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)	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)	$5,000 yearly out of pocket limit	$3,000 yearly out of pocket limit	$5,000 in-network $9,500 combined in and out-of-network	$5,000 in-network $9,500 combined in and out-of-network
Annual Physical & 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)	$25 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	$0	$0	$30 in-network $60 out-of-network	$30 in-network $65 out-of-network
Inpatient Hospital Services	$300 per day, for days 1 – 5 $0 per day, for days 6+	$160 per day, for days 1 – 5 $0 per day, for days 6+	In-network $300 per day, for days 1 – 5 $0 per day, for days 6+ Out-of-network $350 per day, for days 1 – 5 20% per day, for days 6+	In-network $370 per day, for days 1 – 5 $0 per day, for days 6+ Out-of-network 35% coinsurance
Ambulatory Surgical Center (ASC)	$175	$90	$175 in-network 35% out-of-network	$275 in-network 40% out-of-network
Emergency Care	$100 (waived if admitted within 24 hours)	$90 (waived if admitted within 24 hours)	$100 (waived if admitted within 24 hours)	$100 (waived if admitted within 24 hours)
Urgent Care Visit	$10 copay per visit	$0 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: $0 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: $20 Outpatient X-ray services: $0 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
Over-the-Counter Allowance* Exclusively from NationsBenefits with free shipping	$125 allowance quarterly For over-the-counter purchases made by phone, online or by mail order form from NationsBenefits.	$135 allowance quarterly For over-the-counter purchases made by phone, online or by mail order form from NationsBenefits.	$125 allowance quarterly For over-the-counter purchases made by phone, online or by mail order form from NationsBenefits.	$145 allowance quarterly For over-the-counter purchases made by phone, online or by mail order form from NationsBenefits.
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 Benefit 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 Benefit 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 Benefit 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 Benefit 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 – 1 per ear Members can also use their Prepaid Benefit 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 – 1 per ear Members can also use their Prepaid Benefit 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 – 1 per ear Members can also use their Prepaid Benefit 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 – 1 per ear Members can also use their Prepaid Benefit Card Wellness allowance to help pay for Hearing Aids
Dental Services Dominion PPO In-Network Providers. Benefit limits apply	$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	$2,000 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	$2,000 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	$2,500 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	14 days post discharge (28 meals) provided by Heart To Home Meals $0 for meals	14 days post discharge (28 meals) provided by Heart To Home Meals $0 for meals	14 days post discharge (28 meals) provided by Heart To Home Meals $0 for meals	14 days post discharge (28 meals) provided by Heart To Home Meals $0 for meals
Personal Emergency Response System	$0 for device & monitoring	$0 for device & monitoring	$0 for device & monitoring	$0 for device & monitoring

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) $5,000 yearly out of pocket limit
Annual Physical & Wellness Exam $0 copay
Primary Care Provider (PCP) visit $0 copay
Specialist Office Visit (in person or via Telehealth) $25 copay per visit
Speech/Language, Physical & Occupational Therapy Visit $0
Inpatient Hospital Services $300 per day, for days 1 – 5 $0 per day, for days 6+
Ambulatory Surgical Center (ASC) $175
Emergency Care $100 (waived if admitted within 24 hours)
Urgent Care Visit $10 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: $0 Lab services: $0
Diagnostic Radiology Services $100
Over-the-Counter Allowance* $125 allowance quarterly For over-the-counter purchases made by phone, online or by mail order form from NationsBenefits.
Vision Services $0 routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefit 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 – 1 per ear Members can also use their Prepaid Benefit 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 14 days post discharge (28 meals) provided by Heart To Home Meals $0 for meals
Personal Emergency Response System $0 for device & monitoring

Mass Advantage Plus (HMO)
Monthly Plan Premium $95 Monthly Premium
Maximum Out of Pocket (MOOP) $3,000 yearly out of pocket limit
Annual Physical & 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 $0
Inpatient Hospital Services $160 per day, for days 1 – 5 $0 per day, for days 6+
Ambulatory Surgical Center (ASC) $90
Emergency Care $90 (waived if admitted within 24 hours)
Urgent Care Visit $0 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
Over-the-Counter Allowance* $135 allowance quarterly For over-the-counter purchases made by phone, online or by mail order form from NationsBenefits.
Vision Services $0 routine Eye Exam Up to $200 allowance annually for eyewear Members can also use their Prepaid Benefit 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 – 1 per ear Members can also use their Prepaid Benefit Card Wellness allowance to help pay for Hearing Aids
Dental Services $2,000 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 14 days post discharge (28 meals) provided by Heart To Home Meals $0 for meals
Personal Emergency Response System $0 for device & monitoring

Mass Advantage Premiere (PPO)
Monthly Plan Premium $0 Monthly Premium
Maximum Out of Pocket (MOOP) $5,000 in-network $9,500 combined in and out-of-network
Annual Physical & 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 $300 per day, for days 1 – 5 $0 per day, for days 6+ Out-of-network $350 per day, for days 1 – 5 20% per day, for days 6+
Ambulatory Surgical Center (ASC) $175 in-network 35% out-of-network
Emergency Care $100 (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
Over-the-Counter Allowance* $125 allowance quarterly For over-the-counter purchases made by phone, online or by mail order form from NationsBenefits.
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 Benefit 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 – 1 per ear Members can also use their Prepaid Benefit Card Wellness allowance to help pay for Hearing Aids
Dental Services $2,000 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 14 days post discharge (28 meals) provided by Heart To Home Meals $0 for meals
Personal Emergency Response System $0 for device & monitoring

Mass Advantage Extra (PPO)
Monthly Plan Premium $0 Monthly Premium
Maximum Out of Pocket (MOOP) $5,000 in-network $9,500 combined in and out-of-network
Annual Physical & 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 $30 in-network $65 out-of-network
Inpatient Hospital Services In-network $370 per day, for days 1 – 5 $0 per day, for days 6+ Out-of-network 35% coinsurance
Ambulatory Surgical Center (ASC) $275 in-network 40% out-of-network
Emergency Care $100 (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: $20 Outpatient X-ray services: $0 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
Over-the-Counter Allowance* $145 allowance quarterly For over-the-counter purchases made by phone, online or by mail order form from NationsBenefits.
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 Benefit 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 – 1 per ear Members can also use their Prepaid Benefit Card Wellness allowance to help pay for Hearing Aids
Dental Services $2,500 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 14 days post discharge (28 meals) provided by Heart To Home Meals $0 for meals
Personal Emergency Response System $0 for device & monitoring

Prepaid Benefit Card


	Mass Advantage Basic (HMO)	Mass Advantage Plus (HMO)	Mass Advantage Premiere (PPO)	Mass Advantage Extra (PPO)
Wellness	$600 annual allowance for: Fitness (fitness centers and online exercise program such as Bold and wearables such as Fitbit) Mental Health apps such as Headspace or Calm Eyewear Weight Watchers Hearing Aids	$700 annual allowance for: Fitness (fitness centers and online exercise program such as Bold and wearables such as Fitbit) Mental Health apps such as Headspace or Calm Eyewear Weight Watchers Hearing Aids	$400 annual allowance for: Fitness (fitness centers and online exercise program such as Bold and wearables such as Fitbit) Mental Health apps such as Headspace or Calm Eyewear Weight Watchers Hearing Aids	$775 annual allowance for: Fitness (fitness centers and online exercise program such as Bold and wearables such as Fitbit) Mental Health apps such as Headspace or Calm Eyewear Weight Watchers Hearing Aids
Homemaking	$500 allowance annually: For light housekeeping from plan-approved vendors	$1,000 allowance annually: For light housekeeping from plan-approved vendors	N/A	N/A
Parking** at Medical Sites	$50 allowance annually	$50 allowance annually	N/A	$50 allowance annually
Healthy Groceries**	N/A	N/A	N/A	$75 allowance quarterly for purchasing healthy groceries

Prepaid Benefit Card

Mass Advantage Basic (HMO)
Wellness $600 annual allowance for: Fitness (fitness centers and online exercise program such as Bold and wearables such as Fitbit) Mental Health apps such as Headspace or Calm Eyewear Weight Watchers Hearing Aids
Homemaking $500 allowance annually: For light housekeeping from plan-approved vendors
Parking** at Medical Sites $50 allowance annually
Healthy Groceries** N/A

Mass Advantage Plus (HMO)
Wellness $700 annual allowance for: Fitness (fitness centers and online exercise program such as Bold and wearables such as Fitbit) Mental Health apps such as Headspace or Calm Eyewear Weight Watchers Hearing Aids
Homemaking $1,000 allowance annually: For light housekeeping from plan-approved vendors
Parking** at Medical Sites $50 allowance annually
Healthy Groceries** N/A

Mass Advantage Premiere (PPO)
Wellness $400 annual allowance for: Fitness (fitness centers and online exercise program such as Bold and wearables such as Fitbit) Mental Health apps such as Headspace or Calm Eyewear Weight Watchers Hearing Aids
Homemaking N/A
Parking** at Medical Sites N/A
Healthy Groceries** N/A

Mass Advantage Extra (PPO)
Wellness $775 annual allowance for: Fitness (fitness centers and online exercise program such as Bold and wearables such as Fitbit) Mental Health apps such as Headspace or Calm Eyewear Weight Watchers Hearing Aids
Homemaking N/A
Parking** at Medical Sites $50 allowance annually
Healthy Groceries** $75 allowance quarterly for purchasing healthy groceries

*Purchases must be made through the NationsBenefits online store or through NationsBenefits providers.

**The parking and grocery benefits are part of a special supplemental program designed for individuals with chronic illnesses. Eligible conditions include chronic alcohol and other drug dependence, autoimmune disorders, cancer, cardiovascular disorders, chronic heart failure, dementia, diabetes, end-stage liver disease, end-stage renal disease (ESRD), severe hematologic disorders, HIV/AIDS, chronic lung disorders, chronic and disabling mental health conditions, neurologic disorders, and stroke. 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 details, 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.


	Mass Advantage Basic (HMO)	Mass Advantage Plus (HMO)	Mass Advantage Premiere (PPO)	Mass Advantage Extra (PPO)
Annual Prescription Drug Deductible	$0 annual deductible across all plans	$0 annual deductible across all plans	$0 annual deductible across all plans	$0 annual deductible across all plans
Low-Cost Insulin	Low-cost insulin coverage is available to all members. Members will not pay more than $35 for a one month’s supply of insulin.	Low-cost insulin coverage is available to all members. Members will not pay more than $35 for a one month’s supply of insulin.	Low-cost insulin coverage is available to all members. Members will not pay more than $35 for a one month’s supply of insulin.	Low-cost insulin coverage is available to all members. Members will not pay more than $35 for a one month’s supply of insulin.
Initial Coverage Retail & Mail Order 30/31 - 100 Day Supply	You pay the following until your total out of pocket drug costs reach $2,000.	You pay the following until your total out of pocket drug costs reach $2,000.	You pay the following until your total out of pocket drug costs reach $2,000.	You pay the following until your total out of pocket drug costs reach $2,000.
Tier 1 – Preferred Generic	$0 / $0	$0 / $0	$0 / $0	$2 / $4
Tier 2 – Generic	$0 / $0	$0 / $0	$0 / $0	$6 / $12
Tier 3 – Preferred Brand	$47 / $94	$47 / $94	$42 / $84	$42 / $84
Tier 4 – Non-Preferred Brand	50%	45%	50%	50%
Tier 5 – Specialty	33%	33%	33%	33%
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 annual deductible across all plans
Low-Cost Insulin Low-cost insulin coverage is available to all members. Members will not pay more than $35 for a one month’s supply of insulin.
Initial Coverage You pay the following until your total out of pocket drug costs reach $2,000.
Tier 1 – Preferred Generic $0 / $0
Tier 2 – Generic $0 / $0
Tier 3 – Preferred Brand $47 / $94
Tier 4 – Non-Preferred Brand 50%
Tier 5 – Specialty 33%
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 annual deductible across all plans
Low-Cost Insulin Low-cost insulin coverage is available to all members. Members will not pay more than $35 for a one month’s supply of insulin.
Initial Coverage You pay the following until your total out of pocket drug costs reach $2,000.
Tier 1 – Preferred Generic $0 / $0
Tier 2 – Generic $0 / $0
Tier 3 – Preferred Brand $47 / $94
Tier 4 – Non-Preferred Brand 45%
Tier 5 – Specialty 33%
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 annual deductible across all plans
Low-Cost Insulin Low-cost insulin coverage is available to all members. Members will not pay more than $35 for a one month’s supply of insulin.
Initial Coverage You pay the following until your total out of pocket drug costs reach $2,000.
Tier 1 – Preferred Generic $0 / $0
Tier 2 – Generic $0 / $0
Tier 3 – Preferred Brand $42 / $84
Tier 4 – Non-Preferred Brand 50%
Tier 5 – Specialty 33%
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 annual deductible across all plans
Low-Cost Insulin Low-cost insulin coverage is available to all members. Members will not pay more than $35 for a one month’s supply of insulin.
Initial Coverage You pay the following until your total out of pocket drug costs reach $2,000.
Tier 1 – Preferred Generic $2 / $4
Tier 2 – Generic $6 / $12
Tier 3 – Preferred Brand $42 / $84
Tier 4 – Non-Preferred Brand 50%
Tier 5 – Specialty 33%
Catastrophic Coverage You pay $0 for all covered Part D drugs for the remainder of the calendar year.

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.

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.

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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