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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 2025, 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 3 out of 5 stars in 2025.
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 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:
Sign up for Mass Advantage Extra (PPO)
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Drug Coverage
The Mass Advantage Extra (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $6.00 copay, while preferred brand drugs have 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0.00.
Additional Benefits
The Mass Advantage Extra (PPO) plan offers a wide range of benefits. You'll have no copay for primary care, home health services, and preventive services. The plan also covers inpatient hospital stays with a copay, outpatient services, emergency services, and various therapies and services. The plan includes coverage for hearing, vision, and dental services, with copays ranging from $15 to $45 for routine exams. Other benefits include coverage for ambulance services, durable medical equipment, and home infusion services, as well as coverage for OTC items and a meal benefit for chronic illnesses.
Inpatient Hospital See details
The Mass Advantage Extra (PPO) plan covers inpatient hospital stays, including acute and psychiatric care, with prior authorization required. For inpatient hospital-acute, you'll pay a $370 copay for days 1-5, and no copay for days 6-90. For inpatient hospital psychiatric, you'll pay a $350 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for inpatient hospital-acute, as well as additional days and non-Medicare-covered stays for inpatient hospital psychiatric, are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a copay between $0 and $300, Observation Services have a $300 copay, Ambulatory Surgical Center (ASC) Services have a $275 copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered under the Mass Advantage Extra (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $275 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 6 one-way trips per year, with no copay or coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Mass Advantage Extra (PPO) plan. Emergency Services have a $100 copay and no coinsurance, while Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Coverage has a $90 copay and no coinsurance. However, Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Mass Advantage Extra (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, and physician specialist services with a $45 copay. The plan also covers mental health specialty services with a $30 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $30 copay. Other Health Care Professional services require prior authorization and have a $45 copay, and psychiatric services, and opioid treatment program services have a $25 copay, and additional telehealth benefits are available with a $0 - $45 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Mass Advantage Extra (PPO) plan covers preventive services, including annual physical exams, additional preventive services, and kidney disease education services. The plan also covers Personal Emergency Response Systems, Wigs for Hair Loss Related to Chemotherapy (up to $500 per year), Weight Management Programs, Alternative Therapies, and Fitness Benefits. Health Education, In-Home Safety Assessments, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, 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, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $45 copay for 1 visit per year, and prescription hearing aids with a copay between $600 and $2075 for 2 visits per year; fitting/evaluation for hearing aids, inner ear hearing aids, outer ear hearing aids, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a $45 copay, and eyewear with a combined maximum benefit of $200 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Mass Advantage Extra (PPO) plan covers Medicare dental services with a $45 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and orthodontics has a maximum benefit of $2500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Mass Advantage Extra (PPO) plan, but require prior authorization. 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 by the Mass Advantage Extra (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay, but require coinsurance, while Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay of $20, while Lab Services are not covered. Diagnostic Radiological Services have a copay of $150, and Therapeutic Radiological Services have a copay of $60; however, Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Mass Advantage Extra (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Mass Advantage Extra (PPO) plan, but the specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. There is a copay for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, with no copay for days 1-20, a $190 copay for days 21-51, and no copay for days 52-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Mass Advantage Extra (PPO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $145 every three months, and a meal benefit for chronic illnesses. 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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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.
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