Mass General Brigham Advantage Premier (PPO)

Plan information

Get to know our 2024 benefit information for Mass General Brigham Advantage Premier (PPO). You can find a summary of cost sharing for commonly used benefits in the table below, or get to know detailed information in the Summary of Benefits and Evidence of Coverage plan documents.

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: $0-$125 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: $75-$150 copay; OUT: 20% coinsurance
Lab IN: $0 copay; OUT: $10 copay
Plus more value
Comprehensive dental services allowance / preventative services $2,500 / $0 copay
Hearing aids1 / routine hearing exam $699-$999 copay per hearing aid per year / $0 copay
Eyewear allowance / routine eye exam $300 per year / $0 copay
Over-the-counter purchases $120 every three months
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: $3,150; IN and OUT combined: $5,450

Ready to enroll?

Learn how to enroll in a Medicare Advantage plan from Mass General Brigham Health Plan.