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Mass General Brigham Advantage (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mass General Brigham Advantage (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mass General Brigham Advantage (PPO) in 2025, please refer to our full plan details page.
Mass General Brigham Advantage (PPO) is a PPO plan offered by Mass General Brigham Incorporated available for enrollment in 2025 to people living in Eastern Massachusetts. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Mass General Brigham Advantage (PPO) 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 Mass General Brigham Advantage (PPO).
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 Mass General Brigham Advantage (PPO), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9550.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Mass General Brigham Advantage (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. The copay varies depending on the drug tier and whether you use a preferred or standard pharmacy. For example, the copay for a preferred generic drug is $5.00, while the copay for a standard generic drug is $47.00. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for your prescriptions.
Additional Benefits
The Mass General Brigham Advantage (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll find no copay for primary care visits, preventive services, and home health services. The plan also includes coverage for hearing, vision, and dental services with copays for exams and specific services. Additionally, the plan covers ambulance, emergency, and skilled nursing facility services, as well as home infusion and dialysis services, with either copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $300, and outpatient substance abuse services have a $30 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Mass General Brigham Advantage (PPO) 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 by the Mass General Brigham Advantage (PPO) plan. Ground and air ambulance services have a $275 copay, and transportation services to any health-related location are covered with a maximum plan benefit coverage amount of $120 every three months.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Mass General Brigham Advantage (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $50 copay, and Worldwide Emergency Transportation has a $275 copay; all services have no coinsurance.
Primary Care See details
The Mass General Brigham Advantage (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, physician specialist services with a $50 copay, and mental health specialty services with a $30 copay for individual and group sessions. The plan also covers other health care professionals with a copay between $0 and $50, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a $25 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Mass General Brigham Advantage (PPO) plan covers preventive services, including annual physical exams, with no copay. The plan also covers wigs for hair loss related to chemotherapy, with a maximum benefit of $350 per year, as well as weight management programs, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 counseling services are not covered.
Hearing Services See details
Hearing Services include Routine Hearing Exams with a $50 copay for one visit per year, and Fitting/Evaluation for Hearing Aids with no copay. Prescription Hearing Aids (all types) are covered with a copay between $699 and $999 for two visits per year, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered; OTC Hearing Aids are also not covered.
Vision Services See details
Vision Services include eye exams with a $50 copay. Eyewear is covered, with a combined maximum benefit of $200 every year for both in-network and out-of-network services. Contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Mass General Brigham Advantage (PPO) plan covers Medicare dental services with a $50 copay. Other dental services are covered up to a $1500 maximum benefit per year, and include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not 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 under the Mass General Brigham Advantage (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance; Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay of $20, while Lab Services are not covered. Diagnostic Radiological Services have a copay up to $160 with a minimum of $75, Therapeutic Radiological Services have a copay up to $60 with a minimum of $60, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Mass General Brigham Advantage (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Mass General Brigham Advantage (PPO) plan, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, for days 21-44, the copay is $160, and for days 45-100, there is no copay.
Other Services See details
The Mass General Brigham Advantage (PPO) plan does not cover acupuncture, 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. Over-the-counter (OTC) items are covered with a maximum benefit of $85.00 every three months, and the plan offers a meal benefit for chronic illness.
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