Medicare Plan Options

Once you’re eligible for Medicare, you have several options for customizing your coverage to fit your needs. The basic Original Medicare plan is an affordable option if you need little more than routine care. If you’re looking for more robust coverage, Massachusetts’s Medicare Advantage program is administered by private health insurance companies and features plans with broader scopes of care. Private companies also provide prescription drug and Medigap coverage, which you can add to your Original Medicare plan to further control your health expenses.

Original Medicare

Original Medicare is the basic health care program that the federal government administers. It’s a fee-for-service plan, meaning that health care providers are paid for each service they perform. There are two parts in this program, including Part A, which covers inpatient hospital stays, hospice, nursing home care, and home health care, and Part B, which covers doctor’s office visits, medical supplies, and preventative care. Every year, you have to meet a deductible before Medicare pays out for services. After you meet your deductible, you generally pay 20% of the cost of Medicare-approved services.

Medicare Advantage Plans

Medicare Advantage Plans, or Part C, are another option for getting your hospital and medical benefits. Private health insurance companies provide these plans according to rules laid out by the federal government. The plans include all the benefits of Original Medicare, plus some additional benefits such as prescription drug coverage and vision, dental, and hearing services. There are several types of Medicare Advantage Plans, including HMOPPO, SNP, and PPFS plans. Regardless of your plan type, you pay the Part B deductible. Your plan may have an additional deductible, depending on its scope of coverage, but many plans are offered at no extra cost.

Medicare Prescription Drug Coverage Plans

Prescription drug coverage, also called Part D, isn’t included under Original Medicare’s benefits. Instead, private health insurance companies sell these plans, enabling you to find one that covers the medications you need. Part D has specific enrollment periods during which you can sign up or switch to a different plan. Unless you have creditable prescription drug coverage from another source, it’s a good idea to purchase Part D coverage when you first sign up for Medicare, even if you don’t rely on medications at that time. Otherwise, you pay a penalty of 1% for every month you wait to enroll for the duration of your policy.

Medicare Supplement Insurance Plans

Medicare Supplement Insurance Plans, or Medigap, are sold by private health insurance companies only to those with Original Medicare. Medigap makes your health coverage more affordable by covering a portion of your deductibles and copays. Massachusetts has its own unique set of plans, which include the Core Plan, Supplement 1, and Supplement 1A. All plans cover the coinsurance for hospital care and medical costs, up to three pints of blood, and copays for hospice care. Supplement 1 and 1A plans have additional benefits, such as coverage for skilled nursing facility coinsurance, medical emergencies you experience overseas, and state-mandated benefits.

Medicare in Massachusetts by the Numbers

People enrolled in Original Medicare  Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
986,476 Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
$10,015 -1.00%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in Massachusetts

Massachusetts has several agencies and programs that help you understand your Medicare coverage and get the most from your policy. Through the following programs, you can get answers to questions about Original Medicare benefits and available Medicare Advantage, Medigap, and prescription drug plans. The state also has a program to help you identify and protect yourself from Medicare fraud.

Massachusetts Division of Insurance

The Massachusetts Division of Insurance oversees insurance policies sold in the state and monitors health insurance companies to ensure they handle claims ethically. The Division provides you with up-to-date and objective information regarding coverage options and advocates on your behalf if an insurance claim isn’t handled properly by the company. Through the website, you can file a  complaint about insurance-related problems or find out when insurance enrollment periods open.

Contact Information: Website | 877-563-4467

Serving Health Insurance Needs of Everyone

SHINE is the statewide senior health insurance information program that provides Massachusetts residents with free, unbiased information regarding their health insurance options. The program is primarily staffed by trained volunteers who meet with you one-on-one and answer any questions you have about your Medicare benefits. SHINE volunteers can help you determine which Medigap, Medicare Advantage, and prescription drug plans are available in your region and compare rates and benefits. They can also help you address billing errors or dispute denied claims.

Contact InformationWebsite | 800-243-4636

Massachusetts Senior Medicare Patrol Program

The statewide SMP program helps you protect yourself from Medicare fraud by providing information on common scams and unethical Medicare billing practices. This program is staffed by volunteers who speak at community events on topics such as recognizing billing errors and what to do if you’re a target of fraud. Volunteers also provide one-on-one assistance to help you review your medical bills, recognize discrepancies such as charges for services you didn’t receive, and report Medicare fraud or abuse to authorities.

Contact Information: Website | 800-892-0890

Central Massachusetts Area Agency on Aging

The Central Massachusetts Area Agency on Aging is one of 23 AAAs in the state that serve those aged 60 and over through a broad array of programs and services. Through the local agency, you can connect with SHINE counselors who can help you understand your Medicare benefits and address gaps in your coverage. Counselors provide advice and information in group and one-on-one formats and can help you find the right Medicare options for your needs. To find your local AAA office, visit the Massachusetts Healthy Aging Collaborative site.

Contact Information: Website | 508-852-5539

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