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:

plan-advantage-2025

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 
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.

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:

plan-advantage-2024
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

 

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.

Please note: Drugs purchased outside the U.S. are not Medicare approved and are not covered.

Enroll in your new plan  

Ready to enroll? Sign up online, over the phone, or via mail. Learn more about your enrollment options and get started today.  

 

Enroll now

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.

October 1-March 31
8 AM-8 PM ET, Mon-Sun

April 1-September 30
8 AM-8 PM ET, Mon-Fri

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