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Health New England Medicare Compass (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health New England Medicare Compass (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health New England Medicare Compass (PPO) in 2026, please refer to our full plan details page.
Health New England Medicare Compass (PPO) is a PPO plan offered by Baystate Health, Inc. available for enrollment in 2025 to people living in Hampden, Hampshire, Franklin, Berkshire Counties. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that Health New England Medicare Compass (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Health New England Medicare Compass (PPO).
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 Health New England Medicare Compass (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $490.00 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 combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Health New England Medicare Compass (PPO)
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Drug Coverage
The Health New England Medicare Compass (PPO) prescription drug plan features an annual drug deductible of $490. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month, 2-month, or 3-month supply at a preferred pharmacy, while standard pharmacies charge a $5 copay for a 1-month supply. Tier 2 generic drugs cost a $10 copay for a 1-month supply at preferred pharmacies and a $20 copay at standard pharmacies. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at preferred pharmacies and a $47 copay at standard pharmacies. Higher-tier medications carry coinsurance, with Tier 4 non-preferred drugs requiring 30% coinsurance and Tier 5 specialty drugs requiring 27% coinsurance. Utilizing preferred pharmacies and preferred mail-order services generally offers the lowest out-of-pocket costs under this plan.
Additional Benefits
The Health New England Medicare Compass (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copays for preventive services, home health care, and unlimited transportation to approved medical sites. For standard doctor visits, members pay a $25 copay for primary care and a $50 copay for specialists with no coinsurance. Inpatient hospital stays require a $375 daily copay for the first several days, after which there is no copay, while emergency care carries a $130 copay that is waived if you are admitted. This plan also includes strong dental, vision, and hearing benefits, highlighted by no copays for preventive dental care up to a $775 annual limit and no copays for routine annual hearing exams. Vision services feature a $50 copay for eye exams and no copay for eyewear up to a $300 annual maximum. Additionally, members can access over-the-counter items with no copay, receiving up to $65 in quarterly reimbursements.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Health New England Medicare Compass (PPO) with no coinsurance, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $375 daily copay for days 1 to 7 and no copay for days 8 and beyond, while psychiatric stays require a $375 daily copay for days 1 to 6 and no copay for days 7 to 90.
Outpatient Services See details
Health New England Medicare Compass (PPO) covers outpatient hospital services with a copay of $0 to $450 and observation services with a $450 copay per stay, both featuring no coinsurance. Ambulatory surgical center services require a $225 copay with no coinsurance, outpatient substance abuse sessions have a $50 copay with no coinsurance, and outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Health New England Medicare Compass (PPO) with a $50.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Health New England Medicare Compass (PPO) covers ground and air ambulance services with a $325 copay and no coinsurance, while transportation services are partially covered. Under this plan, you pay no copay and no coinsurance for unlimited one-way rides to plan-approved health-related locations, though transportation to any other health-related location is not covered.
Emergency Services See details
Health New England Medicare Compass (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $50 for urgent care, $130 for emergency care, and $325 for emergency transportation.
Primary Care See details
Health New England Medicare Compass (PPO) covers primary care visits for a $25 copay, specialist visits for a $50 copay, and physical, occupational, and speech therapies for a $45 copay, all with no coinsurance. Mental health and psychiatric sessions require a $50 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Health New England Medicare Compass (PPO) with no copay and no coinsurance, though additional preventive benefits are only partially covered. Covered services include annual physical exams, fitness benefits, and kidney disease education, while excluded services include health education, personal emergency response systems, in-home safety assessments, alternative therapies, and therapeutic massage.
Hearing Services See details
Health New England Medicare Compass (PPO) covers hearing exams with a $50 copay and no coinsurance, though routine yearly exams have no copay. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $999, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Health New England Medicare Compass (PPO) covers vision services with no deductibles, offering eye exams for a $50 copay and no coinsurance, alongside eyewear with no copay or coinsurance. The plan includes a $300 annual combined maximum benefit for both in- and out-of-network eyewear, covering contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are covered by Health New England Medicare Compass (PPO), with Medicare-covered dental services requiring a $50 to $450 copay and no coinsurance. Other preventive and comprehensive dental services have no copay and no coinsurance, up to a combined annual maximum benefit of $775 for both in-network and out-of-network care.
Home Infusion bundled Services See details
Health New England Medicare Compass (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Part B insulin has a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and infusion drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Health New England Medicare Compass (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Health New England Medicare Compass (PPO) partially covers medical equipment with no copay, 25% coinsurance, and prior authorization requirements. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered under this plan, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Health New England Medicare Compass (PPO) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic tests, procedures, and lab services require a $25 copay and no coinsurance, while diagnostic radiology has no copay and no coinsurance, outpatient X-rays carry a $35 copay and coinsurance, and therapeutic radiology requires a copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Health New England Medicare Compass (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Health New England Medicare Compass (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, although some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Health New England Medicare Compass (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary and additional days beyond the Medicare-covered limit are not covered. Patients will pay a daily copayment of $10 for days 1 to 20, $200 for days 21 to 50, and no copay for days 51 to 100.
Other Services See details
Health New England Medicare Compass (PPO) provides coverage for acupuncture and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance, offering up to $65 every three months via reimbursement, excluding nicotine replacement therapy and naloxone.
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