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Mass Advantage Basic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mass Advantage Basic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mass Advantage Basic (HMO) in 2025, please refer to our full plan details page.
Mass Advantage Basic (HMO) is a HMO plan offered by Central Mass Health Holding LLC available for enrollment in 2025 to people living in Massachusetts (Partial). This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Mass Advantage Basic (HMO) 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 Advantage Basic (HMO).
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 Advantage Basic (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 Maximum Out-Of-Pocket cost of $5000.00 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 Advantage Basic (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different amounts depending on the drug tier and pharmacy type. For example, you will pay no copay for preferred generic drugs at a standard or mail order pharmacy. For standard generic drugs, you will pay a $47 copay at both standard and mail order pharmacies. For preferred brand drugs and non-preferred drugs, you will pay coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Mass Advantage Basic (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays, outpatient services, and ambulance services, each with varying copays. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, with specific copays for exams and other services. Additionally, the plan provides benefits for home infusion, dialysis, medical equipment, and diagnostic services, with some services requiring coinsurance. Other notable benefits include coverage for skilled nursing facilities with a tiered copay structure and over-the-counter items with a quarterly allowance. However, some services like routine chiropractic care, podiatry services, and certain dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-5 of Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stays, there is a $300 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $175, observation services with a $200 copay, and ambulatory surgical center services with a $175 copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $30. Outpatient blood services are also covered, including services not usually covered by Medicare plans, with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about cost.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $295 copay. Transportation services to a plan-approved health-related location are covered for 12 one-way trips per year, using rideshare services, bus/subway, or other transportation.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Mass Advantage Basic (HMO) plan. Emergency Services have a $100 copay, Urgently Needed Services have a $10 copay, and Worldwide Emergency Coverage has a $90 copay; all have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Mass Advantage Basic (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with no copay or coinsurance, physician specialist services with a $25 copay, mental health specialty services with a $25 copay for individual and group sessions, other health care professional services and psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with no copay or coinsurance, additional telehealth benefits with a $0-$20 copay, and opioid treatment program services. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered by the Mass Advantage Basic (HMO) plan. Specific services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $25 copay, as well as coverage for prescription hearing aids with a copay between $600 and $2075. Fitting/evaluation for hearing aids, 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 are covered, including routine eye exams with a $25 copay. Eyewear is covered with a combined maximum benefit of $200 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $25 copay. Other dental services like Oral Exams (2 visits per year), Dental X-Rays, and Prophylaxis (Cleaning) (2 visits per year) are covered. Orthodontic services are covered with a maximum benefit of $1500 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Mass Advantage Basic (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Lab Services and Outpatient X-Ray Services are not covered. Diagnostic Procedures/Tests have a copay of $15, while Diagnostic Radiological Services have a copay of $100, and Therapeutic Radiological Services have a copay of $50.
Home Health Services See details
Home Health Services are covered by the Mass Advantage Basic (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Mass Advantage Basic (HMO) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-51 the copay is $188, and for days 52-100, there is no copay.
Other Services See details
The Mass Advantage Basic (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $125.00 every three months. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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