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Health New England Medicare Basic No Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health New England Medicare Basic 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 Basic No Rx (HMO) in 2025, please refer to our full plan details page.
Health New England Medicare Basic 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 Basic 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 Basic 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 Basic 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 $5500.00 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 Basic No Rx (HMO).
Additional Benefits
The Health New England Medicare Basic No Rx (HMO) plan offers a range of benefits, including inpatient and outpatient hospital care, with varying copays. Emergency, urgent, and ambulance services are covered, with copays ranging from $55 to $250. The plan also covers primary care, specialist visits, and therapy services, with copays generally between $20 and $50. This plan includes coverage for preventive services, hearing, vision, and dental services, with copays for exams and services. Additionally, it covers home infusion, dialysis, medical equipment, and diagnostic services, often with coinsurance. Other benefits include home health, skilled nursing facilities, and additional services like acupuncture, OTC items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For acute care, you'll pay a $300 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. For psychiatric care, you'll also pay a $300 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 are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $450, Observation Services have a $450 copay, Ambulatory Surgical Center (ASC) Services have a $225 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay between $50 and $50.
Partial Hospitalization See details
Partial Hospitalization is covered by the Health New England Medicare Basic No Rx (HMO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $250 copay, but Transportation Services to health-related locations 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; there is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services have a $25 copay, Chiropractic Services have a $20 copay, and Occupational Therapy Services have a $45 copay. Physician Specialist Services have a $50 copay, and Mental Health Specialty Services have a $50 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $45 copay. Additional Telehealth Benefits have a $25 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered. Some services are not covered, including 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 benefit, 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, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a $50 copay for each routine exam and fitting/evaluation for hearing aids, while 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 $50 copay, and eyewear with a combined maximum benefit of $200 every two years. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and contact lenses are covered, and upgrades are also covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic services, with a copay of $50 to $450; other services covered include prophylaxis (cleaning), fluoride treatment, and more. This plan also covers orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, 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 20%.
Dialysis Services See details
Dialysis Services are covered by the Health New England Medicare Basic No Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Health New England Medicare Basic No Rx (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Health New England Medicare Basic No Rx (HMO) plan covers diagnostic and radiological services. Diagnostic services have no copay, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $275, while Therapeutic Radiological Services have a coinsurance of 20% and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by Health New England Medicare Basic No Rx (HMO), with no copay or coinsurance. However, 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 Basic No Rx (HMO) plan. Some services are covered, but 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 under the Health New England Medicare Basic No Rx (HMO) plan, but require prior authorization. For days 1-20, there is a $10 copay; for days 21-50, the copay is $200; and for days 51-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Health New England Medicare Basic No Rx (HMO) plan covers acupuncture, over-the-counter (OTC) items, and a meal benefit. The plan covers OTC items up to $65 every three months, and covers a meal benefit for chronic illnesses; however, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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, 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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