Understand Medicare in Massachusetts
Medicare, the United States federal medical insurance program, provides coverage for almost 1.4 million people in Massachusetts who qualify for Medicare. You can get Medicare if you’re 65 or older or have a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $506 per month in 2023. Part B costs $164.90 per month but can be more if you have higher income. There are 113 Medicare Advantage Plans in the state that are an alternative to Original Medicare. Learn more about your Medicare options in Massachusetts.
Medicare Plans in Massachusetts
|Compare ratings of Massachusetts’s Medicare plan providers:|
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||J.D. Power ranking|
|Aetna||4 stars||A+||A+||6th out of 9|
|Blue Cross Blue Shield||4.5 stars||A||A+||5th out of 9|
|Cigna||4 stars||A-||Not rated||8th out of 9|
|Humana||4 stars||A-||A+||2nd out of 9|
|UnitedHealthcare||3.5 stars||A+||A-||4th out of 9|
Medicare Plan Options in Massachusetts
Residents of Massachusetts have multiple Medicare plans to choose from. Many are tiered to help Massachusetts residents find the plan that is best suited to your lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. Massachusetts’ Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.
|Original Medicare (Parts A and B)||Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
|Medicare Advantage Plans (Part C)||Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
|Medicare Prescription Drug Coverage Plans (Part D)||Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
|Medicare Supplement Insurance Plans (Medigap)||Some Massachusetts seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
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|
|989,454||Part A: $0 to $506 per month*
Part B: $164.90 per month**
*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
Getting support can help when you’re making Medicare decisions. Massachusetts has numerous locations where enrollees can receive help through the State Health Insurance Program (SHIP), also known as Serving the Health Insurance Needs of Everyone (SHINE). SHINE has counselors throughout the state that work with local nonprofits and public health agencies, as well as Area Agencies on Aging (AAAs), to provide seniors with Medicare information.
Central Massachusetts Agency on Aging
The Central Massachusetts Agency on Aging offers information and resources in the 61 cities and towns in the state’s center. They also administer programs designed to help seniors 60 and older maintain their health and independence, including resources to guide you through the Medicare enrollment process, and the counselors will help you understand the available benefits fully.
Contact information: Website | (413) 527-7138
Massachusetts Division of Insurance
The state’s Division of Insurance protects consumers by ensuring that insurers adhere to regulations, and monitoring factors like licensure, rates, and reviews. The division also administers the SHINE program that offers free, unbiased Medicare guidance. e.
Contact information: Website | (617) 521-7794
Massachusetts Department of Human Services
The state’s Department of Human Services provides health benefits for qualifying individuals along with other resources.
Contact information: Website | (800) 841-2900
This state program can help you pay for Medicare expenses if you qualify. You could also save on out-of-pocket costs like Medicare Advantage premiums.
Contact information: Website | ( 800) 841-2900
Learn More from Our Sources
- Medicare | How do Medicare Advantage plans work? | Last accessed March 2023
- Medicare | How to get prescription drug coverage | Last accessed March 2023
- Medicare | Medicare Advantage Plans cover all Medicare services | Last accessed March 2023
- Medicare | What Medicare covers | Last accessed March 2023
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed March 2023