A non-government entity
Health New England Medicare Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health New England Medicare Value (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 Value (HMO) in 2026, please refer to our full plan details page.
Health New England Medicare Value (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 Value (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 Value (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 Value (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.
This plan has a $490.00 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 $6750.00 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 Health New England Medicare Value (HMO) plan features a $490 annual drug deductible. For Tier 1 preferred generic drugs, you will pay no copay for any supply length at a preferred pharmacy or for a 3-month supply via preferred mail order. Tier 2 generic drugs are also highly affordable, with a 1-month copay starting at $10 at preferred pharmacies and $20 at standard pharmacies. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at preferred pharmacies, while standard pharmacies charge $47. Higher-tier medications transition to coinsurance, with Tier 4 non-preferred drugs requiring a flat 33% coinsurance across all pharmacy options. Specialty drugs in Tier 5 carry a 27% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Health New England Medicare Value (HMO) plan offers comprehensive coverage for essential medical services with predictable copays and no coinsurance for most primary care. Members pay a $20 copay for primary care visits and a $50 copay for specialist visits, routine eye exams, and routine hearing exams. Inpatient hospital stays require a $375 daily copay for the first six to seven days, after which there is no copay for the remainder of the stay. To support your overall wellness, the plan provides several additional benefits with no copays or coinsurance, including preventive care, home health services, and unlimited transportation to plan-approved locations. You also receive up to $775 annually for dental care, a $300 annual eyewear allowance, and a $65 quarterly allowance for over-the-counter items with no copay. Emergency services are covered with a $130 copay, which is waived if you are admitted to the hospital.
Inpatient Hospital See details
Health New England Medicare Value (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 through 7 of acute stays (with no copay for days 8 and beyond) and a $375 daily copay for days 1 through 6 of psychiatric stays (with no copay for days 7 through 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Health New England Medicare Value (HMO) plan are covered with no coinsurance, including outpatient hospital services with a $0 to $450 copay and ambulatory surgical center services with a $225 copay, both requiring prior authorization. Additionally, patients will pay a $450 copay per stay for observation services, a $50 copay for outpatient substance abuse sessions, and no copay or coinsurance for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by Health New England Medicare Value (HMO) with a $50 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Health New England Medicare Value (HMO), requiring a $350 copay and no coinsurance for Medicare-covered ground and air ambulance services. Transportation is partially covered, offering unlimited 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 Value (HMO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance, requiring copays of $130, $50, and $350 respectively.
Primary Care See details
Health New England Medicare Value (HMO) covers primary care visits for a $20 copay and specialist visits for a $50 copay, both with no coinsurance. Physical, occupational, and speech therapies require a $45 copay with no coinsurance, mental health services have a $50 copay with no coinsurance, and opioid treatment has no copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Health New England Medicare Value (HMO) partially covers preventive services with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, and kidney disease education. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, alternative therapies, and therapeutic massage.
Hearing Services See details
Health New England Medicare Value (HMO) covers hearing exams with a $50 copay and no coinsurance, though routine annual exams have no copay. Prescription hearing aids are partially covered with a $499 to $999 copay and no coinsurance, while over-the-counter (OTC), inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Health New England Medicare Value (HMO) covers routine eye exams with a $50 copay and no coinsurance, with no deductible. Eyewear is also covered with no copay and no coinsurance up to a $300 combined annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Health New England Medicare Value (HMO) covers Medicare-covered dental services with a $50 to $450 copay and no coinsurance, which require prior authorization. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum benefit of $775 every year.
Home Infusion bundled Services See details
Health New England Medicare Value (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Health New England Medicare Value (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Health New England Medicare Value (HMO) with no copay and a 25% coinsurance, and prior authorization is required. Durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered under this benefit, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Health New England Medicare Value (HMO) covers diagnostic and radiological services, requiring prior authorization for all services. Diagnostic procedures and lab services have a $25 copay with no coinsurance, diagnostic radiological services have no copay, outpatient X-rays have a $35 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Health New England Medicare Value (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Health New England Medicare Value (HMO) covers some services for Cardiac Rehabilitation Services with no coinsurance, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Health New England Medicare Value (HMO) covers skilled nursing facility (SNF) care 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 Value (HMO) covers other services including acupuncture, meal benefits for chronic illnesses, and up to $65 in over-the-counter items every three months with no copay and no coinsurance. However, this benefit is only partially covered, as nicotine replacement therapy, naloxone, and certain other services are not covered.
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