Medicare Advantage details for providers

Mass General Brigham Health Plan is updating its Medicare Advantage plans to support affordable, coordinated, and sustainable care for members.

Starting January 1, 2027, we will no longer offer Medicare Advantage PPO plans, and members may choose from our Medicare Advantage HMO-POS options instead. This change applies only to Mass General Brigham Health Plan Medicare Advantage members and does not affect our commercial and MassHealth members.

As a non-profit health plan, we are making this change to keep members’ costs down while preserving comprehensive coverage options. Across the country, rising health care costs and federal Medicare Advantage reimbursement rates that have not kept pace with the cost of care have prompted many health plans to make similar changes.

What providers should know

• To support this transition, Mass General Brigham Health Plan is providing proactive and personalized outreach to help our members understand their options and continue receiving the care they need. 
  
• Members can make changes to their plans this fall during the Annual Enrollment Period from October 15 through December 7.
• Members are encouraged to call our Customer Service support team at 855-833-3668 (TTY: 711) Monday–Sunday, 8 a.m. to 8 p.m. ET or email HealthPlanMedAdvCustomerService@mgb.org. Medicare Advisors are also available to answer questions and provide information about plan options.
• For help comparing all Medicare coverage options, members can also contact Medicare directly at 800-MEDICARE or visit Medicare.gov.

Our HMO-POS plans will support coordinated care and continue to provide comprehensive benefits and access to a high-quality provider network. 

We appreciate your partnership in supporting our Medicare Advantage members and helping ensure a smooth transition for those affected by this change.

Please refer any patient questions to our website, MassGeneralBrighamAdvantage.org.

Yes, all eligibility can be checked by visiting the Provider Portal: Provider.MassGeneralBrighamHealthPlan.org.

Yes, our Medicare Advantage members can call 855-833-3668 for Customer Service. Our hours are:

October 1 – March 31, 8 AM-8 PM ET, Mon-Sun  
April 1 – September 30, 8 AM-8 PM ET, Mon-Fri

Providers can continue to utilize the existing Provider Services line by calling 855-444-4647.

• Mass General Brigham Advantage Core (HMO-POS) 
• Mass General Brigham Advantage Secure (HMO-POS) 
• Mass General Brigham Advantage Plus (HMO-POS) 

Mass General Brigham Health Plan offers a Medicare Prescription Payment Plan to all members. The Medicare Prescription Payment Plan is a voluntary payment option that works with a member’s current Medicare Part D prescription drug coverage, and it helps members manage their out-of-pocket drug costs by spreading them across monthly payments that may vary throughout the plan year (January – December). This payment option may help members manage their expenses, but it doesn’t save money or lower their drug costs.

If a member selects this payment option, each month they’ll continue to pay their plan premium (if they have one), and they’ll get a bill to pay for their prescription drugs (instead of paying the pharmacy). There’s no cost to for members to participate in the Medicare Prescription Payment Plan and participation is voluntary. Members must voluntarily opt into the Medicare Prescription Payment Plan to participate. To maximize this payment option, members should opt-in to this payment option prior to filling their prescriptions.

For more information about the program, please see the following resources:

Mass General Brigham Health Plan MPPP page

Medicare.gov fact sheet

Medicare.gov MPPP site

Members that may benefit from the Medicare Prescription Payment Plan if:

• They have high covered Part D drug costs early in the plan calendar year.
• They will exceed the $2,100 annual out-of-pocket maximum Medicare Part D drug cost amount for 2026 before September.
• They want to spread their covered Part D drug costs throughout the rest of the year.

Members that may not benefit from the Medicare Prescription Payment Plan.

• Members with low yearly out-of-pocket covered Part D drug costs (<$2,000 per year).
• Members receiving or eligible for Extra Help from Medicare.
• Members receiving or eligible for a Medicare Savings Program.
• Members receiving help paying for drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP), a coupon program, or other health coverage.
• Members in plans that exclusively charge $0 cost sharing for covered Part D Drugs.

Members can opt-in to this payment option or obtain additional information about this payment option here.

Members who are active in the Medicare Prescription Payment Plan and remain in the same Part D Plan will be automatically renewed for the following plan year. New members or Members who change their Part D plan must opt into the Medicare Prescription Payment Plan each year.  Members may opt in during the annual election period beginning in October or may wait until the plan year to opt into the Medicare Prescription Payment Plan. However, if they would like the Medicare Prescription Payment Plan to be active January 1st, then they must opt into the program during the annual election period.

Members may opt out or leave the Medicare Prescription Payment Plan at any time by contacting the health or drug plan. Leaving the Medicare Prescription Payment Plan will not affect their Medicare drug coverage and other Medicare benefits.

If a member does not pay their Medicare Prescription Payment Plan bill, they’ll be removed from the Medicare Prescription Payment Plan. Members are required to pay the amount owed but will not pay any interest or fees, even if the payment is late. If a member is removed from the Medicare Prescription Payment Plan, they are still enrolled in their Medicare health or drug plan.

You can confirm your participation by utilizing our online provider directory or by calling 855-444-4647.

You can also visit the Medicare Advantage Provider Directory.

Referrals will be required across all three plans for certain in-network specialty office visits. Check plan documents carefully to verify which specialists require referrals. Providers submit referrals via the Provider Portal. 

Authorizations will be required where applicable. 

You can view the Medicare Advantage prior authorization and notification guidelines here: Medicare Advantage Prior Authorization and Notification Guidelines.

We are thrilled to have you included in the Medicare Advantage network. There is no additional action required for you to start seeing Medicare Advantage members.

We're here to help! Please complete the form below and a Mass General Brigham Health Plan representative will follow-up with you.