Members

Thank you for continuing to be a valued member of Health New England.

Welcome Members

Thank you for choosing Health New England Medicare Advantage. We know you have many choices when it comes to your Medicare coverage and we are happy you chose Health New England. We take pride in ensuring our members understand their plans and we are always here to help.

Resources

Visit our Resources page to help find the information you are looking for.

Learn More

Plans

Find plan documents and benefit information.

Learn More

Benefits & Allowances

We offer programs, various tools and clinical programs for members to reinforce their health and wellness efforts.

Learn More

Forms

Looking for a form? Our Forms Library is the place to go.

Learn More

Pharmacy Benefits

Search for your pharmacy and prescription drugs through our online lookup.

Learn More

Find a Provider

Find doctors, hospitals, and other health care providers in Health New England’s Medicare Advantage network.

Learn More

Annual Notices

Each year you will receive an Annual Notice of Changes (ANOC), which details any change in coverage, costs or service area that will be effective in January. You will also receive an Evidence of Coverage (EOC) document, which is a comprehensive guide to your health care coverage. It details covered medical care and services, prescription drug coverage (if applicable) and information about your rights and responsibilities.

These documents are available below for each plan for viewing and printing. You may also request a hard copy by calling Member Services.

National Coverage Determinations

As a Medicare health plan, Health New England Medicare Advantage covers all services required by Original Medicare. We only make mid-year benefit changes when Medicare changes its coverage rules. When this happens, Medicare issues a National Coverage Determination (NCD) explaining whether Medicare will pay for an item or service. It is our policy to post changes within 30 days of the effective date of the NCD. All NCDs are effective on the date the decision memorandum is released. If the newly covered service is covered outside of the contract, the covered service may be obtained from any Medicare provider, including out-of-network providers.

Effective January 19, 2021, The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover a blood-based biomarker test as an appropriate colorectal cancer screening test once every 3 years for Medicare beneficiaries when performed in a Clinical Laboratory Improvement Act (CLIA)-certified laboratory, when ordered by a treating physician.

Learn More

Effective January 19, 2021, for clarity, the term Transcatheter Mitral Valve Repair (TMVR) is being replaced with mitral valve Transcatheter Edge-to-Edge Repair (TEER) to more precisely define the treatment addressed in this proposed NCD, which is applicable to TEER for the treatment of functional mitral regurgitation (MR) and degenerative MR.

Learn More

Effective January 27, 2020, The Centers for Medicare & Medicaid Services (CMS) has determined that Next Generation Sequencing (NGS) as a diagnostic laboratory test is reasonable and necessary and covered nationally, when performed in a CLIA-certified laboratory, when ordered by a treating physician and when certain requirements are met.

Learn More

Effective January 21, 2020, The Centers for Medicare & Medicaid Services (CMS) will cover acupuncture for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act. Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances.

Learn More

Effective July 2, 2019, The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries under the following circumstances:

1. For beneficiaries with suspected white coat hypertension, which is defined as an average office blood pressure of systolic blood pressure greater than 130 mm Hg but less than 160 mm Hg or diastolic blood pressure greater than 80 mm Hg but less than 100 mm Hg on two separate clinic/office visits with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are <130/80 mm Hg.

2. For beneficiaries with suspected masked hypertension, which is defined as average office blood pressure between 120 mm Hg and 129 mm Hg for systolic blood pressure or between 75 mm Hg and 79 mm Hg for diastolic blood pressure on two separate clinic/office visits with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are ≥130/80 mm Hg.

Learn More

Effective August 7, 2019, A.The Centers for Medicare & Medicaid Services (CMS) covers autologous treatment for cancer with T-cells expressing at least one chimeric antigen receptor (CAR) when administered at healthcare facilities enrolled in the FDA risk evaluation and mitigation strategies (REMS) and used for a medically accepted indication as defined at Social Security Act section 1861(t)(2) i.e., is used for either an FDA-approved indication (according to the FDA-approved label for that product), or for other uses when the product has been FDA-approved and the use is supported in one or more CMS-approved compendia.

Learn More

Effective January 18, 2017, the Centers for Medicare & Medicaid Services (CMS) covers leadless pacemakers through Coverage with Evidence Development (CED). CMS covers leadless pacemakers when procedures are performed in Food and Drug Administration (FDA) approved studies. CMS also covers, in prospective longitudinal studies, leadless pacemakers that are used in accordance with the FDA approved label for devices that have either an associated ongoing FDA approved post-approval study or completed an FDA post-approval study.

Learn More

Effective May 25, 2017 the Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (PAD). Up to 36 sessions over a 12 week period are covered if all of the components of a SET program are met.

Learn More

Effective October 3, 2016, The Centers for Medicare & Medicaid Services (CMS) covers percutaneous LAAC for non-valvular atrial fibrillation (NVAF) through Coverage with Evidence Development (CED) under 1862(a)(1)(E) of the Social Security Act with certain conditions.

Learn More

Effective July 1, 2015, in Accordance with the Achieving a Better Life Experience Act of 2014 Section 203 of the Achieving a Better Life Experience (ABLE) Act of 2014 implements changes to treat VES prosthetic devices and related accessories as statutorily noncovered in the same manner that erectile dysfunction drugs are treated in Part D.

Learn More

Effective July 9, 2015, Medicare has determined that the evidence is sufficient to add Human Papillomavirus (HPV) testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap smear test. CMS will cover screening for cervical cancer with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.

Learn More

Effective April 13, 2015, Medicare will cover annual voluntary HIV screening for all beneficiaries age 15 to 65, and for beneficiaries younger than 15 and older than 65 who are at increased risk for HIV infection. Medicare will cover a maximum of 3 voluntary screenings for pregnant beneficiaries under certain conditions.

Learn More

Effective February 5, 2015, Medicare covers lung cancer screening with low dose computed tomography (LDCT)  if all eligibility requirements listed in the National Coverage Determination are met.

Learn More

Connect with Us

Call us at (413) 787-0010 (TTY: 711)
Toll free at (877) 443-3314
8 a.m. - 8 p.m. / Mon - Fri (Oct. 1 - Mar. 31: 8 a.m. - 8 p.m. / 7 days a week)

Other Contact Options

Last Updated 5/26/2021