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Mass General Brigham Advantage Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mass General Brigham Advantage Premier (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 Premier (PPO) in 2025, please refer to our full plan details page.
Mass General Brigham Advantage Premier (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 Premier (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 Premier (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 Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $140.00. 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 $5450.00 (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 $5450.00 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 Premier (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs with this plan. During the initial coverage phase, you'll pay a copay for your prescriptions. For example, you'll pay a $5 copay for preferred generic drugs at a standard pharmacy, and $47 for standard generic drugs. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Mass General Brigham Advantage Premier (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the specific service. The plan also covers primary care, preventive services, hearing, vision, and dental services, with specific copays for exams and other treatments. Additionally, the plan includes coverage for ambulance and transportation services, emergency services, and home health services with no copay. This plan provides coverage for home infusion, dialysis, and medical equipment with coinsurance or copays. Other covered benefits include partial hospitalization, skilled nursing facility stays, and access to over-the-counter items. However, some services like cardiac rehabilitation, certain dental procedures, and specific types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-3, and no copay for days 4-90, while for Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-3, and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $125, observation services, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services are covered, with individual and group sessions both having a copay of $10. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered with a $20 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $200 copay, with no coinsurance. 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 Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $30 copay, and Worldwide Emergency Transportation has a $200 copay; all services have no coinsurance.
Primary Care See details
The Mass General Brigham Advantage Premier (PPO) plan covers 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. Chiropractic services have a $20 copay, and Physician Specialist Services have a $25 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams, additional preventive services, kidney disease education services, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay. 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 of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. This plan also covers wigs for hair loss related to chemotherapy with a maximum benefit of $350 per year, weight management programs, fitness benefits, and remote access technologies.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids, which are covered with no copay. Prescription hearing aids are covered with a copay between $699 and $999 (2 per year), but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $25 copay, and eyewear with a combined maximum plan benefit of $300 every year for both in-network and out-of-network services; however, eyeglass lenses, eyeglass frames, and upgrades are not covered. Contact lenses are covered.
Dental Services See details
The Mass General Brigham Advantage Premier (PPO) plan covers Medicare Dental Services with a $25 copay. Other dental services, including 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 are covered, but some services require prior authorization, and there are limits on the number of visits and maximum coverage amounts. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin and other Medicare Part B drugs. 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 Premier (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, with a 20% coinsurance for Durable Medical Equipment and Prosthetic Devices, and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services with no copay, and diagnostic radiological services with a copay of up to $150, and therapeutic radiological services with a copay of up to $60. Outpatient X-Ray Services and Diagnostic Procedures/Tests are not covered.
Home Health Services See details
Home Health Services are covered by the Mass General Brigham Advantage Premier (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Mass General Brigham Advantage Premier (PPO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Mass General Brigham Advantage Premier (PPO) plan, but require prior authorization. There is no copay for days 1-20, a $160 copay for days 21-44, and no copay for days 45-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) items with a maximum benefit of $120 every three months, and a meal benefit for a chronic illness. 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 are not covered.
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