Health New England

One Monarch Place,
Suite 1500

Springfield, MA 01144


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HNE Medicare Plus (HMO)

This is a high level overview of premium and benefit information for this plan. HNE Medicare Plus (HMO) covers both Medicare Part B prescription drugs* and Medicare Part D prescription drugs.

Monthly Plan Premium


Medical Out-of-Pocket Maximum


Deductible Not Applicable

Office Visits ($0 annual preventive exam)


Specialist Office Visits


Inpatient Hospital (3 copayment maximum)

$600 per admission

Outpatient Surgery


Skilled Nursing Facility (SNF)

Days 1-20: $40 copayment per day*
Days 21-100: $0 copayment per day

World Wide Emergency Room (ER)




Outpatient Rehabilitation (Prior authorization after visit 25)**


High Cost Imaging


Lab work/X-rays $0

Durable Medical Equipment/Prosthetics

15% Coinsurance*

Additional Benefits

Routine Hearing Exam+ $25
Routine Eye Exam+ $0

Vision Eyewear Allowance+

$100 eyewear allowance every two years

Dental Services Allowance+

$150 allowance per year

Fitness Center/Weight Watchers®/Over-the-Counter Items+

$150 allowance per year

Wig Allowance+ $350 per year (if on chemotherapy)

Prescription Drug (Part D) Coverage

Deductible Not Applicable

Initial Coverage
Up to $2,850 in Drug Costs

$10 Generics; $40 Brand;
$75 Brand Non-preferred;
33% Specialty

Coverage Gap - Over $2,850 in Drug Costs; Up to $4,550 in Out-of-Pocket Costs

For generic drugs, you pay either a $10 copayment or 72% of the costs, whichever is lower. For brand name drugs, you pay 47.5% of the price (plus a portion of the dispensing fee) or the HNE negotiated price, whichever is lower.

Catastrophic Coverage
Over $4,550 in Out-of-Pocket Costs

$2.55 for Generics and $6.35 for all other drugs; or 5% coinsurance

Mail-order (Three month supply) ++

$20 Generics; $80 Brand;
$225 Brand Non-preferred


Make sure that you are familiar with HNE Medicare Advantage plan options before you decide to enroll online. Explore Your Plan Options to review this important information.

If you have additional questions about which HNE Medicare Advantage plan option may be right for you, please call us, attend an Informational Session, or visit us at our office in Springfield. Our contact information is listed below.


*Some services require prior authorization. Our network providers know what we cover under your benefit plan. They also know what requires prior authorization and will request approval from HNE on your behalf.

**Prior Authorization required for rehabilitation services after visit 25 or if services are rendered in a SNF as an outpatient benefit when member is a resident of the SNF.

+HNE additional benefits include allowances that must be used within the one or two calendar year period, as well as other additional benefits. Refer to the Summary of Benefits or call Member Services if you have questions about what items and services are covered.

++Mail-order: During the coverage gap stage, generics are covered at $20 for a three month supply; for all other drugs, you pay 47.5% of the price or the HNE negotiated price, whichever is lower. During the catastrophic coverage stage, standard catastrophic coverage applies for all plans.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. benefits, formulary, pharmacy, network, premium and/or copayments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

See Eligibility Requirements on the Enrollment Form and Instructions.

Remember, you can join, switch, or drop a Medicare Advantage Plan only at certain times of year. See Key Enrollment Dates for details.


Member Services:
Local: 413.787.0010 or
Toll Free: 877.443.3314
TTY/TTD: 800.439.2370
8 a.m. – 8 p.m. / Mon - Fri
(Oct. 1 - Feb. 14:
8 a.m. – 8 p.m./7 days a week)


Prescription Drug Questions:
Toll Free: 800.546.5677
TTY/TTD: 866.706.4757
24 hours a day/7 days a week


NCQA Plan Ranking LogoHealth New England (HNE) is the top-ranked Medicare Advantage HMO Plan in Massachusetts and the 13th Medicare Advantage Plan in the U.S. in NCQA’s Medicare Health Insurance Plan Rankings 2013–2014.


The National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care.


HNE Medicare Advantage is an HMO plan with a Medicare contract.
Enrollment in HNE Medicare Advantage depends on contract renewal.

H8578_2014_049 Approved
The information on this page was last updated on 09/30/2013

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