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Health New England Medicare Premium No Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health New England Medicare Premium No Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health New England Medicare Premium No Rx (HMO) in 2025, please refer to our full plan details page.
Health New England Medicare Premium No Rx (HMO) is a HMO plan offered by Baystate Health, Inc. available for enrollment in 2025 to people living in Hampden, Hampshire, Franklin, Berkshire Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Health New England Medicare Premium No Rx (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Health New England Medicare Premium No Rx (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 Health New England Medicare Premium No Rx (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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 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
Prescription drugs are not covered by Health New England Medicare Premium No Rx (HMO).
Additional Benefits
The Health New England Medicare Premium No Rx (HMO) plan offers a range of benefits, including inpatient hospital stays with a $150 copay for the first six days, and no copay for days 7-90. Outpatient services, like doctor visits and some therapies, have copays ranging from $0 to $200. The plan also covers emergency services, hearing and vision exams, and dental services, along with home infusion, dialysis, and medical equipment with varying copays or coinsurance. This plan includes additional benefits like preventive services, such as annual exams and screenings, and also covers acupuncture and over-the-counter items up to $65 every three months. However, some services are not covered, including certain home health and personal care services, as well as specific therapies. Be sure to review the details of each benefit to understand the specific costs and limitations.
Inpatient Hospital See details
Inpatient Hospital benefits cover acute and psychiatric inpatient hospital stays. For days 1-6, there is a $150 copay, and days 7-90 have no copay. Additional days for inpatient hospital-acute are covered with no copay. Non-Medicare-covered stays and upgrades for inpatient hospital-acute, and additional days and non-Medicare-covered stays for inpatient hospital-psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $200, Observation Services with a $200 copay, Ambulatory Surgical Center (ASC) Services with a $100 copay, Individual and Group Sessions for Outpatient Substance Abuse with a $30 copay, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Health New England Medicare Premium No Rx (HMO) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Health New England Medicare Premium No Rx (HMO) plan. Medicare-covered Ground and Air Ambulance Services have a $250 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $55 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
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 are covered. Chiropractic services have a $20 copay, while Occupational Therapy Services have a $30 copay. Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services each have a $30 copay. Mental Health and Psychiatric individual and group sessions each have a $30 copay, and Other Health Care Professional services have a copay between $0 and $20. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Health New England Medicare Premium No Rx (HMO) plan covers preventive services, including Medicare-covered preventive services with prior authorization, annual physical exams, and additional preventive services like medical nutrition therapy, wigs for hair loss related to chemotherapy, weight management programs, fitness benefits, remote access technologies, and kidney disease education services. The plan also covers glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, health education, in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, 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 are not covered.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered. Prescription hearing aids are partially covered, with up to two hearing aids covered per year with a copay between $499 and $999, while inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $30 copay, and also includes coverage for eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. There is a combined maximum of $200 every two years for eyewear.
Dental Services See details
Dental services are covered, including Medicare Dental Services with a copay of $30-$200, and other dental services with a $750 annual maximum. 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), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are all covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Health New England Medicare Premium No Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Health New England Medicare Premium No Rx (HMO) plan. Durable Medical Equipment (DME) and Prosthetic Devices are covered with a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance; however, 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 Health New England Medicare Premium No Rx (HMO) plan. Diagnostic services have no copay, but diagnostic procedures, tests, and lab services are not covered. Diagnostic Radiological Services have a copay of at most $175.00. Therapeutic Radiological Services have at most 20% coinsurance, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Health New England Medicare Premium No Rx (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Pulmonary Rehabilitation Services. There is a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan, but require prior authorization. There is no copay for days 1-20 and days 51-100, but there is a $150 copay for days 21-50. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and meal benefits. Acupuncture is covered, and over-the-counter items are covered up to $65 every three months, while meal benefits are also covered for chronic illnesses. The plan does not cover 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.
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