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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 2025, 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 3.5 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3000.00 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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you will have no copay for preferred generic drugs purchased through standard mail. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan also offers a Part D premium reduction if you qualify for the low-income subsidy.
Additional Benefits
The Mass Advantage Plus (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $160 copay for the first 5 days, and no copay for days 6-90. The plan also covers a wide range of outpatient services, with copays varying from $0 to $100, as well as primary care, preventive, hearing, vision, and dental services with copays between $15 and $90. Emergency services and ambulance services are also covered, with copays of $90 and $200 respectively. Additional benefits include coverage for home health services with no copay, and skilled nursing facility services with no copay for days 1-20 and days 52-100. The plan also provides coverage for home infusion services, medical equipment, and offers a quarterly over-the-counter (OTC) benefit of $135. Be aware that some services, such as certain diagnostic and radiological services, and additional hours of care, are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with prior authorization. For days 1-5, there is a $160 copay, and for days 6-90, there is no copay.
Outpatient Services See details
The Mass Advantage Plus (HMO) plan covers outpatient services including outpatient hospital services with a copay between $0 and $100, observation services with a $150 copay, and ambulatory surgical center (ASC) services with a $90 copay. Outpatient substance abuse services and outpatient blood services are also covered, with copays ranging from $10 to $100 for substance abuse services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Mass Advantage Plus (HMO) plan, but requires prior authorization. There is no information about the cost of the service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Mass Advantage Plus (HMO) plan. Ground and air ambulance services have a $200 copay, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered for up to 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Mass Advantage Plus (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, and Urgently Needed Services has no copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Mass Advantage Plus (HMO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services, Physician Specialist Services, Individual and Group Mental Health and Psychiatric Sessions all have a $15 copay. Additional Telehealth Benefits have a copay between $0 and $10, and Occupational Therapy and Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Mass Advantage Plus (HMO) plan covers preventive services including Medicare-covered zero-dollar preventive services, annual physical exams, and additional preventive services. The plan also covers Personal Emergency Response Systems (PERS), wigs for hair loss related to chemotherapy (up to $500 per year), weight management programs, alternative therapies, In-Home Support Services, and fitness benefits.
Hearing Services See details
Hearing exams are covered with a $15 copay, with one routine hearing exam covered per year. Prescription hearing aids are covered, with a copay between $600 and $2075 for two hearing aids per year. Fitting/evaluation for hearing aids, prescription hearing aids (inner ear, outer ear, over the ear) and OTC hearing aids are not covered.
Vision Services See details
The Mass Advantage Plus (HMO) plan covers vision services including eye exams with a $15 copay. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 every year.
Dental Services See details
The Mass Advantage Plus (HMO) plan covers Medicare Dental Services with a $15 copay, as well as 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), and Oral and Maxillofacial Surgery, but does not cover Maxillofacial Prosthetics, Implant Services, or Orthodontics. The plan also offers Orthodontic Services with a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Mass Advantage Plus (HMO) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 15%.
Dialysis Services See details
Dialysis Services are covered by the Mass Advantage Plus (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered under the Mass Advantage Plus (HMO) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The Mass Advantage Plus (HMO) plan offers partial coverage for Diagnostic and Radiological Services. Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $90.00.
Home Health Services See details
Home Health Services are covered by the Mass Advantage Plus (HMO) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but 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, but require prior authorization. For days 1-20, there is no copay, for days 21-51 there is a $75 copay, and for days 52-100, there is no copay.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a $135 benefit every three months, and a meal benefit for chronic illness, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered. The plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit, and covers all drugs on the CMS OTC list.
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