Monthly plan premium
This is paid in addition to your Part B premium. $52
Doctor visits
(In = in-network providers, OUT = out-of-network providers)
Primary care IN $0 copay; OUT $20 copay
Specialist IN $40 copay; OUT $50 copay
Emergency Care
Emergency care (in- and out-of-network) $105 copay
Urgent care (in- and out-of-network $50 copay
Emergency ambulance $200 copay
Hospital, surgery, and rehabilitation services
Inpatient hospital stays IN: $230 days 1-5; $0 days 6-90; OUT: 30% coinsurance
Outpatient hospital IN: $200 copay; OUT: 30% coinsurance
Outpatient physical, occupational, and speech therapy IN: $15 copay; OUT: $50 copay
Cardiac rehabilitation IN and OUT: $0 copay
Diagnostic services
Outpatient x-ray (radiology) IN: $10 copay; OUT: 20% coinsurance
Outpatient CT scans, PT scans, and MRIs IN: $160 copay; OUT: 20% coinsurance
Lab IN: $0 copay; OUT: 20% coinsurance
Plus more value
Comprehensive dental services allowance / preventative services $1000 / $0 copay
Hearing aids1 / routine hearing exam $699-$999 copay1 / $0 copay
Eyewear allowance / routine eye exam $250 per year / $0 copay
Over-the-counter purchases $60 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: $7,000
1Per hearing aid per year

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Learn how to enroll or download your application.