Medicare Advantage Plans in Massachusetts

Fact Checked
Published: June 11, 2021

Medicare Advantage is a component of Medicare, known as Part C, but instead of being offered by the federal government, it is offered by private health insurance companies. Any Medicare Advantage Plan needs to offer the same coverage as Medicare Part A (hospital visits, skilled nursing care, surgery, hospice, etc.). and Medicare Part B (doctor’s office visits, mental health, ambulance services, etc.). Medicare Advantage Plans, however, can offer additional coverage not included in Original Medicare plans, including prescription drugs and coverage of items like hearing, vision, fitness facilities, and dental.





  • In 2019, there were 57 Medicare Advantage Plans available in Massachusetts.
  •  21% of the total Medicare population in Massachusetts is enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $10,015 per beneficiary in Pennsylvania which is 1% lower than the national average.
  • Available Medicare Advantage Plans range from 1 to 45 across Massachusetts’ 14 counties.

Anyone enrolled in Original Medicare can switch to a Medicare Advantage Plan during a designated enrollment period. Medicare Advantage Plans offer different levels of premiums, deductibles and copays. You’re not allowed to select a Medicare Advantage Plan if it is not available in your county.

Medicare Advantage Plans in Massachusetts

Types of Medicare Advantage Plans

Once you learn which Medicare Advantage Plans are available in your county in Massachusetts, you can then discover more about each plan and the benefits each one offers. There are basically four different kinds of plans available in Massachusetts. Each type offers advantages and disadvantages, so examine each one carefully and find one that best suits your needs.

Health Maintenance Organizations (HMO)

The HMO model will be familiar to anyone who has received health care from an employer. An HMO plan requires you to use in-network providers, get a referral to see a specialist, and select a primary health care physician. These plans often offer extra benefits like dental, vision, and hearing. Some require you to continue to pay Part B premiums. Some, but not all, provide prescription drug coverage. HMOs are among the least expensive Medicare Advantage Plans.

Preferred Provider Organizations (PPO)

PPOs cost more than HMOs but offer more flexibility. While in-network health care is available, you can use out-of-network providers although you’ll pay more. You don’t need a referral to see a specialist, nor do you need to name a primary care provider. Most PPO plans offer prescription drug coverage as well as extra benefits like vision, dental, and hearing.

Private Fee-for-Service Plans (PFFS)

While a PFFS plan offers great flexibility, there are pros and cons you should be aware of. Under a PFFS plan, the health insurance company decides how much it will pay for your health care and how much you will pay. Any health care provider who accepts your PFFS plan’s fee structure can provide service, but not all providers will accept it (except in emergencies). Most of these plans offer prescription drug coverage, and you can add on a Part D plan if necessary.

Special Needs Plans (SNP)

These plans are designed to provide health care coverage to people with specific illnesses such as cancer, HIV/AIDS, End-Stage Renal Disease (ESRD), those who reside in a nursing care facility, or seniors who are eligible for both Medicare and Medicaid. All SNPs are required to provide prescription drug coverage, although you must use in-network providers, name a primary care physician, and obtain referrals to see a specialist.

Enrollment and eligibility for Medicare Advantage Plans in Massachusetts

Eligibility

You must be at least 65 years of age or suffer from a disability to qualify for Medicare. You need to be a U.S. citizen or a permanent resident of the United States for the past five years. The Medicare Advantage Plan you wish to enroll in must be available in the county where you live.

Enrollment periods

  • The Initial Enrollment Period starts three months before your 65th birthday, the month of your birthday, and three months following your birthday. Remember, you need to be enrolled in Medicare Part A and Part B to join a Medicare Advantage Plan.
  • During the Open Enrollment Period, which lasts from October 15-December 7, you can change from Original Medicare to a Medicare Advantage Plan or vice versa. You can also change your Medicare Advantage Plan for another.
  • Open Enrollment specifically for Medicare Advantage Plans takes place between January 1 and March 31. You can change your Medicare Advantage Plan or return to Original Medicare. You cannot switch from Original Medicare to a Medicare Advantage Plan. If you have not previously signed up for Medicare Part B (i.e., you were still working or on your spouse’s health care plan), you can sign up for it now and then select a Medicare Advantage Plan between April 1 and June 30. Your coverage would begin on July 1.

Prescription drug coverage

Many Medicare Advantage Plans, such as HMOs and PPOs, provide prescription drug coverage but often require separate premiums. It is important to remember that if you join an HMO or a PPO plan that does not provide prescription drug coverage, you cannot purchase a separate Medicare Part D prescription drug coverage plan. If you do, you will be expelled from your Medicare Advantage Plan and returned to Original Medicare. Most PFFS plans provide prescription drug coverage, but you can purchase a stand-alone Medicare Part D plan if your plan doesn’t. All SNPs are required by law to provide prescription drug coverage.

Medicare Advantage Resources in Massachusetts

If you’re going to select a Medicare Advantage Plan you want to make sure it’s one that best suits your health care needs and is affordable. It can seem confusing and frustrating deciding whether to go with Original Medicare or join a Medicare Advantage Plan (and which Medicare Advantage Plan). Fortunately, there are numerous resources available to seniors in Massachusetts that can help them make informed decisions.

MassOptions 

MassOptions is an organization that exists to help seniors make informed choices by providing access to community services and support networks. You can talk for free with a trained specialist who will provide you with personalized information about your health care options. They will also assist you in locating the right community organization or resource to help you.

Contact Information: Website | (800) 243-4636

MassHealth

Oriented towards health care for seniors and people who need long-term-care services, MassHealth can help individuals aged 65 and older. They can provide information about your options under Medicare and assist you with extra health care or dental care if needed. You can receive this coverage at a medical institution or at your home.

Contact Information: Website | (800) 841-2900

SHINE

The goal of the Serving the Health Insurance Needs of Everyone (SHINE) program is to assist everyone in Massachusetts who needs counseling and information about Medicare and other health care options. If you’re about to become eligible for Medicare, or if you already have it, you can arrange a meeting with a trained consultant who can provide you with information on your available options and benefits. The program can also provide help for people on limited incomes to pay for health care.

Contact Information: Website | (800) 243-4636

Councils on Aging and Senior Centers

The various councils and senior centers located around the state serve seniors, their families, or their caregivers by providing services, as well as information and counseling on health care options. Some of the services provided include transportation, congregate meals, opportunities to socialize, recreational and fitness activities, and lifelong learning sessions. The priorities of each council are based on local needs.

Contact Information: Website | (413) 527-6425

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