Compare Our Plans

At Mass Advantage, we are committed to continually improving our benefits and the level of support we provide to our members. Along with medical and prescription drug coverage, we provide extra benefits and programs beyond Original Medicare to boost your health and well-being. Compare our four plan options and choose the plan that works best for you.


Benefit	Mass Advantage Basic (HMO)	Mass Advantage Plus (HMO)	Mass Advantage Premiere (PPO)	Mass Advantage Extra (PPO)
Monthly Plan Premium	$0 Monthly Premium	$95 Monthly Premium	$0 Monthly Premium	$0 Monthly Premium
Maximum Out of Pocket (MOOP)	$6,750 yearly out of pocket limit	$4,750 yearly out of pocket limit	$6,000 in-network $9,500 combined in and out-of-network	$6,750 in-network $10,000 combined in and out-of-network
Annual Physical and Wellness Exam	$0 copay	$0 copay	$0 copay	$0 copay
Primary Care Provider (PCP) visit	$0 copay	$0 copay	$0 in-network $20 out-of-network	$0 in-network $20 out-of-network
Specialist Office Visit (in person or via Telehealth)	$30 copay per visit	$15 copay per visit	$30 in-network $50 out-of-network	$45 in-network $65 out-of-network
Speech/Language, Physical & Occupational Therapy Visit	$20	$10	$30 in-network $60 out-of-network	$40 in-network 45% out-of-network
Inpatient Hospital Services	$350 per day, for days 1 – 5 $0 per day, for days 6 – 180	$210 per day, for days 1 – 6 $0 per day, for days 7 – 180	In-network $350 per day, for days 1 – 5 $0 per day, for days 6 – 180 Out-of-network $350 per day, for days 1 – 5 20% per day, for days 6 – 90 $0 per day, for days 91 – 180	In-network $350 per day, for days 1 – 6 $0 per day, for days 7 – 180 Out-of-network Days 1-90: 35% coinsurance Days 91-180: $0 copay per day
Ambulatory Surgical Center (ASC)	$175	$90	$175 in-network 35% out-of-network	$300 in-network 40% out-of-network
Emergency Care	$130 (waived if admitted within 24 hours)	$130 (waived if admitted within 24 hours)	$130 (waived if admitted within 24 hours)	$130 (waived if admitted within 24 hours)
Urgent Care Visit	$20 copay per visit	$15 copay per visit	$30 in-network $30 out-of-network	$40 in-network $40 out-of-network
Ambulance (Ground & Air) One-Way Medicare-Covered Trip	$295	$200	$275	$275
Diagnostic Tests, X-rays and Lab Services	Diagnostic tests and procedures: $15 Outpatient X-ray services: $5 Lab services: $0	Diagnostic tests and procedures: $0 Outpatient X-ray services: $0 Lab services: $0	In Network Diagnostic tests and procedures: $20 Outpatient X-ray services: $0 Lab services: $0 Out of Network Diagnostic tests and procedures: 30% Outpatient X-ray services: $10 Lab services: 30%	In Network Diagnostic tests and procedures: $30 Outpatient X-ray services: $15 Lab services: $0 Out of Network Diagnostic tests and procedures: 40% Outpatient X-ray services: 40% Lab services: 40%
Diagnostic Radiology Services CT / PET / MRI	$100	$90	$100 in-network 30% out-of-network	$150 in-network 40% out-of-network
Vision Services EyeMed In-Network Providers (1 exam annually)	$0 routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefits Card Wellness allowance to pay for additional eyewear costs	$0 routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefits Card Wellness allowance to pay for additional eyewear costs	$0 in-network / $45 out-of-network, routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefits Card Wellness allowance to pay for additional eyewear costs	$0 in-network / $65 out-of-network, routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefits Card Wellness allowance to pay for additional eyewear costs
Hearing Services* Exclusively from NationsBenefits (1 exam annually)	$0 routine Hearing Exam 6 hearing aid options available: ranging from $600 - $2,075 per hearing aid Limit 2 aids per year Members can also use their Prepaid Benefits Card Wellness allowance to help pay for Hearing Aids	$0 routine Hearing Exam 6 hearing aid options available: ranging from $600 - $2,075 per hearing aid Limit 2 aids per year Members can also use their Prepaid Benefits Card Wellness allowance to help pay for Hearing Aids	$0 in-network / $65 out-of-network, routine Hearing Exam 6 hearing aid options available: ranging from $600 - $2,075 per hearing aid Limit 2 aids per year Members can also use their Prepaid Benefits Card Wellness allowance to help pay for Hearing Aids	$0 in-network / $65 out-of-network, routine Hearing Exam 6 hearing aid options available: ranging from $600 - $2,075 per hearing aid Limit 2 aids per year Members can also use their Prepaid Benefits Card Wellness allowance to help pay for Hearing Aids
Dental Services Dominion PPO In-Network Providers. Benefit limits apply	$1,000 allowance annually for comprehensive services $0 for preventive dental services including routine dental exams, cleanings, and X-rays $0 for comprehensive services including restorative services, periodontics, and extractions	$1,500 allowance annually for comprehensive services $0 for preventive dental services including routine dental exams, cleanings, and X-rays $0 for comprehensive services including restorative services, periodontics, and extractions	$1,000 allowance annually for comprehensive services $0 for preventive dental services including routine dental exams, cleanings, and X-rays $0 for comprehensive services including restorative services, periodontics, and extractions	$1,500 allowance annually for comprehensive services $0 for preventive dental services including routine dental exams, cleanings, and X-rays $0 for comprehensive services including restorative services, periodontics, and extractions
Non-Emergency Transportation Services	$0 / 12 non-emergency one-way rides annually	$0 / 12 non-emergency one-way rides annually	$0 / 6 non-emergency one-way rides annually	$0 / 6 non-emergency one-way rides annually
Post Discharge Meal Services	$0 for up to 2 meals per day for 14 calendar days post-discharge from an inpatient stay at a hospital or following surgery provided by Heart To Home	$0 for up to 2 meals per day for 14 calendar days post-discharge from an inpatient stay at a hospital or following surgery provided by Heart To Home	$0 for up to 2 meals per day for 14 calendar days post-discharge from an inpatient stay at a hospital or following surgery provided by Heart To Home	$0 for up to 2 meals per day for 14 calendar days post-discharge from an inpatient stay at a hospital or following surgery provided by Heart To Home
Personal Emergency Response System	100% covered	100% covered	100% covered	100% covered
Bold’s Online Exercise Programs	$0 copay Live and on-demand fitness classes, including strength training, balance, yoga, and Tai Chi — all at no cost for Mass Advantage members and accessible from home. You can take Bold classes at any time. All you need is your computer, smartphone, or tablet.	$0 copay Live and on-demand fitness classes, including strength training, balance, yoga, and Tai Chi — all at no cost for Mass Advantage members and accessible from home. You can take Bold classes at any time. All you need is your computer, smartphone, or tablet.	$0 copay Live and on-demand fitness classes, including strength training, balance, yoga, and Tai Chi — all at no cost for Mass Advantage members and accessible from home. You can take Bold classes at any time. All you need is your computer, smartphone, or tablet.	$0 copay Live and on-demand fitness classes, including strength training, balance, yoga, and Tai Chi — all at no cost for Mass Advantage members and accessible from home. You can take Bold classes at any time. All you need is your computer, smartphone, or tablet.

Compare Our Plans

At Mass Advantage, we are committed to continually improving our benefits and the level of support we provide to our members. Along with medical and prescription drug coverage, we provide extra benefits and programs beyond Original Medicare to boost your health and well-being. Compare our four plan options and choose the plan that works best for you.

Mass Advantage Basic (HMO)
Monthly Plan Premium $0 Monthly Premium
Maximum Out of Pocket (MOOP) $6,750 yearly out of pocket limit
Annual Physical and Wellness Exam $0 copay
Primary Care Provider (PCP) visit $0 copay
Specialist Office Visit (in person or via Telehealth) $30 copay per visit
Speech/Language, Physical & Occupational Therapy Visit $20
Inpatient Hospital Services $350 per day, for days 1 – 5 $0 per day, for days 6 – 180
Ambulatory Surgical Center (ASC) $175
Emergency Care $130 (waived if admitted within 24 hours)
Urgent Care Visit $20 copay per visit
Ambulance (Ground & Air) One-Way Medicare-Covered Trip $295
Diagnostic Tests, X-rays and Lab Services Diagnostic tests and procedures: $15 Outpatient X-ray services: $5 Lab services: $0
Diagnostic Radiology Services $100
Vision Services $0 routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefits Card Wellness allowance to pay for additional eyewear costs
Hearing Services* $0 routine Hearing Exam 6 hearing aid options available: ranging from $600 - $2,075 per hearing aid Limit 2 aids per year Members can also use their Prepaid Benefits Card Wellness allowance to help pay for Hearing Aids
Dental Services $1,000 allowance annually for comprehensive services $0 for preventive dental services including routine dental exams, cleanings, and X-rays $0 for comprehensive services including restorative services, periodontics, and extractions
Non-Emergency Transportation Services $0 / 12 non-emergency one-way rides annually
Post Discharge Meal Services $0 for up to 2 meals per day for 14 calendar days post-discharge from an inpatient stay at a hospital or following surgery provided by Heart To Home
Personal Emergency Response System 100% covered
Bold’s Online Exercise Programs $0 copay Live and on-demand fitness classes, including strength training, balance, yoga, and Tai Chi — all at no cost for Mass Advantage members and accessible from home. You can take Bold classes at any time. All you need is your computer, smartphone, or tablet.

Mass Advantage Plus (HMO)
Monthly Plan Premium $95 Monthly Premium
Maximum Out of Pocket (MOOP) $4,750 yearly out of pocket limit
Annual Physical and Wellness Exam $0 copay
Primary Care Provider (PCP) visit $0 copay
Specialist Office Visit (in person or via Telehealth) $15 copay per visit
Speech/Language, Physical & Occupational Therapy Visit $10
Inpatient Hospital Services $210 per day, for days 1 – 6 $0 per day, for days 7 – 180
Ambulatory Surgical Center (ASC) $90
Emergency Care $130 (waived if admitted within 24 hours)
Urgent Care Visit $15 copay per visit
Ambulance (Ground & Air) One-Way Medicare-Covered Trip $200
Diagnostic Tests, X-rays and Lab Services Diagnostic tests and procedures: $0 Outpatient X-ray services: $0 Lab services: $0
Diagnostic Radiology Services $90
Vision Services $0 routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefits Card Wellness allowance to pay for additional eyewear costs
Hearing Services* $0 routine Hearing Exam 6 hearing aid options available: ranging from $600 - $2,075 per hearing aid Limit 2 aids per year Members can also use their Prepaid Benefits Card Wellness allowance to help pay for Hearing Aids
Dental Services $1,500 allowance annually for comprehensive services $0 for preventive dental services including routine dental exams, cleanings, and X-rays $0 for comprehensive services including restorative services, periodontics, and extractions
Non-Emergency Transportation Services $0 / 12 non-emergency one-way rides annually
Post Discharge Meal Services $0 for up to 2 meals per day for 14 calendar days post-discharge from an inpatient stay at a hospital or following surgery provided by Heart To Home
Personal Emergency Response System 100% covered
Bold’s Online Exercise Programs $0 copay Live and on-demand fitness classes, including strength training, balance, yoga, and Tai Chi — all at no cost for Mass Advantage members and accessible from home. You can take Bold classes at any time. All you need is your computer, smartphone, or tablet.

Mass Advantage Premiere (PPO)
Monthly Plan Premium $0 Monthly Premium
Maximum Out of Pocket (MOOP) $6,000 in-network $9,500 combined in and out-of-network
Annual Physical and Wellness Exam $0 copay
Primary Care Provider (PCP) visit $0 in-network $20 out-of-network
Specialist Office Visit (in person or via Telehealth) $30 in-network $50 out-of-network
Speech/Language, Physical & Occupational Therapy Visit $30 in-network $60 out-of-network
Inpatient Hospital Services In-network $350 per day, for days 1 – 5 $0 per day, for days 6 – 180 Out-of-network $350 per day, for days 1 – 5 20% per day, for days 6 – 90 $0 per day, for days 91 – 180
Ambulatory Surgical Center (ASC) $175 in-network 35% out-of-network
Emergency Care $130 (waived if admitted within 24 hours)
Urgent Care Visit $30 in-network $30 out-of-network
Ambulance (Ground & Air) One-Way Medicare-Covered Trip $275
Diagnostic Tests, X-rays and Lab Services In Network Diagnostic tests and procedures: $20 Outpatient X-ray services: $0 Lab services: $0 Out of Network Diagnostic tests and procedures: 30% Outpatient X-ray services: $10 Lab services: 30%
Diagnostic Radiology Services $100 in-network 30% out-of-network
Vision Services $0 in-network / $45 out-of-network, routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefits Card Wellness allowance to pay for additional eyewear costs
Hearing Services* $0 in-network / $65 out-of-network, routine Hearing Exam 6 hearing aid options available: ranging from $600 - $2,075 per hearing aid Limit 2 aids per year Members can also use their Prepaid Benefits Card Wellness allowance to help pay for Hearing Aids
Dental Services $1,000 allowance annually for comprehensive services $0 for preventive dental services including routine dental exams, cleanings, and X-rays $0 for comprehensive services including restorative services, periodontics, and extractions
Non-Emergency Transportation Services $0 / 6 non-emergency one-way rides annually
Post Discharge Meal Services $0 for up to 2 meals per day for 14 calendar days post-discharge from an inpatient stay at a hospital or following surgery provided by Heart To Home
Personal Emergency Response System 100% covered
Bold’s Online Exercise Programs $0 copay Live and on-demand fitness classes, including strength training, balance, yoga, and Tai Chi — all at no cost for Mass Advantage members and accessible from home. You can take Bold classes at any time. All you need is your computer, smartphone, or tablet.

Mass Advantage Extra (PPO)
Monthly Plan Premium $0 Monthly Premium
Maximum Out of Pocket (MOOP) $6,750 in-network $10,000 combined in and out-of-network
Annual Physical and Wellness Exam $0 copay
Primary Care Provider (PCP) visit $0 in-network $20 out-of-network
Specialist Office Visit (in person or via Telehealth) $45 in-network $65 out-of-network
Speech/Language, Physical & Occupational Therapy Visit $40 in-network 45% out-of-network
Inpatient Hospital Services In-network $350 per day, for days 1 – 6 $0 per day, for days 7 – 180 Out-of-network Days 1-90: 35% coinsurance Days 91-180: $0 copay per day
Ambulatory Surgical Center (ASC) $300 in-network 40% out-of-network
Emergency Care $130 (waived if admitted within 24 hours)
Urgent Care Visit $40 in-network $40 out-of-network
Ambulance (Ground & Air) One-Way Medicare-Covered Trip $275
Diagnostic Tests, X-rays and Lab Services In Network Diagnostic tests and procedures: $30 Outpatient X-ray services: $15 Lab services: $0 Out of Network Diagnostic tests and procedures: 40% Outpatient X-ray services: 40% Lab services: 40%
Diagnostic Radiology Services $150 in-network 40% out-of-network
Vision Services $0 in-network / $65 out-of-network, routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefits Card Wellness allowance to pay for additional eyewear costs
Hearing Services* $0 in-network / $65 out-of-network, routine Hearing Exam 6 hearing aid options available: ranging from $600 - $2,075 per hearing aid Limit 2 aids per year Members can also use their Prepaid Benefits Card Wellness allowance to help pay for Hearing Aids
Dental Services $1,500 allowance annually for comprehensive services $0 for preventive dental services including routine dental exams, cleanings, and X-rays $0 for comprehensive services including restorative services, periodontics, and extractions
Non-Emergency Transportation Services $0 / 6 non-emergency one-way rides annually
Post Discharge Meal Services $0 for up to 2 meals per day for 14 calendar days post-discharge from an inpatient stay at a hospital or following surgery provided by Heart To Home
Personal Emergency Response System 100% covered
Bold’s Online Exercise Programs $0 copay Live and on-demand fitness classes, including strength training, balance, yoga, and Tai Chi — all at no cost for Mass Advantage members and accessible from home. You can take Bold classes at any time. All you need is your computer, smartphone, or tablet.

Prepaid Benefits Card


Benefit	Mass Advantage Basic (HMO)	Mass Advantage Plus (HMO)	Mass Advantage Premiere (PPO)	Mass Advantage Extra (PPO)
Wellness	$650 annual allowance for: Fitness Fees Fitness-related items purchased through NationsBenefits Mental Health apps such as Headspace or Calm Additional Eyewear costs Weight management programs Additional costs for Hearing Aids*	$850 annual allowance for: Fitness Fees Fitness-related items purchased through NationsBenefits Mental Health apps such as Headspace or Calm Additional Eyewear costs Weight management programs Additional costs for Hearing Aids*	$550 annual allowance for: Fitness Fees Fitness-related items purchased through NationsBenefits Mental Health apps such as Headspace or Calm Additional Eyewear costs Weight management programs Additional costs for Hearing Aids*	$750 annual allowance for: Fitness Fees Fitness-related items purchased through NationsBenefits Mental Health apps such as Headspace or Calm Additional Eyewear costs Weight management programs Additional costs for Hearing Aids*
Healthy Food and Produce**	$75 quarterly allowance for healthy food and produce at approved retail locations as well as through mail order using NationsBenefits	$75 quarterly allowance for healthy food and produce at approved retail locations as well as through mail order using NationsBenefits	N/A	N/A
Over-the-Counter Allowance In person at select retail stores or by mail order from NationsBenefits with free home delivery	$100 allowance quarterly For over-the-counter purchases	$110 allowance quarterly For over-the-counter purchases	$100 allowance quarterly For over-the-counter purchases	$120 allowance quarterly For over-the-counter purchases

Prepaid Benefits Card

Mass Advantage Basic (HMO)
Wellness $650 annual allowance for: Fitness Fees Fitness-related items purchased through NationsBenefits Mental Health apps such as Headspace or Calm Additional Eyewear costs Weight management programs Additional costs for Hearing Aids*
Healthy Food and Produce** $75 quarterly allowance for healthy food and produce at approved retail locations as well as through mail order using NationsBenefits
Over-the-Counter Allowance $100 allowance quarterly For over-the-counter purchases

Mass Advantage Plus (HMO)
Wellness $850 annual allowance for: Fitness Fees Fitness-related items purchased through NationsBenefits Mental Health apps such as Headspace or Calm Additional Eyewear costs Weight management programs Additional costs for Hearing Aids*
Healthy Food and Produce** $75 quarterly allowance for healthy food and produce at approved retail locations as well as through mail order using NationsBenefits
Over-the-Counter Allowance $110 allowance quarterly For over-the-counter purchases

Mass Advantage Premiere (PPO)
Wellness $550 annual allowance for: Fitness Fees Fitness-related items purchased through NationsBenefits Mental Health apps such as Headspace or Calm Additional Eyewear costs Weight management programs Additional costs for Hearing Aids*
Healthy Food and Produce** N/A
Over-the-Counter Allowance $100 allowance quarterly For over-the-counter purchases

Mass Advantage Extra (PPO)
Wellness $750 annual allowance for: Fitness Fees Fitness-related items purchased through NationsBenefits Mental Health apps such as Headspace or Calm Additional Eyewear costs Weight management programs Additional costs for Hearing Aids*
Healthy Food and Produce** N/A
Over-the-Counter Allowance $120 allowance quarterly For over-the-counter purchases

*Purchases must be made through the NationsBenefits providers.

**The Healthy Food & Produce benefit is part of a special supplemental program designed for individuals with chronic illnesses. A few eligible conditions include Cardiovascular disorders, Diabetes, Cancer, Chronic lung disorders and Chronic Heart Failure. Please note that eligibility for this benefit cannot be guaranteed based solely on your condition. All applicable eligibility requirements must be met before the benefit is provided. For detailed information about additional eligible conditions or benefit information, please contact us.

Prescription Drug Benefits

What you pay for your prescription drugs depends on what coverage level you are in, and which tier your drug is on.


Benefit	Mass Advantage Basic (HMO)	Mass Advantage Plus (HMO)	Mass Advantage Premiere (PPO)	Mass Advantage Extra (PPO)
Annual Prescription Drug Deductible	$0 deductible for Tier 1 & Tier 2 $200 deductible for Tiers 3, 4 & 5	$0 deductible for Tier 1 & Tier 2 $150 deductible for Tiers 3, 4 & 5	$0 deductible for Tier 1 & Tier 2 $250 deductible for Tiers 3, 4 & 5	$0 deductible for Tier 1 & Tier 2 $200 deductible for Tiers 3, 4 & 5
Low-Cost Insulin	You pay no more than $35 for a one-month supply of each covered insulin product, no matter which cost-sharing tier it’s on. The deductible does not apply to covered Part D insulins.	You pay no more than $35 for a one-month supply of each covered insulin product, no matter which cost-sharing tier it’s on. The deductible does not apply to covered Part D insulins.	You pay no more than $35 for a one-month supply of each covered insulin product, no matter which cost-sharing tier it’s on. The deductible does not apply to covered Part D insulins.	You pay no more than $35 for a one-month supply of each covered insulin product, no matter which cost-sharing tier it’s on. The deductible does not apply to covered Part D insulins.
Initial Coverage Retail & Mail Order 30/31 - 100 Day Supply	Once you have met your Part D deductible, you pay the copays and coinsurance amounts applicable to the tiers in which your drugs are covered until your total out-of-pocket costs reach $2,100. These costs include payments you have made as well as contributions from Mass Advantage and other assistance programs like Extra Help.	Once you have met your Part D deductible, you pay the copays and coinsurance amounts applicable to the tiers in which your drugs are covered until your total out-of-pocket costs reach $2,100. These costs include payments you have made as well as contributions from Mass Advantage and other assistance programs like Extra Help.	Once you have met your Part D deductible, you pay the copays and coinsurance amounts applicable to the tiers in which your drugs are covered until your total out-of-pocket costs reach $2,100. These costs include payments you have made as well as contributions from Mass Advantage and other assistance programs like Extra Help.	Once you have met your Part D deductible, you pay the copays and coinsurance amounts applicable to the tiers in which your drugs are covered until your total out-of-pocket costs reach $2,100. These costs include payments you have made as well as contributions from Mass Advantage and other assistance programs like Extra Help.
Tier 1 – Preferred Generic	$0 / $0 / $0	$0 / $0 / $0	$0 / $0 / $0	$0 / $0 / $0
Tier 2 – Generic	$0 / $0 / $0	$0 / $0 / $0	$0 / $0 / $0	$0 / $0 / $0
Tier 3 – Preferred Brand	$47 / $94 / $94	$47 / $94 / $94	$42 / $84 / $84	$37 / $74 / $74
Tier 4 – Non-Preferred Brand	40%	40%	40%	30%
Tier 5 – Specialty	30%	30%	30%	30%
Catastrophic Coverage	You pay $0 for all covered Part D drugs for the remainder of the calendar year.	You pay $0 for all covered Part D drugs for the remainder of the calendar year.	You pay $0 for all covered Part D drugs for the remainder of the calendar year.	You pay $0 for all covered Part D drugs for the remainder of the calendar year.

Prescription Drug Benefits

What you pay for your prescription drugs depends on what coverage level you are in, and which tier your drug is on.

Mass Advantage Basic (HMO)
Annual Prescription Drug Deductible $0 deductible for Tier 1 & Tier 2 $200 deductible for Tiers 3, 4 & 5
Low-Cost Insulin You pay no more than $35 for a one-month supply of each covered insulin product, no matter which cost-sharing tier it’s on. The deductible does not apply to covered Part D insulins.
Initial Coverage Once you have met your Part D deductible, you pay the copays and coinsurance amounts applicable to the tiers in which your drugs are covered until your total out-of-pocket costs reach $2,100. These costs include payments you have made as well as contributions from Mass Advantage and other assistance programs like Extra Help.
Tier 1 – Preferred Generic $0 / $0 / $0
Tier 2 – Generic $0 / $0 / $0
Tier 3 – Preferred Brand $47 / $94 / $94
Tier 4 – Non-Preferred Brand 40%
Tier 5 – Specialty 30%
Catastrophic Coverage You pay $0 for all covered Part D drugs for the remainder of the calendar year.

Mass Advantage Plus (HMO)
Annual Prescription Drug Deductible $0 deductible for Tier 1 & Tier 2 $150 deductible for Tiers 3, 4 & 5
Low-Cost Insulin You pay no more than $35 for a one-month supply of each covered insulin product, no matter which cost-sharing tier it’s on. The deductible does not apply to covered Part D insulins.
Initial Coverage Once you have met your Part D deductible, you pay the copays and coinsurance amounts applicable to the tiers in which your drugs are covered until your total out-of-pocket costs reach $2,100. These costs include payments you have made as well as contributions from Mass Advantage and other assistance programs like Extra Help.
Tier 1 – Preferred Generic $0 / $0 / $0
Tier 2 – Generic $0 / $0 / $0
Tier 3 – Preferred Brand $47 / $94 / $94
Tier 4 – Non-Preferred Brand 40%
Tier 5 – Specialty 30%
Catastrophic Coverage You pay $0 for all covered Part D drugs for the remainder of the calendar year.

Mass Advantage Premiere (PPO)
Annual Prescription Drug Deductible $0 deductible for Tier 1 & Tier 2 $250 deductible for Tiers 3, 4 & 5
Low-Cost Insulin You pay no more than $35 for a one-month supply of each covered insulin product, no matter which cost-sharing tier it’s on. The deductible does not apply to covered Part D insulins.
Initial Coverage Once you have met your Part D deductible, you pay the copays and coinsurance amounts applicable to the tiers in which your drugs are covered until your total out-of-pocket costs reach $2,100. These costs include payments you have made as well as contributions from Mass Advantage and other assistance programs like Extra Help.
Tier 1 – Preferred Generic $0 / $0 / $0
Tier 2 – Generic $0 / $0 / $0
Tier 3 – Preferred Brand $42 / $84 / $84
Tier 4 – Non-Preferred Brand 40%
Tier 5 – Specialty 30%
Catastrophic Coverage You pay $0 for all covered Part D drugs for the remainder of the calendar year.

Mass Advantage Extra (PPO)
Annual Prescription Drug Deductible $0 deductible for Tier 1 & Tier 2 $200 deductible for Tiers 3, 4 & 5
Low-Cost Insulin You pay no more than $35 for a one-month supply of each covered insulin product, no matter which cost-sharing tier it’s on. The deductible does not apply to covered Part D insulins.
Initial Coverage Once you have met your Part D deductible, you pay the copays and coinsurance amounts applicable to the tiers in which your drugs are covered until your total out-of-pocket costs reach $2,100. These costs include payments you have made as well as contributions from Mass Advantage and other assistance programs like Extra Help.
Tier 1 – Preferred Generic $0 / $0 / $0
Tier 2 – Generic $0 / $0 / $0
Tier 3 – Preferred Brand $37 / $74 / $74
Tier 4 – Non-Preferred Brand 30%
Tier 5 – Specialty 30%
Catastrophic Coverage You pay $0 for all covered Part D drugs for the remainder of the calendar year.

Amazon Pharmacy & Prime Therapeutics Pharmacy

Manage your prescriptions easily with our wide pharmacy network. Enjoy the flexibility of having your medications shipped directly to your home with free shipping through Amazon Pharmacy or Prime Therapeutics Pharmacy.

Different out of pocket cost may apply for people who have limited incomes, live in long term care facilities, or have access to Indian/Tribal/Urban (Indian Health Services) providers.

Questions?

We’re here to help.

From October 1 to March 31, we’re available 7 days a week from 8 am to 8 pm EST. From April 1 to September 30, we’re available Monday through Friday from 8 am to 8 pm EST.

Call: (844) 794-0231

TTY: 711

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