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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H9904-002 Cross-check on Medicare.gov →

Mass Advantage Extra (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$200.00 Annual Deductible
829 Drugs Covered
1 States Served

Top Covered Drugs

Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.

# Drug Name Type Tier 30-Day Copay
1 Nortriptyline Hydrochloride Brand Tier 3 $0.00 Details
2 Xalkori CRIZOTINIB Brand Tier 5 $0.00 Details
3 Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate Brand Tier 5 $0.00 Details
4 Valsartan valsartan Brand Tier 1 $0.00 Details
5 Nefazodone Hydrochloride Brand Tier 4 $0.00 Details
6 Diltiazem Hydrochloride Brand Tier 2 $0.00 Details
7 Valsartan valsartan Brand Tier 1 $0.00 Details
8 Omeprazole Brand Tier 1 $0.00 Details
9 Haloperidol Brand Tier 3 $0.00 Details
10 Ciprofloxacin Brand Tier 2 $0.00 Details
11 Combivent Respimat ipratropium bromide and albuterol Brand Tier 4 $0.00 Details
12 FARXIGA DAPAGLIFLOZIN Brand Tier 3 $0.00 Details
13 Aptivus tipranavir Brand Tier 5 $0.00 Details
14 Fluvoxamine maleate Brand Tier 3 $0.00 Details
15 NOVOLOG insulin aspart Brand Tier 3 $0.00 Details
16 Primaquine Phosphate Brand Tier 4 $0.00 Details
17 Lenalidomide Brand Tier 5 $0.00 Details
18 Loxapine Brand Tier 3 $0.00 Details
19 Nefazodone Hydrochloride Brand Tier 4 $0.00 Details
20 Ciprofloxacin in Dextrose ciprofloxacin Brand Tier 4 $0.00 Details

Showing 20 of 829 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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