Go Back

Health New England Medicare Plus (HMO)

H8578 - 004 - 0

(3.5 / 5)

Health New England Medicare Plus (HMO) is a Medicare Advantage Plan by Health New England Medicare Advantage Plans.

This page features plan details for 2025 Health New England Medicare Plus (HMO) H8578 – 004 – 0 available in Hampden, Hampshire, Franklin, Berkshire Counties.

Locations

Health New England Medicare Plus (HMO) is offered in the following locations.

Berkshire County, Massachusetts

Franklin County, Massachusetts

Hampden County, Massachusetts

Click to see more locations

Plan Overview

Health New England Medicare Plus (HMO) offers the following coverage and cost-sharing.

Insurer:	Health New England Medicare Advantage Plans
Health Plan Deductible:	$0
MOOP:	$5,000 In-network
Drugs Covered:	Yes

Ready to sign up for Health New England Medicare Plus (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Health New England Medicare Plus (HMO) has a monthly premium of $113.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.

Part B	Part C	Part D	Part B Give Back	Total
$185.00	$98.80	$14.20	$	$

Please Note:

Your Part B premium may differ based on factors including late enrollment, income, and disability status.
You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Health New England Medicare Plus (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:	$350.00
Drug Out-Of-Pocket maximum:	$2,000.00
Drug Benefit Type:	Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part D	LIS Full
$14.20	$0.00

Initial Coverage Phase

After you pay your $350.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

30 Day

60 Day

90 Day

30 Day

Tier	Pref. Pharm	Std. Pharm
1) Preferred Generic		$5.00 Copay
2) Generic	$10.00 Copay	$20.00 Copay
3) Preferred Brand	$45.00 Copay	$47.00 Copay
4) Non-Preferred Drug	38.00% Coinsurance	38.00% Coinsurance
5) Specialty Tier	28.00% Coinsurance	28.00% Coinsurance

60 Day

Tier	Pref. Pharm	Std. Pharm
1) Preferred Generic		$10.00 Copay
2) Generic	$20.00 Copay	$40.00 Copay
3) Preferred Brand	$90.00 Copay	$94.00 Copay
4) Non-Preferred Drug	38.00% Coinsurance	38.00% Coinsurance
5) Specialty Tier

90 Day

Tier	Pref. Pharm	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic		$15.00 Copay		$10.00 Copay
2) Generic	$30.00 Copay	$60.00 Copay	$20.00 Copay	$40.00 Copay
3) Preferred Brand	$135.00 Copay	$141.00 Copay	$90.00 Copay	$94.00 Copay
4) Non-Preferred Drug	38.00% Coinsurance	38.00% Coinsurance	38.00% Coinsurance	38.00% Coinsurance
5) Specialty Tier

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Health New England Medicare Plus (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

- In-Network: No

Comprehensive Dental

Adjunctive General Services
- In-Network: No Coins – No Co pay (Limits Apply)
Endodontics
- In-Network: No Coins – No Co pay (Limits Apply)
Implant Services
- In-Network: No Coins – No Co pay (Limits Apply)
Maxillofacial Prosthetics
- In-Network: No Coins – No Co pay (Limits Apply)
Oral and Maxillofacial Surgery
- In-Network: No Coins – No Co pay (Limits Apply)
Orthodontics
- In-Network: No Coins – No Co pay (Limits Apply)
Periodontics
- In-Network: No Coins – No Co pay (Limits Apply)
Prosthodontics, fixed
- In-Network: No Coins – No Co pay (Limits Apply)
Prosthodontics, removable
- In-Network: No Coins – No Co pay (Limits Apply)
Restorative Services
- In-Network: No Coins – No Co pay (Limits Apply)

Diagnostic and Preventive Dental

Dental X-Rays
- In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
Fluoride Treatment
- In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
Oral Exams
- In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
Other Diagnostic Dental Services
- In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
Other Preventive Dental Services
- In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
Prophylaxis (cleaning)
- In-Network: No Coins – No Copay (Limits Apply, Authorization Required)

Diagnostic procedures/lab services/imaging

Lab services
- $0 copay (Authorization Required)
Diagnostic radiology services (e.g., MRI)
- $0-275 copay (Authorization Required)
Diagnostic tests and procedures
- $0 copay (Authorization Required)
Outpatient x-rays
- $25 copay (Authorization Required)

Doctor visits

Specialist
- $40 copay per visit
Primary
- $20 copay per visit

Emergency care/Urgent care

Emergency
- $125 copay per visit (always covered)
Urgent care
- $55 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment
- $40 copay
Routine foot care
- Not covered

Ground ambulance

- $250 copay

Health plan deductible

- $0

Hearing

Fitting/evaluation
- $0 copay
Medicare-Covered Hearing Exam
- $40 copay
Hearing aids
- $499-999 copay (Limits Apply)
Hearing aids OTC
- Not covered

Inpatient hospital coverage

- $250 per day for days 1 through 6
  $0 per day for days 7 through 90

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

- $5,000 In-network

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)
- 20% coinsurance per item (Authorization Required)
Prosthetics (e.g., braces, artificial limbs)
- 20% coinsurance per item (Authorization Required)
Diabetes supplies
- $0 copay (Authorization Required)

Medicare Part B drugs

Chemotherapy
- 0-20% coinsurance (Authorization Required)
Other Part B drugs
- 0-20% coinsurance (Authorization Required)

Mental health services

Outpatient group therapy visit
- $40 copay
Outpatient group therapy visit with a psychiatrist
- $40 copay
Outpatient individual therapy visit
- $40 copay
Inpatient hospital – psychiatric
- $250 per day for days 1 through 6
  $0 per day for days 7 through 90
Outpatient individual therapy visit with a psychiatrist
- $40 copay

Optional supplemental benefits

- No

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- $0-300 copay per visit (Authorization Required)

Preventive care

- $0 copay (Authorization Required)

Rehabilitation services

Physical therapy and speech and language therapy visit
- $40 copay (Authorization Required)
Occupational therapy visit
- $40 copay (Authorization Required)

Skilled Nursing Facility

- $0 per day for days 1 through 20
  $175 per day for days 21 through 50
  $0 per day for days 51 through 100 (Authorization Required)

Transportation

- Not covered

Vision

Eyeglass lenses
- $0 copay (Limits Apply)
Eyeglasses (frames and lenses)
- $0 copay (Limits Apply)
Upgrades
- $0 copay (Limits Apply)
Eyeglass frames
- $0 copay (Limits Apply)
Routine eye exam
- $0 copay (Limits Apply)
Contact lenses
- $0 copay (Limits Apply)
Other
- $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

- Covered