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Mass General Brigham Advantage Signature (PPO)

H9485 - 003 - 0
3.5 out of 5 stars (3.5 / 5)

Mass General Brigham Advantage Signature (PPO) is a Medicare Advantage Plan by Mass General Brigham Health Plan.

This page features plan details for 2025 Mass General Brigham Advantage Signature (PPO) H9485 – 003 – 0 available in Eastern Massachusetts.

Locations

Mass General Brigham Advantage Signature (PPO) is offered in the following locations.

Bristol County, Massachusetts
Dukes County, Massachusetts
Essex County, Massachusetts

Click to see more locations

Plan Overview

Mass General Brigham Advantage Signature (PPO) offers the following coverage and cost-sharing.

Insurer:Mass General Brigham Health Plan
Health Plan Deductible:$0
MOOP:$0 In and Out-of-network
$0 In-network
Drugs Covered:Yes

Ready to sign up for Mass General Brigham Advantage Signature (PPO) ?

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

Mass General Brigham Advantage Signature (PPO) has a monthly premium of $299.00. 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 $243.30 $55.70 $ $
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

Mass General Brigham Advantage Signature (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
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 DLIS Full
$55.70$3.20

Initial Coverage Phase

After you pay your $0.00 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.

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

Mass General Brigham Advantage Signature (PPO) 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 (Authorization Required)
  • Endodontics
    • In-Network: No Coins – No Co pay (Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply, Authorization Required)
  • Periodontics
    • In-Network: No Coins – No Co pay (Authorization Required)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay
  • Restorative Services
    • In-Network: No Coins – No Co pay (Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • In-Network: $0 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $0 copay (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: $0 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: $0 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0 copay (Authorization Required)
  • Lab services
    • Out-of-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0 copay (Authorization Required)

Doctor visits

  • Primary
    • Out-of-Network: $0 copay
    • In-Network: $0 copay
  • Specialist
    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Emergency care/Urgent care

  • Urgent care
    • $0 copay
  • Emergency
    • $0 copay

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $0 copay
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • Out-of-Network: $0 copay

Ground ambulance

    • Out-of-Network: $0 copay
    • In-Network: $0 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • In-Network: $0 copay
    • Out-of-Network: $40 copay
  • Medicare-Covered Hearing Exam
    • In-Network: $0 copay
  • Hearing aids
    • Out-of-Network: $699-999 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Hearing aids
    • In-Network: $699-999 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $0 copay

Inpatient hospital coverage

    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)

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

    • $0 In and Out-of-network
      $0 In-network

Medical equipment/supplies

  • Diabetes supplies
    • Out-of-Network: $0 copay (Authorization Required)
    • In-Network: $0 copay (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: $0 copay (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: $0 copay (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: $0 copay (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: $0 copay (Authorization Required)

Medicare Part B drugs

  • Other Part B drugs
    • In-Network: $0 copay (Authorization Required)
  • Chemotherapy
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: $0 copay (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • Out-of-Network: $0 copay (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: $0 copay
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $0 copay
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $0 copay
    • Out-of-Network: $0 copay
  • Inpatient hospital – psychiatric
    • In-Network: $0 copay (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $0 copay
  • Outpatient individual therapy visit
    • In-Network: $0 copay
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $0 copay
  • Outpatient individual therapy visit
    • Out-of-Network: $0 copay

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)
  • Occupational therapy visit
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)

Skilled Nursing Facility

    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)

Transportation

    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)

Vision

  • Eyeglass frames
    • Not covered
  • Other
    • Not covered
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)

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

    • Covered

Ready to sign up for Mass General Brigham Advantage Signature (PPO) ?

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

Need more information on Mass General Brigham Advantage Signature (PPO)? See 2025 Mass General Brigham Advantage Signature (PPO) at MedicareAdvantageRX.com.

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All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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