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 2025, 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 3.5 out of 5 stars in 2025.
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 has a $490 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy used. You will enter the next coverage phase once your total drug costs reach $2,000. In the initial coverage phase, you can expect to pay $10 or $20 for preferred generics, $45 or $47 for standard generics, 36% coinsurance for preferred brands, and 27% coinsurance for non-preferred drugs. Once your out-of-pocket drug costs reach $2,000, you will enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs.
Additional Benefits
The Health New England Medicare Value (HMO) plan offers a variety of benefits with varying costs. The plan covers inpatient hospital stays with a $375 copay for the first six days, and no copay for days 7-90. Emergency services have a $125 copay, and primary care visits cost $20. This plan also includes coverage for outpatient services, with copays ranging from $0 to $450, as well as hearing and vision services with copays of $50. Dental services are covered with a $740 annual maximum benefit, and home health services are covered with no copay. Additionally, the plan offers benefits like acupuncture with no copay, and a quarterly allowance of $55 for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For days 1-6, the copay is $375, and there is no copay for days 7-90.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $450, observation services with a $450 copay, ambulatory surgical center services with a $225 copay, and outpatient substance abuse services. Individual and group sessions for outpatient substance abuse have a copay of $50. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Health New England Medicare Value (HMO) plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $250 copay, 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 by the Health New England Medicare Value (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $250 copay.
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. Primary Care Physician Services and Chiropractic Services have a $20 copay, Occupational Therapy Services has a $45 copay, Physician Specialist Services have a $50 copay, and Physical Therapy and Speech-Language Pathology Services have a $45 copay. Mental Health and Psychiatric Services have a $50 copay for individual and group sessions. Additional Telehealth Benefits have a $25 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with prior authorization, annual physical exams, and additional preventive services, with some services like Health Education, In-Home Safety Assessment, and others not covered. This plan also covers Wigs for Hair Loss Related to Chemotherapy with a maximum benefit of $350 every year.
Hearing Services See details
Hearing Services includes coverage for hearing exams, with a $50 copay. Prescription hearing aids are covered, but only the "Prescription Hearing Aids (all types)" benefit, with a copay between $499 and $999. OTC hearing aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $50 copay, routine eye exams (1 per year), and other eye exam services (2 per year). Eyewear benefits include coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $200 every two years.
Dental Services See details
Dental services are covered, with a maximum benefit of $740 per year. Medicare dental services have a copay between $50 and $450, while other services like oral exams, dental x-rays, and orthodontics are covered with no copay.
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 under the Health New England Medicare Value (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance for Medicare-covered items, with no copay. Diabetic Equipment includes Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, but Diabetic Supplies are not covered, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic procedures/tests and lab services have a $25 copay, while diagnostic radiological services have a copay of at most $300, and outpatient X-ray services have a $35 copay. Therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Health New England Medicare Value (HMO) plan 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 technically covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. There is a copay for the services that are covered, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Health New England Medicare Value (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 for SNF are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture is covered with no copay or coinsurance, and there is no limit to the number of treatments. OTC items are covered up to $55 every three months, and the plan provides a meal benefit for chronic illness. 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, 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 are not covered.
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