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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 2026, 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 out of 5 stars in 2026.
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 comprehensive medical coverage with predictable copays and no coinsurance for many essential services. Inpatient hospital stays require a $300 daily copay for the first six days followed by no copay, while primary care visits have a $15 copay and specialist visits cost $40. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgently needed care is available for a $50 copay. For supplemental wellness, the plan provides preventive and comprehensive dental care with no copay up to a $1,500 annual limit, alongside a $200 eyewear allowance every two years. Members also enjoy no copay for unlimited one-way medical transportation, home health services, and a $100 quarterly over-the-counter reimbursement. While some services like cardiac rehabilitation are excluded, dialysis and durable medical equipment are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Health New England Medicare Basic No Rx (HMO) covers inpatient hospital services with no coinsurance and a $300 daily copay for days 1 to 6, followed by no copay for days 7 to 90 for both acute and psychiatric stays. The benefit is partially covered because unlimited additional acute days are included at no copay, while additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Health New England Medicare Basic No Rx (HMO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $450 copay per stay for observation services. Additionally, ambulatory surgical center services require a $225 copay, outpatient substance abuse sessions have a $40 copay, and blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Health New England Medicare Basic No Rx (HMO) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Health New England Medicare Basic No Rx (HMO) covers ground and air ambulance services with a $350 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Health New England Medicare Basic No Rx (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $130 for emergency care, $50 for urgent care, and $350 for emergency transportation.
Primary Care See details
Health New England Medicare Basic No Rx (HMO) covers primary care and telehealth visits for a $15 copay and no coinsurance, while specialist visits, mental health sessions, and physical, occupational, and speech therapies require a $40 copay and no coinsurance. Opioid treatment is available with no copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Health New England Medicare Basic No Rx (HMO) offers partial coverage for preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, fitness benefits, and kidney disease education. However, several sub-services are not covered under this plan, such as health education, in-home safety assessments, personal emergency response systems, and therapeutic massage.
Hearing Services See details
Health New England Medicare Basic No Rx (HMO) covers hearing exams with a $40 copay and no coinsurance, including one annual routine exam with no copay. Prescription hearing aids are partially covered with copays between $499 and $999 and no coinsurance, though OTC, inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services covered by Health New England Medicare Basic No Rx (HMO) include routine eye exams for a $40 copay and no coinsurance, with no deductible. Eyewear, including contacts, frames, lenses, and upgrades, is covered with no copay and no coinsurance up to a $200 maximum limit every two years.
Dental Services See details
Health New England Medicare Basic No Rx (HMO) covers Medicare-certified dental services with a $40 to $450 copay and no coinsurance, subject to prior authorization. Other preventive and comprehensive dental services, including cleanings, exams, and implants, are covered with no copay and no coinsurance up to a $1,500 maximum annual benefit.
Home Infusion bundled Services See details
Health New England Medicare Basic No Rx (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while other Part B drugs, including chemotherapy and radiation drugs, have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Health New England Medicare Basic No Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Health New England Medicare Basic No Rx (HMO) partially covers medical equipment with no copay and a 20% coinsurance, and prior authorization is required. While durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered under this benefit, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Health New England Medicare Basic No Rx (HMO) partially covers diagnostic services with no copay or coinsurance, though diagnostic procedures, tests, and lab services are not covered. Radiological services require prior authorization and feature no copay for diagnostic radiology, a 20% coinsurance for therapeutic radiology, and a $30.00 copay for outpatient X-rays.
Home Health Services See details
Home health services are covered under the Health New England Medicare Basic No Rx (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Health New England Medicare Basic No Rx (HMO) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Health New England Medicare Basic No Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $200 daily copay for days 21 to 50, and no copay for days 51 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Health New England Medicare Basic No Rx (HMO) covers acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits with no copays and no coinsurance. Members receive unlimited acupuncture treatments and a $100 quarterly OTC reimbursement, though nicotine replacement therapy and naloxone are not covered.
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