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Mass Advantage Extra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mass Advantage Extra (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mass Advantage Extra (PPO) in 2026, please refer to our full plan details page.
Mass Advantage Extra (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 Extra (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 Extra (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 Extra (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 $200.00 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 $10000.00 (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 $10000.00 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 Extra (PPO) plan features a $200 annual prescription drug deductible. Beneficiaries pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. For Tier 3 (Preferred Brand) drugs, you will pay a $37 copay for a one-month supply and a $74 copay for a two- or three-month supply. Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) prescriptions require a 30% coinsurance across all supply lengths at standard pharmacies and standard mail order. These cost-sharing rates apply during the plan's initial coverage phase.
Additional Benefits
The Mass Advantage Extra (PPO) plan offers robust medical coverage with predictable out-of-pocket costs to help you manage your healthcare budget. Members enjoy no copay and no coinsurance for primary care doctor visits, preventive services, and home health care. For specialized care, inpatient hospital stays require a daily copay of $380 for days 1 through 6 with no coinsurance, while emergency room visits carry a $130 copay. In addition to core medical care, this plan features excellent supplemental benefits like dental coverage with no copay or coinsurance for preventive and comprehensive services up to a $1,500 annual limit. Routine vision and hearing exams are available with a $45 copay, and eyewear is covered with no copay up to a $200 yearly limit. Members also receive a $120 reimbursement every three months for eligible over-the-counter items with no copay, alongside covered durable medical equipment which carries a 20% coinsurance.
Inpatient Hospital See details
Mass Advantage Extra (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $380 for days 1 through 6 of acute stays and $375 for days 1 through 6 of psychiatric stays, with no copay for days 7 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Mass Advantage Extra (PPO) covers outpatient services with no coinsurance, featuring copays ranging from no copay up to $300 for outpatient hospital and ambulatory surgical center services, and a $40 copay for outpatient substance abuse sessions. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Mass Advantage Extra (PPO) with a $55.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Mass Advantage Extra (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services are partially covered, offering up to 6 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Mass Advantage Extra (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, alongside urgently needed services for a $40 copay and no coinsurance. Worldwide emergency services are partially covered with a $130 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Mass Advantage Extra (PPO) features primary care doctor visits and select telehealth services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Additional covered benefits include physical, occupational, and speech therapy for a $40 copay, mental health and psychiatric sessions for a $30 copay, and opioid treatment for a $25 copay, all with no coinsurance, while podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by the Mass Advantage Extra (PPO) plan with no copay and no coinsurance for covered care such as annual physicals, weight management, and fitness benefits. Excluded sub-services that are not covered include health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Mass Advantage Extra (PPO), featuring routine hearing exams for a $45 copay and no coinsurance once per year. Prescription hearing aids are covered with no coinsurance and a copay ranging from $600 to $2,075 for up to two aids per year, but hearing aid fitting/evaluations, OTC hearing aids, and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Mass Advantage Extra (PPO) because other eye exam services are not covered. Routine eye exams are covered once yearly with a $45 copay and no coinsurance, and eyewear is covered with no copay, no coinsurance, and a $200 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
Mass Advantage Extra (PPO) dental services are partially covered, featuring a $45 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for preventive and comprehensive services up to a $1,500 annual limit. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Mass Advantage Extra (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Mass Advantage Extra (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Mass Advantage Extra (PPO) with no copays, though prior authorization is required for all services. Durable medical equipment, prosthetics, and medical supplies require a 20% coinsurance, while diabetic equipment is partially covered with no coinsurance as diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under the Mass Advantage Extra (PPO) plan with no coinsurance, though prior authorization is required. While diagnostic procedures and tests require a $30 copay, diagnostic radiological services carry a $150 copay, therapeutic radiological services carry a $60 copay, and outpatient x-rays carry a $15 copay, lab services are not covered.
Home Health Services See details
Mass Advantage Extra (PPO) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the Mass Advantage Extra (PPO) plan, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
Mass Advantage Extra (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 to 20 and days 52 to 100, a $190 daily copay for days 21 to 51, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Mass Advantage Extra (PPO) partially covers other services, providing over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit, but the plan offers up to $120 every three months in reimbursement for eligible over-the-counter items.
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