TABLE OF CONTENTS
When Americans turn 65 they become eligible to access Medicare, which is a federal health insurance program. In addition to the age eligibility, some people may qualify for Medicare if they have a disability or certain medical conditions. When it’s time to enroll, the first major choice is whether or not to choose Original Medicare, which is administered by the federal government, or a Medicare Advantage Plan (MA Plan), which is offered by health insurance providers, but must adhere to federal rules.
Massachusetts residents have several Medicare Advantage plans available, as do citizens in every state. MA plans (also called Medicare Part C) often provide extra coverage that cannot be found through Original Medicare. Here’s what Massachusetts residents need to know if they are considering a Medicare Advantage plan.
Compare ratings of insurance companies offering Medicare Advantage Plans in Massachusetts:
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|Aetna||4 stars||A||A+||2.5 to 4.5 stars||Fifth out of 10|
|Blue Cross Blue Shield||3.8 stars||A – B+T||A+||2.5 to 4.5 starts||Sixth and ninth out of 10|
|Cigna||4 stars||A-||Not rated||2.5 to 4.5 stars||Seventh out of 10|
|UnitedHealthcare||3.5 stars||A-||A-||4 stars||Fourth out of 10|
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 113 Medicare Advantage Plans available in Massachusetts, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
With only about one-quarter of eligible Massachusetts residents choosing a Medicare Advantage Plan, the state is below national enrollment levels. Despite having an average of 34 plans available, more people decide to enroll in Original Medicare. That said, if you’re a new enrollee or not satisfied with your coverage, it’s worth investigating MA plans in Massachusetts.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In Massachusetts, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
HMOs typically require that you receive all services from in network providers:
PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
PFFS plans don’t require a primary care physician or referrals for specialists:
SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Massachusetts Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|Mass.gov – Turning Age 65 and Medicare Enrollment||Phone: 617-727-2310||Medicare is a federal health insurance program for retirees age 65 or older and people with disabilities|
|ShineMA.org – Medicare Options||N/A||SHINE provides FREE unbiased health insurance counseling information and assistance to Massachusetts residents with Medicare, their caregivers and those approaching Medicare eligibility|
|Resource||Contact||How they help|
|American Hospital Association – Medicare Advantage||Phone: 1-800-424-4301||The AHA provides education for health care leaders and is a source of information on health care issues and trends.|
|CMS.gov – Medicare Advantage Applications||N/A||This page provides important information on the application process for Part C Medicare Advantage plans.|
|Medicare.gov – Medicare Advantage Plans||Phone: 1-800-633-4227||This government website provides information on the Medicare Advantage program.|