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Mass General Brigham Advantage Secure (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mass General Brigham Advantage Secure (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mass General Brigham Advantage Secure (HMO-POS) in 2025, please refer to our full plan details page.
Mass General Brigham Advantage Secure (HMO-POS) is a HMO-POS plan offered by Mass General Brigham Incorporated available for enrollment in 2025 to people living in Eastern Massachusetts. The overall rating for this plan is not yet available for 2025.
It's important to know that Mass General Brigham Advantage Secure (HMO-POS) 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 Mass General Brigham Advantage Secure (HMO-POS).
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 Advantage Secure (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $52.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7000.00 (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 $7000.00 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 Mass General Brigham Advantage Secure (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay depending on the drug tier and the pharmacy you use. For example, standard generic drugs have a $47 copay, while preferred generic drugs have a $5 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Mass General Brigham Advantage Secure (HMO-POS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services and preventive services often have no copay. The plan includes coverage for hearing, vision, and dental services, with copays and maximum benefits for specific services. Additional benefits include ambulance and transportation services, emergency services, and home health services, each with their own cost-sharing structure.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $250 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will also pay a $250 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and the plan does not cover additional days or non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $200, observation services, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a $20 copay, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Mass General Brigham Advantage Secure (HMO-POS) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Mass General Brigham Advantage Secure (HMO-POS) plan. Ground and air ambulance services have a $200 copay, and transportation services to any health-related location are covered. Transportation services to a plan-approved health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services and Worldwide Emergency Coverage have a $105 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Transportation has a $200 copay; all have no coinsurance. Worldwide Urgent Coverage has a $50 copay and no coinsurance.
Primary Care See details
The Mass General Brigham Advantage Secure (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $15 copay, physician specialist services with a $45 copay, and mental health specialty services with a $20 copay for individual and group sessions. Also covered are physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a $0-$45 copay, and opioid treatment program services. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services with no copay. Additional covered services include wigs for hair loss related to chemotherapy, weight management programs, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Some services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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.
Hearing Services See details
Hearing services include routine hearing exams with a $45 copay, and the fitting/evaluation for hearing aids is covered. Prescription hearing aids (all types) are covered with a copay between $699 and $999. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $45 copay, and routine eye exams once per year. Eyewear has a combined maximum benefit of $250 per year, and contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Mass General Brigham Advantage Secure (HMO-POS) plan covers dental services, including oral exams with a $45 copay, dental x-rays, prophylaxis (cleaning), fluoride treatments, and oral and maxillofacial surgery. This plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed) with prior authorization. Maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit of $2,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Mass General Brigham Advantage Secure (HMO-POS) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Mass General Brigham Advantage Secure (HMO-POS) plan, with Diagnostic Procedures/Tests having a $20 copay, Diagnostic Radiological Services having a copay of at most $160, Therapeutic Radiological Services having a copay of at most $60, and Outpatient X-Ray Services having a $10 copay; however, Lab Services are not covered. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered by the Mass General Brigham Advantage Secure (HMO-POS) plan, but the specific services of Cardiac Rehabilitation Services, 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 by the Mass General Brigham Advantage Secure (HMO-POS) plan, but require prior authorization. For days 1-20 and 45-100, there is no copay, while days 21-44 have a $160 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Mass General Brigham Advantage Secure (HMO-POS) plan covers Over-the-Counter (OTC) items with a maximum benefit of $95.00 every three months, including nicotine replacement therapy and Naloxone. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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