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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 2026, 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 2026.
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 $150.00. 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 $350.00 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 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) medicare plan features a $350 annual drug deductible. Under this plan, there is no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, you will pay a low copay starting at $5.00 for a one-month supply. For Tier 3 preferred brand drugs, the copay is $47.00 for a one-month supply at standard pharmacies and mail order. Tier 4 non-preferred drugs require a 25% coinsurance, and Tier 5 specialty drugs have a 29% coinsurance for a one-month supply. These tier-based costs help you understand your out-of-pocket expenses for prescriptions.
Additional Benefits
The Mass General Brigham Advantage Premier (PPO) plan provides comprehensive healthcare coverage with predictable out-of-pocket costs, featuring no copays and no coinsurance for primary care visits, annual physicals, and home health services. Specialist office visits require a $25 copay, while inpatient hospital stays are covered with a $150 daily copay for the first three days and no copay for days four through ninety. Emergency room visits carry a $150 copay, which is waived if admitted within twenty-four hours, and urgent care services are available for a $30 copay. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental services up to a $2,500 annual limit with no copay, and a $300 annual eyewear allowance. Routine hearing exams are available with a $25 copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Members also receive no-copay over-the-counter items up to $120 every three months and health-related transportation up to $120 every three months.
Inpatient Hospital See details
Mass General Brigham Advantage Premier (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $150 per day for days 1 through 3, followed by no copay for days 4 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Mass General Brigham Advantage Premier (PPO) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $125, while ambulatory surgical center and blood services have no copay and no coinsurance. Outpatient substance abuse individual and group sessions are covered with a $10 copay and no coinsurance.
Partial Hospitalization See details
Mass General Brigham Advantage Premier (PPO) covers partial hospitalization services with a $20.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Mass General Brigham Advantage Premier (PPO), featuring a $300 copay and no coinsurance for both ground and air ambulance services. Additionally, transportation to any health-related location is covered with no copay and no coinsurance, up to a maximum benefit limit of $120 every three months.
Emergency Services See details
Mass General Brigham Advantage Premier (PPO) covers emergency services with a $150 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with no coinsurance and copays of $150, $30, and $300, respectively.
Primary Care See details
Mass General Brigham Advantage Premier (PPO) covers primary care physician services and opioid treatment with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, and speech therapies have a $20 copay and no coinsurance, while mental health and psychiatric sessions carry a $10 copay and no coinsurance. Some chiropractic services are covered, but routine and other chiropractic services are not covered, and podiatry is not covered.
Preventive Services See details
Preventive services are covered by Mass General Brigham Advantage Premier (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness, weight management, remote access, and chemotherapy wigs (up to $350 annually), but do not cover health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home/bathroom safety modifications, or counseling.
Hearing Services See details
Hearing Services are partially covered by Mass General Brigham Advantage Premier (PPO), offering routine hearing exams for a $25 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $699 to $999 and no coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Mass General Brigham Advantage Premier (PPO) offers partially covered vision services, which include one routine eye exam per year for a $25 copay and no coinsurance, while other eye exams are not covered. Eyewear is also partially covered with no copay, no coinsurance, and no deductible up to a $300 annual limit for contact lenses and eyeglasses, though individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Mass General Brigham Advantage Premier (PPO) plan, featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services up to a $2,500 annual limit. Other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Mass General Brigham Advantage Premier (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Mass General Brigham Advantage Premier (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Mass General Brigham Advantage Premier (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Mass General Brigham Advantage Premier (PPO) with no coinsurance, requiring prior authorization for all services. Covered care includes lab services with no copay, diagnostic radiological services with a minimum $75 copay, and therapeutic radiological services with a minimum $60 copay, while diagnostic procedures/tests and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Mass General Brigham Advantage Premier (PPO) 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 Mass General Brigham Advantage Premier (PPO) plan. While the benefit technically features no copay and no coinsurance, in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are all not covered.
Skilled Nursing Facility (SNF) See details
Mass General Brigham Advantage Premier (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 45 to 100, a $160 daily copay for days 21 to 44, and additional days beyond the Medicare limit are not covered.
Other Services See details
Mass General Brigham Advantage Premier (PPO) provides partially covered other services, which feature over-the-counter (OTC) items up to $120 every three months and meals for chronic illness with no copay and no coinsurance. Acupuncture and other additional services are not covered under this benefit.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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