Company vs company · Berkshire County, MA · 2027 plan year
Health New England Medicare Advantage Plans vs Fallon Health Medicare Advantage plans
Medicare.gov compares Medicare Advantage plans with each other. This page also shows Original Medicare, so you can see the full trade-off: premiums, copays, the yearly limit, extra benefits, and the rules about doctors and approvals.
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In Massachusetts, you can go back to Medigap later
Massachusetts law makes Medigap companies accept you from February 1 to March 31 each year. Your age and health do not change the price. Coverage from that window starts on June 1. The companies also sell Medigap during the rest of the year. So you can try Medicare Advantage and go back to Original Medicare with Medigap later.
Read about Medigap rights on Medicare.govYour yearly cost, side by side
Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.
Medigap plan with Original Medicare
Massachusetts sets its own Medigap plans: Core and Supplement 1A. Supplement 1 is open only to people who were eligible for Medicare before 2020. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices for these plans, so the totals show Original Medicare without Medigap. Without Medigap you pay 20% of most costs, with no yearly limit. Check Medigap plans and prices for ZIP 01230 on Medicare.gov
Want to check your exact drugs? Medicare.gov lets you enter each drug and shows what each plan charges for it. Enter your drugs on Medicare.gov
Original Medicare
With no Medigap and Blue MedicareRx Value Plus (PDP)
$6,139 a year
- Premiums
- $2,820
- Medical costs
- $1,616
- Drugs
- $1,703
No yearly limit on what you pay for medical care.
Health New England Medicare Standard (HMO)
HMO from Health New England Medicare Advantage Plans
$5,999 a year
- Premiums
- $3,042
- Medical costs
- $1,550
- Drugs
- $1,407
Most you can pay in a bad year, before drugs: $12,042.
Fallon Medicare Plus Blue (HMO)
HMO from Fallon Health
$6,187 a year
- Premiums
- $4,818
- Medical costs
- $805
- Drugs
- $564
Most you can pay in a bad year, before drugs: $8,218.
With these settings, Health New England Medicare Standard (HMO) costs about $140 less a year than Original Medicare.
These are estimates, not quotes. Check every number with Medicare (Medicare.gov or 1-800-MEDICARE) and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Drug costs use typical prices for generic and brand-name drugs. Original Medicare amounts are 2027 projections from the 2026 Medicare Trustees Report. CMS sets the final amounts in November.
Text us about this comparisonWhat you pay each time you get care
In-network costs for one visit or one stay. The Original Medicare amounts follow your Medigap choice above: no Medigap.
Primary doctor visit
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$20
Health New England Medicare Premium (HMO)
$10
Fallon Medicare Plus Blue (HMO)
$10
Fallon Medicare Plus Saver No Rx (HMO)
$0 copay
Specialist visit
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$40
Health New England Medicare Premium (HMO)
$35
Fallon Medicare Plus Blue (HMO)
$15-$30
Prior authorizationFallon Medicare Plus Saver No Rx (HMO)
$20-$40
Prior authorization
Lab tests
Original Medicare, no Medigap
$0
most Medicare-covered tests
Health New England Medicare Plus (HMO)
$0-$15
Prior authorizationHealth New England Medicare Premium (HMO)
$0-$10
Prior authorizationFallon Medicare Plus Blue (HMO)
$0 copay
Prior authorizationFallon Medicare Plus Saver No Rx (HMO)
$0 copay
Prior authorization
MRI or CT scan
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$0-$275
Prior authorizationHealth New England Medicare Premium (HMO)
$0-$200
Prior authorizationFallon Medicare Plus Blue (HMO)
$200
Prior authorizationFallon Medicare Plus Saver No Rx (HMO)
$250
Prior authorization
Emergency room
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$130
Health New England Medicare Premium (HMO)
$130
Fallon Medicare Plus Blue (HMO)
$140
Fallon Medicare Plus Saver No Rx (HMO)
$90
Urgent care
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$50
Health New England Medicare Premium (HMO)
$50
Fallon Medicare Plus Blue (HMO)
$10
Fallon Medicare Plus Saver No Rx (HMO)
$15
Outpatient surgery
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$150
Prior authorizationHealth New England Medicare Premium (HMO)
$150
Prior authorizationFallon Medicare Plus Blue (HMO)
$175
Prior authorizationFallon Medicare Plus Saver No Rx (HMO)
$275
Prior authorization
Ground ambulance
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$375
Prior authorizationHealth New England Medicare Premium (HMO)
$375
Prior authorizationFallon Medicare Plus Blue (HMO)
$250
Prior authorizationFallon Medicare Plus Saver No Rx (HMO)
$250
Prior authorization
Hospital stay, 5 days
Original Medicare, no Medigap
$1,788
Part A deductible each benefit period; $447 a day for days 61-90
Health New England Medicare Plus (HMO)
$1,250
for a 5-day stay
Health New England Medicare Premium (HMO)
$750
for a 5-day stay
Fallon Medicare Plus Blue (HMO)
$300
for a 5-day stay
Prior authorizationFallon Medicare Plus Saver No Rx (HMO)
$1,575
for a 5-day stay
Prior authorization
See every cost in one table
| What you pay in network | Original Medicare, no Medigap | Health New England Medicare Plus (HMO) | Health New England Medicare Premium (HMO) | Fallon Medicare Plus Blue (HMO) | Fallon Medicare Plus Saver No Rx (HMO) |
|---|---|---|---|---|---|
| Monthly premium | Part B $209.50 + drug plan $25.50 | $138 + Part B $209.50 | $188 + Part B $209.50 | $192 + Part B $209.50 | $0 (pays back $75 a month of your Part B premium) + Part B $209.50 |
| Yearly limit on what you pay | No yearly limit | $5,500 in network | $5,000 in network | $3,400 in network | $6,700 in network |
| Medical deductible | $292 Part B; $1,788 Part A each benefit period | $0 | $0 | $0 | $0 |
| Primary doctor visit | 20%, after the $292 yearly Part B deductible | $20 copay | $10 copay | $10 copay | $0 copay |
| Specialist visit | 20%, after the $292 yearly Part B deductible | $40 copay | $35 copay | $15-$30 copayPrior authorization | $20-$40 copayPrior authorization |
| Lab tests | $0, most Medicare-covered tests | $0-$15 copayPrior authorization | $0-$10 copayPrior authorization | $0 copayPrior authorization | $0 copayPrior authorization |
| MRI or CT scan | 20%, after the $292 yearly Part B deductible | $0-$275 copayPrior authorization | $0-$200 copayPrior authorization | $200 copayPrior authorization | $250 copayPrior authorization |
| X-rays | 20%, after the $292 yearly Part B deductible | $25 copayPrior authorization | $20 copayPrior authorization | $0 copayPrior authorization | $0 copayPrior authorization |
| Emergency room | 20%, after the $292 yearly Part B deductible | $130 copay | $130 copay | $140 copay | $90 copay |
| Urgent care | 20%, after the $292 yearly Part B deductible | $50 copay | $50 copay | $10 copay | $15 copay |
| Outpatient hospital | 20%, after the $292 yearly Part B deductible | $0-$325 copayPrior authorization | $0-$250 copayPrior authorization | $200 copayPrior authorization | $275 copayPrior authorization |
| Surgery center | 20%, after the $292 yearly Part B deductible | $150 copayPrior authorization | $150 copayPrior authorization | $175 copayPrior authorization | $275 copayPrior authorization |
| Ground ambulance | 20%, after the $292 yearly Part B deductible | $375 copayPrior authorization | $375 copayPrior authorization | $250 copayPrior authorization | $250 copayPrior authorization |
| Hospital stay | $1,788, Part A deductible each benefit period; $447 a day for days 61-90 | $250 per day for days 1-7; $0 per day for days 8-90 | $150 per day for days 1-7; $0 per day for days 8-90 | $300 per stayPrior authorization | $315 per day for days 1-5; $0 per day for days 6-90Prior authorization |
| Skilled nursing facility | $0, days 1-20, then $223.50 a day for days 21-100 | $0 per day for days 1-20; $175 per day for days 21-100Prior authorization | $0 per day for days 1-20; $150 per day for days 21-100Prior authorization | $15 per day for days 1-20; $75 per day for days 21-44; $0 per day for days 45-100Prior authorization | $0 per day for days 1-20; $185 per day for days 21-100Prior authorization |
| Mental health visit | 20%, after the $292 yearly Part B deductible | $40 copay | $35 copay | $20 copay | $40 copay |
| Physical therapy | 20%, after the $292 yearly Part B deductible | $40 copayPrior authorization | $35 copayPrior authorization | $15 copayPrior authorization | $20 copayPrior authorization |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization | $0 copayPrior authorization | $0 copayPrior authorization | $0 copayPrior authorization |
| Medical equipment | 20%, after the $292 yearly Part B deductible | 20% coinsurancePrior authorization | 20% coinsurancePrior authorization | 10% coinsurancePrior authorization | 20% coinsurancePrior authorization |
| Part B drugs | 20% after the $292 Part B deductible | 0%-20% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization | 0%-10% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with Blue MedicareRx Value Plus (PDP) | $350 | $350 | $0 | No drug coverage |
| Drug tiers (one month, retail) | Preferred Generic: $0 copayGeneric: $3 copayPreferred Brand: 17% coinsuranceNon-Preferred Drug: 35% coinsuranceSpecialty Tier: 25% coinsurance | Preferred Generic: $0 copayGeneric: $10 copayPreferred Brand: 15% coinsuranceNon-Preferred Drug: 39% coinsuranceSpecialty Tier: 29% coinsurance | Preferred Generic: $0 copayGeneric: $10 copayPreferred Brand: 15% coinsuranceNon-Preferred Drug: 40% coinsuranceSpecialty Tier: 29% coinsurance | Preferred Generic: $0 copayGeneric: $7 copayPreferred Brand: $47 copayNon-Preferred Drug: 35% coinsuranceSpecialty Tier: 33% coinsuranceSelect Care Drugs: $0 copay | No drug coverage |
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A higher drug plan premium is not, by itself, a reason to switch
With Original Medicare, you buy a separate drug plan. In Massachusetts, 10 drug plans are for sale for 2027, from $13.30 to $284.70 a month. Half of them cost $114.75 a month or less.
- Every 2027 drug plan limits what you pay for covered drugs to $2,400 a year. The drug coverage in Medicare Advantage plans has the same limit.
- The premium is one part of your yearly cost. The calculator above adds premiums, medical costs, and drug costs, so you can see the whole year.
- A Medicare Advantage plan can cost less in a light year. But you also take on its network and prior authorization rules.
- If your income is limited, Extra Help can pay most of your drug plan premium and drug costs. Check Extra Help at SSA.gov
The two companies in Berkshire County
Health New England Medicare Advantage Plans
- 5 plans for 2027 (not counting special needs plans)
- 1 with a $0 premium; 0 pay back part of your Part B premium
- Yearly limits from $4,500 to $9,000
- Star ratings 3 to 3
- Health New England Medicare Plus (HMO) · $138 a month · limit $5,500
- Health New England Medicare Premium (HMO) · $188 a month · limit $5,000
- Health New England Medicare Basic No Rx (HMO) · $0 a month · limit $5,500
- Health New England Medicare Premium No Rx (HMO) · $44 a month · limit $4,500
- Health New England Medicare Standard (HMO) · $44 a month · limit $9,000
Fallon Health
- 2 plans for 2027 (not counting special needs plans)
- 1 with a $0 premium; 1 pay back part of your Part B premium
- Yearly limits from $3,400 to $6,700
- Star ratings 4 to 4
- Fallon Medicare Plus Blue (HMO) · $192 a month · limit $3,400
- Fallon Medicare Plus Saver No Rx (HMO) · $0 a month · limit $6,700
Doctors, referrals, and prior authorization
Cost is one side. The other side is how you get care. These rules come from the CMS plan files. Prior authorization means the plan must approve a service before you get it.
Original Medicare
- Any doctor or hospital in the U.S. that takes Medicare
- No referrals
- Prior authorization only for a short list of services
Health New England Medicare Plus (HMO)
HMO
- You use doctors and hospitals in the plan network. Outside the network, the plan pays for emergencies and urgent care.
- No referral needed to see a specialist.
Prior authorization for 15 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Surgery center, Ambulance, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Medical equipment, Prosthetics, Diabetic supplies, Skilled nursing, Part B drugs
Health New England Medicare Premium (HMO)
HMO
- You use doctors and hospitals in the plan network. Outside the network, the plan pays for emergencies and urgent care.
- No referral needed to see a specialist.
Prior authorization for 15 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Surgery center, Ambulance, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Medical equipment, Prosthetics, Diabetic supplies, Skilled nursing, Part B drugs
Fallon Medicare Plus Blue (HMO)
HMO
- You use doctors and hospitals in the plan network. Outside the network, the plan pays for emergencies and urgent care.
- You need a referral to see a specialist.
Prior authorization for 18 services
Specialist visits, Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Surgery center, Ambulance, Psychiatrist visits, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Medical equipment, Prosthetics, Diabetic supplies, Hospital stay, Skilled nursing, Part B drugs
Fallon Medicare Plus Saver No Rx (HMO)
HMO
- You use doctors and hospitals in the plan network. Outside the network, the plan pays for emergencies and urgent care.
- You need a referral to see a specialist.
Prior authorization for 18 services
Specialist visits, Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Surgery center, Ambulance, Psychiatrist visits, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Medical equipment, Prosthetics, Diabetic supplies, Hospital stay, Skilled nursing, Part B drugs
Extra benefits
| Extra benefit | Original Medicare | Health New England Medicare Plus (HMO) | Health New England Medicare Premium (HMO) | Fallon Medicare Plus Blue (HMO) | Fallon Medicare Plus Saver No Rx (HMO) |
|---|---|---|---|---|---|
| Dental | No | Comprehensive, up to $500 a year | Comprehensive, up to $550 a year | Comprehensive | Comprehensive |
| Eye exam | No | Yes | Yes | Yes | Yes |
| Glasses or contacts | No | Yes, $300 allowance | Yes, $300 allowance | Yes, $150 allowance | Yes, $150 allowance |
| Hearing aids | No | Yes, copays from $499 | Yes, copays from $499 | Yes, copays from $695 | Yes, copays from $695 |
| Over-the-counter allowance | No | $200 a year | $200 a year | No | $250 a year |
| Fitness benefit | No | Yes | Yes | Yes | Yes |
| Rides to care | No | Yes | Yes | No | Yes |
| Meals after a hospital stay | No | Yes | Yes | No | No |
| Emergency care abroad | No, unless your Medigap plan pays for it | Yes | Yes | Yes | Yes |
| Part B premium giveback | No | No | No | No | $75 a month |
What changed for 2027
Health New England Medicare Plus (HMO)
Renewal Plan · 2026 plan H8578-004-0
- Monthly premium up from $113 to $138
- In-network out-of-pocket maximum up from $5,000 to $5,500
- Outpatient hospital: $0-$300 copay to $0-$325 copay
- Ground ambulance: $350 copay to $375 copay
- Skilled nursing facility: $0 per day for days 1-20; $175 per day for days 21-50; $0 per day for days 51-100 to $0 per day for days 1-20; $175 per day for days 21-100
- Dental maximum down from $840 to $500
- Yearly OTC allowance down from $300 to $200
Health New England Medicare Premium (HMO)
Renewal Plan · 2026 plan H8578-001-0
- Monthly premium up from $168 to $188
- In-network out-of-pocket maximum up from $4,500 to $5,000
- Primary doctor visit: $0 copay to $10 copay
- Specialist visit: $30 copay to $35 copay
- Diagnostic radiology (MRI, CT): $0-$175 copay to $0-$200 copay
- Outpatient hospital: $0-$200 copay to $0-$250 copay
- Ground ambulance: $350 copay to $375 copay
- Skilled nursing facility: $0 per day for days 1-20; $150 per day for days 21-50; $0 per day for days 51-100 to $0 per day for days 1-20; $150 per day for days 21-100
- Dental maximum down from $1,040 to $550
- Yearly OTC allowance down from $300 to $200
Fallon Medicare Plus Blue (HMO)
Renewal Plan · New for 2027
No change found in the fields we track.
Fallon Medicare Plus Saver No Rx (HMO)
Renewal Plan · 2026 plan H9001-039-0
- Skilled nursing facility: $0 per day for days 1-20; $203 per day for days 21-100 to $0 per day for days 1-20; $185 per day for days 21-100
- Yearly OTC allowance up from $175 to $250
More 2027 plans in Berkshire County
County guide: 2027 plans in Berkshire CountyState guide: Massachusetts
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Sources and method
Plan data comes from the CMS 2027 Plan Benefit Package and landscape files. The data is from 2026-10-10. We checked a sample of plans field by field against Medicare.gov. Original Medicare amounts are the 2027 projections in the 2026 Medicare Trustees Report (Tables V.E1 and V.E2). CMS sets the final amounts in November. Massachusetts sets its own Medigap plans: Core and Supplement 1A. Supplement 1 is open only to people who were eligible for Medicare before 2020. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices or cost model for these plans, so the totals show Original Medicare without Medigap. You can look up Medigap plans and prices for ZIP 01230 on Medicare.gov. Totals use typical Medicare-allowed amounts for each service and typical drug prices.
- Health New England Medicare Plus (HMO) on Medicare.gov · plan website · drug list · doctor directory
- Health New England Medicare Premium (HMO) on Medicare.gov · plan website · drug list · doctor directory
- Fallon Medicare Plus Blue (HMO) on Medicare.gov · plan website · drug list · doctor directory
- Fallon Medicare Plus Saver No Rx (HMO) on Medicare.gov · plan website · drug list · doctor directory
- Medigap prices for ZIP 01230 on Medicare.gov
- Medigap plans in Massachusetts: Medicare.gov, Choosing a Medigap Policy (2026), Section 7
- CMS Plan Benefit Package files, 2027
- CMS 2027 landscape files (premiums and limits)
- CMS 2027 plan crosswalk
- CMS 2027 Star Ratings
- 2026 Medicare Trustees Report: projected 2027 Part A and Part B amounts (Tables V.E1 and V.E2)
- CMS 2026 Part A and Part B amounts
- Medicare.gov: Medigap guaranteed issue rights
These are estimates, not quotes, and they are for education only. Check every number with Medicare and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Plans can change their benefits, premiums, drug lists, and networks each year.
Pinnie is not an insurance agent or broker and does not sell Medicare plans. Pinnie is not connected with or endorsed by the U.S. government or the federal Medicare program. For all your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.