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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 2025, 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 3.5 out of 5 stars in 2025.
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 $19.00. 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 $6750.00 (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 $6750.00 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:
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Drug Coverage
The Health New England Medicare Compass (PPO) plan has a $490 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $10 copay at preferred pharmacies and a $20 copay at standard pharmacies. For preferred brand drugs, you will pay 29% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Health New England Medicare Compass (PPO) plan offers a range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient services, with copays for services like emergency care, primary care visits, and specialist visits. Additional benefits include coverage for hearing and vision services, dental, and home health. The plan also covers services like ambulance, diagnostic and radiological services, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For the first 6 days of an inpatient hospital stay, there is a $375 copay, and days 7-90 have no copay; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Health New England Medicare Compass (PPO) plan, with copays ranging from $0 to $450 depending on the specific service. Observation Services have a $450 copay per stay, and Ambulatory Surgical Center (ASC) Services have a $225 copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $50. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Health New England Medicare Compass (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Health New England Medicare Compass (PPO) plan. Ground and Air Ambulance Services have a $300 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Health New England Medicare Compass (PPO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Health New England Medicare Compass (PPO) plan covers primary care physician services with a $25 copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, and physician specialist services with a $50 copay. Mental health specialty services have a $50 copay for individual and group sessions, and psychiatric services also have a $45 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $45 copay, and additional telehealth benefits have a $25 copay.
Preventive Services See details
Preventive Services, including Medicare-covered services, are covered, but Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. This plan also covers Medical Nutrition Therapy, Wigs for Hair Loss Related to Chemotherapy (up to $350 per year), Weight Management Programs, Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
The Health New England Medicare Compass (PPO) plan covers hearing exams with a $50 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $499 and $999, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $50 copay, and eyewear with a combined maximum of $200 every two years. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a yearly maximum of $750 for both in-network and out-of-network services. Medicare Dental Services have a copay between $50 and $400, while other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Health New England Medicare Compass (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
The Health New England Medicare Compass (PPO) plan covers Durable Medical Equipment with 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance, but does not cover Durable Medical Equipment for use outside the home. The plan also covers Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Lab Services have a $25 copay. Diagnostic Radiological Services have a copay of $0 and Therapeutic Radiological Services have a coinsurance of 20%. Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Health New England Medicare Compass (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Health New England Medicare Compass (PPO) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. You will pay a $10 copay for days 1-20, a $200 copay for days 21-50, and no copay for days 51-100.
Other Services See details
The Health New England Medicare Compass (PPO) plan covers acupuncture with no copay and no coinsurance, and over-the-counter (OTC) items with a maximum benefit of $55 every three months. The plan also offers a meal benefit for chronic illness with no maximum benefit. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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