Monthly plan premium
This is paid in addition to your Part B premium. $140
Doctor visits
(In = in-network providers, OUT = out-of-network providers)
Primary care IN $0 copay; OUT $10 copay
Specialist IN $20 copay; OUT $40 copay
Emergency Care
Emergency care (in- and out-of-network) $90 copay
Urgent care (in- and out-of-network $30 copay
Emergency ambulance $200 copay
Hospital, surgery, and rehabilitation services
Inpatient hospital stays IN: $125 days 1-3; $0 days 4 and beyond; OUT: 20% coinsurance
Outpatient hospital IN: $175 copay; OUT: 20% coinsurance
Outpatient physical, occupational, and speech therapy IN: $20 copay; OUT: $40 copay
Cardiac rehabilitation IN and OUT: $0 copay
Diagnostic services
Outpatient x-ray (radiology) IN: $0 copay; OUT: $10 copay
Outpatient CT scans, PT scans, and MRIs IN: $150 copay; OUT: 20% coinsurance
Lab IN: $0 copay; OUT: $10 copay
Plus more value
Comprehensive dental services allowance / preventative services $1500 / $0 copay
Hearing aids1 / routine hearing exam $699-$999 copay1 / $0 copay
Eyewear allowance / routine eye exam $300 per year / $0 copay
Over-the-counter purchases $75 allowance per quarter
Maximum out-of-pocket protection

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.

IN: $3,450; IN and OUT combined: $5,450
1Per hearing aid per year

Ready to enroll?

Enroll online or download your application.