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Mass Advantage Premiere (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mass Advantage Premiere (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mass Advantage Premiere (PPO) in 2025, please refer to our full plan details page.
Mass Advantage Premiere (PPO) is a PPO plan offered by Central Mass Health Holding LLC available for enrollment in 2025 to people living in Massachusetts (Partial). This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Mass Advantage Premiere (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 Advantage Premiere (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 Advantage Premiere (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 $9500.00 (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 $9500.00 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 Advantage Premiere (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at standard and mail order pharmacies. Standard generic drugs have a $42 copay at both standard and mail order pharmacies. Brand name drugs have 50% coinsurance, and non-preferred drugs have 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Mass Advantage Premiere (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. Emergency, urgent, and primary care services are covered, with copays ranging from $15 to $100. The plan also includes coverage for preventive, hearing, vision, and dental services, with specific copays and limitations for each. This plan provides additional benefits such as home health services with no copay, and coverage for medical equipment and home infusion. Additionally, the plan offers over-the-counter (OTC) items and a meal benefit for chronic illnesses. However, some services like cardiac rehabilitation and certain types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will also pay a $300 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Mass Advantage Premiere (PPO) plan covers outpatient hospital services with a copay between $0 and $175, observation services with a $250 copay, ambulatory surgical center services with a $175 copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Mass Advantage Premiere (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Mass Advantage Premiere (PPO), including ground and air ambulance services with a $275 copay, which is waived if admitted to the hospital. Transportation Services to plan-approved health-related locations are covered for up to 6 one-way trips per year, and other health-related transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Mass Advantage Premiere (PPO) plan. Emergency Services have a $100 copay, while Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $90 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Mass Advantage Premiere (PPO) plan covers primary care physician services, chiropractic services (with a $15 copay), occupational therapy (with a $30 copay), physician specialist services (with a $30 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 $30 copay), psychiatric services (with a $30 copay for individual and group sessions), physical therapy and speech-language pathology services (with a $30 copay), additional telehealth benefits (with a $0-$25 copay), and opioid treatment program services (with a $25 copay). Podiatry services are not covered.
Preventive Services See details
The Mass Advantage Premiere (PPO) plan covers preventive services, including annual physical exams, additional preventive services, kidney disease education services, and other preventive services. The plan also covers Personal Emergency Response System (PERS), Wigs for Hair Loss Related to Chemotherapy (with a maximum benefit of $500 per year), alternative therapies, and fitness benefits. Health education, in-home safety assessments, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, and prescription hearing aids with a copay between $600 and $2075, while fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered. Routine hearing exams are limited to 1 per year.
Vision Services See details
Vision Services includes coverage for eye exams with a $30 copay, and eyewear, with a combined maximum of $200 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Mass Advantage Premiere (PPO) plan covers Medicare dental services with a $30 copay, and other dental services including oral exams, dental x-rays, and cleanings, but excludes maxillofacial prosthetics, implant services, and orthodontics. Orthodontic services have a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Mass Advantage Premiere (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs. Other Medicare Part B Drugs have a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs also have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Mass Advantage Premiere (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies and Diabetic Equipment, is covered under the Mass Advantage Premiere (PPO) plan. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and require authorization; Diabetic Equipment requires prior authorization. Durable Medical Equipment for use outside the home, Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The Mass Advantage Premiere (PPO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a $20 copay, diagnostic radiological services with a $100 copay, and therapeutic radiological services with a $50 copay. Lab services and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the Mass Advantage Premiere (PPO) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Mass Advantage Premiere (PPO) plan. Despite the general coverage of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered by this plan.
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 21-51 there is a $190 copay, and for days 52-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for Skilled Nursing Facilities are not covered.
Other Services See details
Other Services include coverage for over-the-counter (OTC) items, with a maximum benefit of $125 every three months, and a meal benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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