital (In/Out)	$0-$300 copay / 40% coinsurance	$0-$200 copay / 30% coinsurance	$0-$125 copay / 20% coinsurance
Outpatient physical, occupational, and speech therapy (In/Out)	$40 copay / $65 copay	$15 copay / $50 copay	$20 copay / $40 copay
Cardiac rehabilitation (In/Out)	$0 copay / $65 copay	$0 copay / $0 copay	$0 copay / $0 copay

Comprehensive dental services allowance / preventative services	$1,500 / $0 copay	$2,000 / $0 copay	$2,500 / $0 copay
Hearing aids / routine eye exam	$699-$999 copay per hearing aid per year / $0 copay	$699-$999 copay per hearing aid per year / $0 copay	$699-$999 copay per hearing aid per year / $0 copay
Eyewear allowance / routine eye exam	$200 per year / $0 copay	$250 per year / $0 copay	$300 per year / $0 copay
Over-the-counter purchases	$85 every three months	$95 every three months	$120 every three months

Out-of-pocket maximum (In + Out combined)	$6,400 / $9,700	$3,350 / $7,000	$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 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 Part D drugs. You may have cost sharing for excluded drugs that are covered under our enhanced benefit. Please note: Drugs purchased outside the U.S. are not Medicare approved and are not covered.

When choosing a new plan, you should review costs and premiums to find the best fit. Review our Medicare Advantage plan comparison chart for basic information including premiums, copays, out-of-pocket maximums, and coinsurance.

It also helps to get a picture of your current healthcare history by asking yourself the following questions:

What were your total healthcare costs in the past year, including premiums, deductibles, copays, and coinsurance?
How often did you visit the doctor or hospital?
What medications do you take currently, and how often do you need to refill your prescriptions?

You can also confirm if your current doctors are covered in-network, and if your current prescriptions are covered. Review our Benefits page for detailed information about what else is included in our plans.

If you have any questions about Medicare Advantage plans from Mass General Brigham Health Plan, set up a call with one of our dedicated Medicare Advisors. They can review your plan options and help you choose the best option.

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