Master Medical Medicare Part A & B Carve-Out Benefits at a Glance
Inpatient Services Master Medical Carve-Out Pays
General or chronic disease hospital care

Full coverage of Medicare deductible and co-insurance for days 1–90

Full coverage of lifetime reserve day co-insurance

Full coverage for room and board and special services (as many days as medically necessary)
Physician or other professional provider Full coverage of Medicare deductible and co-insurance (as many days as medically necessary)
Outpatient Services1 Master Medical Carve-Out Pays
Emergency medical care services and hospital charges for medical care including podiatry, surgery and related anesthesia, radiation therapy, X-rays and laboratory tests, hemodialysis, pap smear tests, and mammograms Full coverage of Medicare deductible and co-insurance
Physical therapy, speech pathology, and occupational therapy in a hospital or emergency room Full coverage of Medicare deductible and co-insurance
  1. Most services may be provided in a hospital outpatient department, clinic, or physician's or other professional provider's office or a home.
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Prescription Drug Coverage

Your plan includes prescription drug coverage. For more information, download the Summary of Benefits.

Prescription Drug Benefits You Pay
Retail pharmacies (up to a 30-day supply)

80% coverage for drugs purchased at designated pharmacies in Massachusetts or any retail pharmacy outside of Massachusetts

When your 20% co-insurance equals $200, benefits will be provided at 100% of the allowed charge for the rest of that calendar year
Mail order pharmacy (up to a 90-day formulary supply when purchased through the mail service program)

Full coverage after a:

$5 copayment for generic drugs

$10 copayment for brand-name drugs
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