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Mass General Brigham SCO (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mass General Brigham SCO (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mass General Brigham SCO (HMO D-SNP) in 2026, please refer to our full plan details page.
Mass General Brigham SCO (HMO D-SNP) is a HMO D-SNP plan offered by Mass General Brigham Incorporated available for enrollment in 2026 to people living in Counties: Bris, Ess, Duk, Midd, Nan, Nor, Ply, Suf. The overall rating for this plan is not yet available for 2026.
It's important to know that Mass General Brigham SCO (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Mass General Brigham SCO (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Mass General Brigham SCO (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Mass General Brigham SCO (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Mass General Brigham SCO (HMO D-SNP) Medicare plan features an annual drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your prescription medications before the plan begins to cover its share of the costs. Understanding this initial cost is essential when budgeting for your yearly healthcare and prescription drug expenses. Specific drug coverage tier details, including individual copayments and coinsurance rates, are currently unavailable for this plan. To determine how your specific medications are covered and if you will face any additional costs after meeting the deductible, it is recommended to review the plan's comprehensive formulary.
Additional Benefits
The Mass General Brigham SCO (HMO D-SNP) plan offers robust healthcare coverage featuring no copays for almost all covered services, including inpatient hospital stays, primary care, and specialist visits. While many services require no copay, a standard 20% coinsurance applies to outpatient services, emergency care, medical equipment, and diagnostic tests. Medicare-defined deductibles apply to inpatient hospital stays, but other key areas like home health and skilled nursing facility services feature no copay and no coinsurance. Additionally, the plan provides valuable supplemental benefits to help manage everyday health costs, including a $200 annual allowance for eyewear and an over-the-counter item benefit of up to $250 every three months with no copay or coinsurance. Dental care is partially covered with no copays, though some services are subject to a 20% coinsurance. Diagnostic hearing exams are also fully covered with no copay, coinsurance, or deductible, making this plan a cost-effective option for essential healthcare needs.
Inpatient Hospital See details
Mass General Brigham SCO (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though Medicare-defined deductibles apply. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered, and prior authorization is required for acute care.
Outpatient Services See details
Mass General Brigham SCO (HMO D-SNP) covers outpatient services with no copayments, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered by Mass General Brigham SCO (HMO D-SNP) with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Mass General Brigham SCO (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Mass General Brigham SCO (HMO D-SNP) with a 20% coinsurance (up to $115 per visit, waived if admitted within 24 hours) and no copay, while urgently needed services require a 20% coinsurance (up to $40) and no copay. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Mass General Brigham SCO (HMO D-SNP) covers primary care, specialist, mental health, psychiatric, therapy, and opioid treatment services with no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Mass General Brigham SCO (HMO D-SNP) provides partially covered preventive services, featuring Medicare-covered zero-dollar services and fitness benefits with no copay and no coinsurance, alongside kidney education and screenings with no copay and 20% coinsurance. Services not covered under this benefit include annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Mass General Brigham SCO (HMO D-SNP) with no copay, no coinsurance, and no deductible for diagnostic exams, though routine exams and fitting evaluations are not covered. While some prescription hearing aid services are covered, no prescription hearing aid types—including inner ear, outer ear, and over the ear—or over-the-counter hearing aids are covered in practice.
Vision Services See details
Vision Services are partially covered by Mass General Brigham SCO (HMO D-SNP) with no deductibles, no copays, and a 20% coinsurance for routine eye exams and contact lenses. One routine eye exam per year and up to $200 annually for eyewear are covered, but other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Mass General Brigham SCO (HMO D-SNP), offering Medicare-covered dental services with no copay and a 20% coinsurance, and other covered dental services with no copay and no coinsurance. While many preventive and restorative services are included, other diagnostic dental services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Mass General Brigham SCO (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Mass General Brigham SCO (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Mass General Brigham SCO (HMO D-SNP) with no copay and 20% coinsurance. This benefit includes durable medical equipment, prosthetics, medical supplies, and diabetic equipment, all of which require prior authorization and may have preferred vendor or manufacturer limitations.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under Mass General Brigham SCO (HMO D-SNP), with prior authorization required and no copays for any services. Covered diagnostic procedures, outpatient X-rays, and diagnostic or therapeutic radiological services are subject to a 20% coinsurance, while lab services are not covered.
Home Health Services See details
Home health services are covered by Mass General Brigham SCO (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Mass General Brigham SCO (HMO D-SNP) with no copay, meaning some services are covered, though standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Mass General Brigham SCO (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered. This benefit does not require a three-day prior inpatient hospital stay before admission.
Other Services See details
Mass General Brigham SCO (HMO D-SNP) provides partial coverage for other services, featuring over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $250 every three months. Acupuncture, meal benefits, and highly integrated services for dual eligibles are not covered under this plan.
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