A non-government entity
Health New England Medicare Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health New England Medicare Plus (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 Plus (HMO) in 2025, please refer to our full plan details page.
Health New England Medicare Plus (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 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 Health New England Medicare 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 Health New England Medicare Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $113.00. 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 $350.00 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 $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:
Sign up for Health New England Medicare Plus (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Health New England Medicare Plus (HMO) plan has a $350 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $10 copay at preferred pharmacies and $20 at standard pharmacies, while preferred brand drugs have a 38% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. If you qualify for low-income subsidy (LIS), the Part D premium is $14.20.
Additional Benefits
The Health New England Medicare Plus (HMO) plan offers a range of benefits with varying cost-sharing structures. Hospital stays have a copay of $250 for the first six days, with no copay for subsequent days. Outpatient services, primary care, specialist visits, and mental health services have copays between $20 and $300. This plan also covers ambulance services with a $250 copay, emergency services with a $125 copay, and hearing and vision services. Dental services are covered with copays ranging from $40 to $300, and other services have a maximum benefit of $775 per year. Many preventive services are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $250 copay for days 1-6, and no copay for days 7-90, while additional days are covered with no copay; non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric services, there is a $250 copay for days 1-6, and no copay for days 7-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $300, observation services have a $300 copay, ambulatory surgical center services have a $150 copay, and both individual and group sessions for outpatient substance abuse have a $40 copay. Outpatient blood services include a waived deductible of three pints.
Partial Hospitalization See details
Partial Hospitalization is covered under the Health New England Medicare Plus (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Health New England Medicare Plus (HMO), including both ground and air ambulance services with a $250 copay, but transportation services to any health-related location are not covered. There is no coinsurance for ambulance services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Health New England Medicare Plus (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Services have varying copays: $125 for Worldwide Emergency Coverage, $55 for Worldwide Urgent Coverage, and $250 for Worldwide Emergency Transportation.
Primary Care See details
The Health New England Medicare Plus (HMO) plan covers primary care physician services and chiropractic services with a $20 copay, as well as occupational therapy services with a $40 copay. Physician specialist services have a $40 copay, while mental health specialty services and psychiatric services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a $20 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Health New England Medicare Plus (HMO) plan covers preventive services, including annual physical exams, with no copay. This plan also covers Medical Nutrition Therapy (MNT) with a limit of 4 sessions and wigs for hair loss related to chemotherapy up to $350 per year. 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, 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 Services are covered, including hearing exams and prescription hearing aids. Hearing exams have a $40 copay, and prescription hearing aids have a copay between $499 and $999, depending on the type.
Vision Services See details
Vision Services include eye exams with a $40 copay, contact lenses, and eyeglasses, including lenses and frames, with a combined maximum benefit of $200 every two years. Routine eye exams are covered once per year, other eye exam services are covered twice per year, and eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered once every two years.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a copay ranging from $40 to $300, and other services with a maximum benefit of $775 per year. Oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, and other preventive services are covered. Restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, oral and maxillofacial surgery, and orthodontics are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 20%.
Dialysis Services See details
Dialysis Services are covered by the Health New England Medicare Plus (HMO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered under the Health New England Medicare Plus (HMO) plan, including Durable Medical Equipment, Prosthetics, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered; Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Health New England Medicare Plus (HMO), though Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $275, Therapeutic Radiological Services have a coinsurance of 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Health New England Medicare Plus (HMO) plan with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Health New England Medicare Plus (HMO) plan. Some services are covered, but Medicare-covered Intensive 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 by the Health New England Medicare Plus (HMO) plan, but require prior authorization. There is no copay for days 1-20 and days 51-100, but there is a $175 copay for days 21-50. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter items, and meal benefits. Acupuncture is covered with no copay or coinsurance, and the plan covers over-the-counter items up to $65 every three months. Meal benefits are also covered for chronic illnesses. However, other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and others are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved