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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 2026, 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 4.5 out of 5 stars in 2026.
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 a $200.00 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 $6750.00 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 features an annual drug deductible of $200. Under this plan, you will have no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications. This benefit applies to one-, two-, and three-month supplies filled at standard retail pharmacies or through standard mail order. For Tier 3 (Preferred Brand) drugs, you will pay a $47 copay for a one-month supply and a $94 copay for two- or three-month supplies. Tier 4 (Non-Preferred Drug) medications require a 40% coinsurance, and Tier 5 (Specialty Tier) drugs require a 30% coinsurance. These cost-sharing rates apply to all supply lengths at standard pharmacies and through standard mail-order services.
Additional Benefits
The Mass Advantage Basic (HMO) plan offers affordable healthcare coverage with no copay for primary care visits, preventive services, and home health care. Most outpatient and emergency services require predictable copays with no coinsurance, including a $30 copay for specialist visits and a $130 copay for emergency room care. For inpatient hospital stays, members pay a $350 daily copay for the first five days and no copay for the remaining covered days. To support overall wellness, this plan features no copay for preventive and comprehensive dental care up to a $1,000 annual limit, alongside a $200 yearly allowance for eyewear with no copay. Routine hearing and eye exams are available for a $25 copay, while medical equipment is covered with no copay and varying coinsurance. Members also enjoy additional perks like over-the-counter benefits, post-discharge meals, and up to 12 free one-way transportation trips per year.
Inpatient Hospital See details
Mass Advantage Basic (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. These benefits are partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Mass Advantage Basic (HMO) covers outpatient hospital services with a $0 to $175 copay, ambulatory surgical center services with a $175 copay, and observation services with a $275 copay per stay, all with no coinsurance. Outpatient substance abuse sessions have a $30 copay, while outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Mass Advantage Basic (HMO) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Mass Advantage Basic (HMO) covers ground and air ambulance services with a $295 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Transportation services are partially covered, providing up to 12 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Mass Advantage Basic (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency services are partially covered with a $130 copay and no coinsurance, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Mass Advantage Basic (HMO) offers primary care and opioid treatment services with no copay and no coinsurance, while specialist visits require a $30 copay with no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies have copays ranging from $20 to $25 with no coinsurance, telehealth ranges from a $0 to $20 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Mass Advantage Basic (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Mass Advantage Basic (HMO) partially covers hearing services, offering one routine hearing exam per year for a $25.00 copay and no coinsurance, and up to two prescription hearing aids annually with a copay ranging from $600.00 to $2075.00 and no coinsurance. Hearing aid fittings and evaluations, OTC hearing aids, and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Mass Advantage Basic (HMO) provides partially covered vision services, including one annual routine eye exam for a $25 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $200 annual maximum allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by Mass Advantage Basic (HMO), with Medicare-covered dental services requiring a $25 copay and no coinsurance, while other covered preventive and comprehensive dental services feature no copay and no coinsurance up to a $1,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Mass Advantage Basic (HMO) with no copay, though prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered by the Mass Advantage Basic (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Mass Advantage Basic (HMO) covers medical equipment with no copays, though coinsurance costs vary. Durable medical equipment and medical supplies require a 20% coinsurance, prosthetic devices require a 50% coinsurance, and diabetic equipment is covered with no coinsurance but is only partially covered because diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Mass Advantage Basic (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required and lab services are not covered. Covered services feature no coinsurance, with copays of $15 for diagnostic procedures, $100 for diagnostic radiological services, $60 for therapeutic radiological services, and $5 for outpatient X-rays.
Home Health Services See details
Home Health Services are fully covered under the Mass Advantage Basic (HMO) plan, offering members access to these services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Mass Advantage Basic (HMO) plan. There is no coverage for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services under this plan.
Skilled Nursing Facility (SNF) See details
Mass Advantage Basic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 52 to 100, a $188 copay applies for days 21 to 51, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Mass Advantage Basic (HMO), which features over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan.
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