Original Medicare vs a plan · Hampden County, MA · 2027 plan year
Original Medicare vs Health New England Medicare Plus (HMO)
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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Health New England Medicare Plus (HMO)
- Plan premium
- $138 a month
- Yearly limit, in network
- $5,500
- 2027 star rating
- 3 of 5
- Prior authorization needed for
- 15 services
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 01034 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 Plus (HMO)
HMO from Health New England Medicare Advantage Plans
$6,803 a year
- Premiums
- $4,170
- Medical costs
- $1,345
- Drugs
- $1,288
Most you can pay in a bad year, before drugs: $9,670.
With these settings, Original Medicare costs about $664 less a year than Health New England Medicare Plus (HMO).
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
Specialist visit
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$40
Lab tests
Original Medicare, no Medigap
$0
most Medicare-covered tests
Health New England Medicare Plus (HMO)
$0-$15
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 authorization
Emergency room
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$130
Urgent care
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$50
Outpatient surgery
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$150
Prior authorization
Ground ambulance
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Health New England Medicare Plus (HMO)
$375
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
See every cost in one table
| What you pay in network | Original Medicare, no Medigap | Health New England Medicare Plus (HMO) |
|---|---|---|
| Monthly premium | Part B $209.50 + drug plan $25.50 | $138 + Part B $209.50 |
| Yearly limit on what you pay | No yearly limit | $5,500 in network |
| Medical deductible | $292 Part B; $1,788 Part A each benefit period | $0 |
| Primary doctor visit | 20%, after the $292 yearly Part B deductible | $20 copay |
| Specialist visit | 20%, after the $292 yearly Part B deductible | $40 copay |
| Lab tests | $0, most Medicare-covered tests | $0-$15 copayPrior authorization |
| MRI or CT scan | 20%, after the $292 yearly Part B deductible | $0-$275 copayPrior authorization |
| X-rays | 20%, after the $292 yearly Part B deductible | $25 copayPrior authorization |
| Emergency room | 20%, after the $292 yearly Part B deductible | $130 copay |
| Urgent care | 20%, after the $292 yearly Part B deductible | $50 copay |
| Outpatient hospital | 20%, after the $292 yearly Part B deductible | $0-$325 copayPrior authorization |
| Surgery center | 20%, after the $292 yearly Part B deductible | $150 copayPrior authorization |
| Ground ambulance | 20%, after the $292 yearly Part B deductible | $375 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 |
| 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 |
| Mental health visit | 20%, after the $292 yearly Part B deductible | $40 copay |
| Physical therapy | 20%, after the $292 yearly Part B deductible | $40 copayPrior authorization |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization |
| Medical equipment | 20%, after the $292 yearly Part B deductible | 20% coinsurancePrior authorization |
| Part B drugs | 20% after the $292 Part B deductible | 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with Blue MedicareRx Value Plus (PDP) | $350 |
| 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 |
Not sure which of these costs apply to you?
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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
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
Extra benefits
| Extra benefit | Original Medicare | Health New England Medicare Plus (HMO) |
|---|---|---|
| Dental | No | Comprehensive, up to $500 a year |
| Eye exam | No | Yes |
| Glasses or contacts | No | Yes, $300 allowance |
| Hearing aids | No | Yes, copays from $499 |
| Over-the-counter allowance | No | $200 a year |
| Fitness benefit | No | Yes |
| Rides to care | No | Yes |
| Meals after a hospital stay | No | Yes |
| Emergency care abroad | No, unless your Medigap plan pays for it | Yes |
| Part B premium giveback | No | No |
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
More 2027 plans in Hampden County
- Tufts Medicare Preferred HMO Smart Saver Rx (HMO), H2256-047 (page for Middlesex County, MA)
- AARP Medicare Advantage from UHC MA-0003 (HMO-POS), H5253-157 (page for Worcester County, MA)
- Medicare PPO Blue ValueRx (PPO), H2230-020 (page for Norfolk County, MA)
- Medicare HMO Blue SaverRx (HMO-POS), H2261-024 (page for Middlesex County, MA)
- HumanaChoice Giveback H5216-138 (PPO) (page for Hartford County, CT)
- AARP Medicare Advantage from UHC MA-0006 (PPO), H8768-055 (page for Worcester County, MA)
- Tufts Medicare Preferred HMO Basic Rx (HMO), H2256-026
- Tufts Medicare Preferred HMO Prime Rx (HMO), H2256-015
County guide: 2027 plans in Hampden 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 01034 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
- Medigap prices for ZIP 01034 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.