Mass General Brigham Advantage (PPO) plan information
Get to know 2025 benefit information for our
Medicare Advantage PPO plan.
2025 Plan information
Explore key 2025 benefit information for Mass General Brigham Advantage (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) Updated 10/1/24
- 2025 Evidence of Coverage (PDF) Updated 10/15/24
- Annual Notice of Changes for 2025 Updated 10/1/24
Did you know?
Advantage PPO has the lowest monthly premium out of our plan options. This plan is best for people who don’t need to go to the doctor very often and want to keep monthly costs lower.
| Monthly plan premium | $0 per month |
| Primary Care (In/Out) | $0 / $20 copay |
| Specialist (In/Out) | $50 / $65 copay |
| Emergency room (In/Out) | $90 copay |
| Urgent care (In/Out) | $50 copay |
| Ambulance (In/Out) | $275 copay |
| Inpatient hospital stays (In/Out) | $350 days 1-5, $0 days 6-90 / 30% coinsurance |
| Outpatient hospital (In/Out) | $0-300 copay / 40% coinsurance |
|
Outpatient physical, occupational, and speech therapy (In/Out) |
$40 / $65 copay |
| Cardiac rehabilitation (In/Out) | $0 / $65 copay |
| Comprehensive dental services allowance / preventative services | $1,500 / $0 copay |
| Hearing aids / routine hearing exam | $699-$999 copay per hearing aid per year / $0 copay |
| Eyewear allowance / routine eye exam | $200 per year / $0 copay |
| Fitness, weight loss, and prescription hearing aid allowance (Flexible Benefit Card) | $450 per year |
| Transportation allowance (Flexible Benefit Card) | $120 per quarter |
| Over-the-counter purchases (Flexible Benefit Card) | $85 per quarter |
| Out-of-pocket maximum (In + Out combined) | $5,500 / $9,550 |
| 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 |
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 (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 10/1/2023
- 2024 Evidence of Coverage (PDF) Updated 10/11/2023
- Annual Notice of Changes for 2024 Updated 10/12/2023
| Monthly plan premium | $0 per month |
| Primary Care (In/Out) | $0 / $20 copay |
| Specialist (In/Out) | $45 / $65 copay |
| Emergency room (In/Out) | $90 copay |
| Urgent care (In/Out) | $50 copay |
| Ambulance (In/Out) | $275 copay |
| Inpatient hospital stays (In/Out) | $335 days 1-5; $0 days 6-90 / 40% coinsurance |
| Outpatient hospital (In/Out) | $0-$300 copay / 40% coinsurance |
|
Outpatient physical, occupational, and speech therapy (In/Out) |
$40 / $65 copay |
| Cardiac rehabilitation (In/Out) | $0 / $65 copay |
| Comprehensive dental services allowance / preventative services | $1,500 / $0 copay |
| Hearing aids / routine hearing exam | $699-$999 copay per hearing aid per year / $0 copay |
| Eyewear allowance / routine eye exam | $200 per year / $0 copay |
| Over-the-counter purchases | $85 every 3 months |
| Out-of-pocket maximum (In + Out combined) | $6,400 / $9,700 |
| 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. 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 |
|
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. |
|
| 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?
Our dedicated Medicare Advisors are here to help. They can answer any questions about our plans including copays, coverage, and benefits.
Call 855-486-3097 (TTY 711)
Or schedule a consultation.
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April 1-September 30
8 AM-8 PM ET, Mon-Fri
