A non-government entity
Mass General Brigham One Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mass General Brigham One Care (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 One Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Mass General Brigham One Care (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 One Care (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 One Care (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 One Care (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 One Care (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:
Sign up for Mass General Brigham One Care (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Mass General Brigham One Care (HMO D-SNP) prescription drug coverage includes an annual drug deductible of $615. Beneficiaries must pay this deductible amount out-of-pocket for covered medications before the plan starts sharing the costs. While specific drug tier details, copays, and coinsurance levels are not currently available for this plan, knowing this deductible is essential for estimating your initial yearly healthcare expenses. For a complete list of covered medications and exact pricing, it is recommended to consult the plan's formulary directly.
Additional Benefits
The Mass General Brigham One Care (HMO D-SNP) offers coverage for essential medical services, generally featuring no copayments alongside a standard 20% coinsurance for outpatient and specialist care. Inpatient hospital stays, home health services, and skilled nursing facility care are covered with no copay and no coinsurance, though prior authorizations and deductibles may apply. Emergency care, primary care visits, and diagnostic services also feature no copay, typically requiring a 20% coinsurance. While the plan covers Medicare-approved preventive services and diagnostic hearing exams with no copay, routine dental, vision, and hearing benefits like eyeglasses and hearing aids are not covered. Additionally, medical equipment, dialysis, and home infusion services are available with no copay and up to a 20% coinsurance. Common supplemental benefits such as routine transportation, fitness programs, and over-the-counter items are excluded under this plan.
Inpatient Hospital See details
Mass General Brigham One Care (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric stays with no copay and no coinsurance, though a deductible applies and acute care requires prior authorization. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Mass General Brigham One Care (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Mass General Brigham One Care (HMO D-SNP) plan with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Mass General Brigham One Care (HMO D-SNP) partially covers ambulance and transportation services, offering ground and air ambulance services with a 20% coinsurance, no copay, and prior authorization requirements. Routine transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Mass General Brigham One Care (HMO D-SNP) covers emergency services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within 24 hours. Urgently needed services are also covered with a 20% coinsurance and no copay, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Mass General Brigham One Care (HMO D-SNP) covers primary care, specialist visits, therapy services, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Mass General Brigham One Care (HMO D-SNP) covers preventive services, providing Medicare-covered zero-dollar preventive services with no copay. While annual physical exams and additional benefits like fitness and health education are not covered, other services such as kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs following a welcome visit are covered with no copay and a 20% coinsurance.
Hearing Services See details
Mass General Brigham One Care (HMO D-SNP) covers diagnostic hearing exams with no copay, no coinsurance, and no deductible. Routine hearing exams, hearing aid fittings and evaluations, and both prescription and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are offered by Mass General Brigham One Care (HMO D-SNP) with no copay and 20% coinsurance, but in practice, the plan does not cover any services. Key benefits, including routine eye exams, other eye exams, contact lenses, and eyeglasses, are all not covered.
Dental Services See details
Mass General Brigham One Care (HMO D-SNP) partially covers dental services, providing coverage for Medicare-covered dental care with no copay and a 20% coinsurance. Routine and comprehensive dental services, such as oral exams, cleanings, x-rays, fluoride, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Mass General Brigham One Care (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and other infusion drugs, carry a 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Mass General Brigham One Care (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Mass General Brigham One Care (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic equipment. Prior authorization is required for these benefits, and certain supplies may be restricted to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Mass General Brigham One Care (HMO D-SNP) partially covers diagnostic and radiological services with prior authorization required, offering no copay and a 20% minimum coinsurance for covered services. Covered services include diagnostic procedures, therapeutic radiology, and outpatient X-rays, while laboratory services are not covered.
Home Health Services See details
Mass General Brigham One Care (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Mass General Brigham One Care (HMO D-SNP) with no copay, though only some services are covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Mass General Brigham One Care (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The plan allows admission with less than a three-day prior inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Mass General Brigham One Care (HMO D-SNP) covers some services under its Other Services benefit, but acupuncture, Over-the-Counter (OTC) items, and meal benefits are not covered. Because these specific sub-services are excluded, there are no copays or coinsurance costs associated with them under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved