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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 2026, 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 4 out of 5 stars in 2026.
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 a $250.00 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 $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) prescription drug plan features an annual drug deductible of $250. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications. This zero-cost coverage applies to one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. Tier 3 preferred brand drugs require a $42 copay for a one-month supply and an $84 copay for two-month or three-month fills. For higher-tier medications, you will pay a 40% coinsurance for Tier 4 non-preferred drugs and a 30% coinsurance for Tier 5 specialty drugs. These coinsurance rates apply to one-month, two-month, and three-month supplies at standard pharmacies and standard mail order.
Additional Benefits
The Mass Advantage Premiere (PPO) plan offers robust healthcare coverage with no copay or coinsurance for primary care visits and preventive services. For specialized care, members pay a $30 copay for specialist visits and routine eye or hearing exams, with no coinsurance. Inpatient hospital stays require a $350 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $130 copay. This plan also includes valuable supplemental benefits, such as dental care up to a $1,000 annual limit and eyewear coverage up to $200, both with no copays or coinsurance. Additionally, members benefit from home health services and up to six one-way transportation trips per year at no cost. Durable medical equipment and dialysis services require a 20% coinsurance with no copay, while a $100 quarterly over-the-counter allowance is provided with no copay or coinsurance.
Inpatient Hospital See details
Mass Advantage Premiere (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Mass Advantage Premiere (PPO) covers outpatient services with no coinsurance, featuring a $0 to $175 copay for outpatient hospital services and a $250 copay per stay for observation services. Ambulatory surgical center services require a $175 copay, outpatient substance abuse sessions have a $40 copay, and outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Mass Advantage Premiere (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Mass Advantage Premiere (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Transportation services are partially covered with no copay or coinsurance for up to 6 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Mass Advantage Premiere (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency services are partially covered with a $130 copay and no coinsurance, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Mass Advantage Premiere (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy services, and outpatient mental health sessions require a $30 copay and no coinsurance. Telehealth services feature a $0 to $25 copay with no coinsurance, but podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Mass Advantage Premiere (PPO) with no copay and no coinsurance for covered benefits, which include annual physical exams, kidney disease education, and glaucoma screenings. While fitness benefits, alternative therapies, and chemotherapy wigs (up to $500 annually) are covered, other services such as health education, therapeutic massage, and nutritional counseling are not covered.
Hearing Services See details
Mass Advantage Premiere (PPO) partially covers hearing services, offering one annual routine hearing exam with a $30 copay and no coinsurance. Prescription hearing aids are covered up to twice per year with no coinsurance and a copay between $600 and $2,075, but fitting evaluations, OTC hearing aids, and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Mass Advantage Premiere (PPO), offering routine eye exams for a $30 copay and no coinsurance once per year, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $200 annual combined maximum for one pair of eyeglasses or contact lenses.
Dental Services See details
Dental services are partially covered by Mass Advantage Premiere (PPO), offering Medicare-covered dental services for a $30 copay and no coinsurance, and other preventive and comprehensive services with no copay and no coinsurance up to a $1,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by Mass Advantage Premiere (PPO) with no copay, although prior authorization and step therapy may apply. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance of 0% to 20%, while Part B insulin drugs are covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Mass Advantage Premiere (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Mass Advantage Premiere (PPO) covers medical equipment with no copays, though durable medical equipment, prosthetics, and medical supplies require prior authorization and carry a 20% coinsurance. Diabetic equipment is covered with no coinsurance, but this benefit is only partially covered as diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Mass Advantage Premiere (PPO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Covered diagnostic procedures and tests require a $20 copay, diagnostic radiological services require a $100 copay, and therapeutic radiological services require a $50 copay, while lab services and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Mass Advantage Premiere (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Mass Advantage Premiere (PPO) with no coinsurance, but only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered, though they carry a $20 copay.
Skilled Nursing Facility (SNF) See details
Mass Advantage Premiere (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and days 52 through 100, and a $190 daily copay for days 21 through 51. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the Mass Advantage Premiere (PPO) are partially covered, offering chronic illness meal benefits and a $100 quarterly over-the-counter (OTC) allowance with no copay and no coinsurance. Acupuncture is not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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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