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Verified against CMS.gov · on April 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 NOVOLOG insulin aspart Brand Tier 3 $0.00 Details
2 Primaquine Phosphate Brand Tier 4 $0.00 Details
3 Lenalidomide Brand Tier 5 $0.00 Details
4 Loxapine Brand Tier 3 $0.00 Details
5 Nefazodone Hydrochloride Brand Tier 4 $0.00 Details
6 Ciprofloxacin in Dextrose ciprofloxacin Brand Tier 4 $0.00 Details
7 Chlorhexidine Gluconate Brand Tier 2 $0.00 Details
8 Imatinib Mesylate Brand Tier 5 $0.00 Details
9 ZEJULA niraparib Brand Tier 5 $0.00 Details
10 Enoxaparin Sodium Enoxaparin sodium Brand Tier 4 $0.00 Details
11 GARDASIL 9 Human Papillomavirus 9-valent Vaccine, Recombinant Brand Tier 1 $0.00 Details
12 VAQTA hepatitis A vaccine, inactivated Brand Tier 1 $0.00 Details
13 Fetzima LEVOMILNACIPRAN HYDROCHLORIDE Brand Tier 4 $0.00 Details
14 Verzenio abemaciclib Brand Tier 5 $0.00 Details
15 Nitroglycerin nitroglycerin Brand Tier 3 $0.00 Details
16 Kaletra Lopinavir and Ritonavir Brand Tier 5 $0.00 Details
17 Venclexta Venetoclax Brand Tier 5 $0.00 Details
18 Buprenorphine Brand Tier 3 $0.00 Details
19 Talzenna talazoparib Brand Tier 5 $0.00 Details
20 Risperidone 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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