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Mass Advantage Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mass Advantage Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mass Advantage Plus (HMO) in 2026, please refer to our full plan details page.
Mass Advantage Plus (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 Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $95.00. 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 $150.00 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 $4750.00 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 Plus (HMO) Medicare plan features a low drug deductible of $150. Under this plan, members enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. This coverage applies to one-month, two-month, and three-month supplies, making essential medications highly accessible. For brand-name and specialty prescriptions, Tier 3 preferred brand drugs require a $47 copay for one month, or a $94 copay for two- and three-month supplies. Tier 4 non-preferred drugs require a 40% coinsurance, and Tier 5 specialty drugs have a 30% coinsurance for all supply durations. These clear cost structures help you plan your healthcare budget with standard pharmacy and standard mail-order options.
Additional Benefits
The Mass Advantage Plus (HMO) plan offers affordable coverage for everyday medical needs, featuring no copay for primary care visits, preventive services, and home health care. For specialized services, members pay a low $15 copay for specialist visits, routine eye exams, and routine hearing exams, while preventive and comprehensive dental services have no copay up to a $1,500 annual limit. If you require inpatient hospital care, there is no coinsurance, and you will pay a $210 daily copay for the first six days and no copay for days seven through 90. Emergency room visits carry a $130 copay and urgently needed services require a $15 copay, both with no coinsurance. The plan also includes valuable extras with no copay, such as a $110 quarterly over-the-counter allowance and up to 12 one-way trips to plan-approved locations. For major medical needs, durable medical equipment and dialysis require a 20% coinsurance, while prescription hearing aids carry copays between $600 and $2,075.
Inpatient Hospital See details
Mass Advantage Plus (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $210 daily copay for days 1 through 6 and no copay for days 7 through 90 per stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Mass Advantage Plus (HMO) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $100, alongside a $150 copay per stay for observation services. Ambulatory surgical center services require a $90 copay with no coinsurance, while outpatient substance abuse sessions have a $10 copay and outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Mass Advantage Plus (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Mass Advantage Plus (HMO) covers ambulance services with a $200 copay (waived if admitted) and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Mass Advantage Plus (HMO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $15 copay, both with no coinsurance. Worldwide emergency services are partially covered with a $130 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Mass Advantage Plus (HMO) covers primary care and opioid treatment services with no copay and no coinsurance, while specialists, psychiatric, and mental health services require a $15 copay and no coinsurance. Physical, occupational, and speech therapies have a $10 copay and no coinsurance, telehealth ranges from no copay to a $10 copay with no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services under Mass Advantage Plus (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and select supplemental benefits like fitness programs and weight management. However, these additional benefits are only partially covered, with services such as health education, therapeutic massage, and in-home safety assessments excluded from coverage.
Hearing Services See details
Hearing services under Mass Advantage Plus (HMO) are partially covered, featuring one annual routine hearing exam for a $15 copay and up to two prescription hearing aids per year with a copay between $600 and $2,075, both with no coinsurance. Hearing aid fittings or evaluations, over-the-counter (OTC) hearing aids, and inner-ear, outer-ear, or over-the-ear hearing aid types are not covered.
Vision Services See details
Vision services are partially covered by Mass Advantage Plus (HMO), offering annual routine eye exams with a $15 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 yearly maximum for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Mass Advantage Plus (HMO) partially covers dental services, offering Medicare-covered dental care for a $15 copay and no coinsurance, and preventive and comprehensive services with no copay and no coinsurance up to a $1,500 annual maximum. While many restorative and surgical procedures are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Mass Advantage Plus (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from 0% to 15%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Mass Advantage Plus (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Mass Advantage Plus (HMO) with no copays, as diabetic supplies and diabetic therapeutic shoes or inserts are not covered. Durable medical equipment, prosthetics, and medical supplies require prior authorization and carry a 20% coinsurance, while covered diabetic equipment has no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under Mass Advantage Plus (HMO) with no coinsurance and required prior authorization. Some diagnostic services are covered, but diagnostic procedures, tests, and lab services are not covered, while diagnostic radiological services require a minimum $90.00 copay, and therapeutic radiology and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by Mass Advantage Plus (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Mass Advantage Plus (HMO) plan, which includes no coverage for intensive cardiac rehabilitation, pulmonary rehabilitation, or SET for PAD services.
Skilled Nursing Facility (SNF) See details
Mass Advantage Plus (HMO) covers Skilled Nursing Facility (SNF) stays with no coinsurance, requiring prior authorization and no preceding three-day hospital stay. There is no copay for days 1 to 20 and days 52 to 100, a $140 copay for days 21 to 51, and additional days beyond 100 days are not covered.
Other Services See details
Mass Advantage Plus (HMO) provides partial coverage for other services, featuring a chronic illness meal benefit and a $110 quarterly over-the-counter (OTC) reimbursement with no copay and no coinsurance. However, acupuncture, Naloxone, and other specific services are not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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