Know your options for Medicare plans in Massachusetts, whether you’re looking for Original Medicare or Medicare Advantage.
Massachusetts has more than 1.3 million people enrolled in Medicare – and the number of plan options is also growing. Comparing the different plans is key to finding the best plan for you.
Medicare plan options include:
You may also elect to add a Medicare Supplement Plan (Medigap) to go along with Original Medicare to help with additional out-of-pocket expenses.
Before you pick a plan, learn about your costs, coverage, and choosing the best Medicare plan for your needs.
To qualify for Medicare, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability and receive Social Security Disability Insurance (SSDI) benefits for at least 24 months. You may qualify for Medicare at a younger age if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board (RRB) benefits at least four months before you turn 65, you’ll be enrolled in Medicare automatically. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
Massachusetts has several Medicare options available to U.S. citizens or permanent residents at least age 65. You are eligible if under age 65 and you have ESRD, ALS, or have been disabled for at least 24 months and draw SSDI.
Original Medicare is the standard coverage for Medicare beneficiaries and has two parts: Part A (hospital insurance) and Part B (medical insurance). Here’s a look at the details about Original Medicare:
Who Original Medicare is best for: Original Medicare is a good option if you want more flexibility. It has a broad coverage area throughout the U.S. If you have several health conditions, you may want to pair your Medicare with a Medigap. Because Original Medicare does not cover prescriptions, enrolling in a stand-alone drug plan is important. If not paired with a Medigap, the out-of-pocket cost is a drawback to the plan.
|Part A premium||Standard Part B premium|
|Usually free||$164.90 per month|
An alternative to Original Medicare, Medicare Advantage Plans – also known as Part C – cover everything Part A and Part B do, but typically offer additional coverage.
Massachusetts Medicare Advantage programs have networks and may only be available in certain areas of Massachusetts. Plan options are based on ZIP code. These plans usually consist of copayments, deductibles, and out-of-pocket maximums that you are responsible for. However, plans can start at a $0 premium and go up from there. The average monthly premium in Massachusetts is $44.26 (in 2023).
The Massachusetts Medicare Advantage Program is made up of four types of plans:
The best Medicare Advantage Plan is the one that meets your individual needs and matches what is most important to you in terms of costs, choice of providers, and ease of access. Massachusetts has 133 plans available in 2022. Medicare Advantage has continued to rise in popularity with Massachusetts residents.
Who Medicare Advantage Plans are best for: This type of plan is best if you are on a fixed income or you are in good health and don’t want to overpay for coverage you don’t use very often. Having one card to use and the additional benefits bundled in the plan can be attractive. To be eligible, you need to be enrolled in Medicare Part A and Part B.
The downsides to Medicare Advantage Plans are mostly related to a limited choice of providers and service areas. Prior authorizations and referrals may also be necessary before receiving certain procedures.
|Plan name||Monthly premium||Yearly drug and premium cost||Deductibles|
|Tufts Medicare Preferred HMO Smart Saver Rx (HMO)||$0||$0||Health: $0
|Tufts Medicare Preferred HMO Saver Rx (HMO)||$0||$0||Health: $0
|Aetna Medicare Explorer Plan (PPO)||$0||$0||Health: $0
Plans calculated based on Boston ZIP code 02124.
Medicare Part D is offered by private insurance but is regulated by Medicare. Part D can be purchased as a stand-alone PDP or as part of a Medicare Advantage Plan (MA-PD).
Massachusetts Part D premiums start at $6.80 a month.
Currently, there are 21 stand-alone PDPs in Massachusetts. Seven of the stand-alone plans and 14 Medicare Advantage Plans with prescription drug coverage participate in the Senior Savings Model, which lowers the cost of insulin out of pocket.
Who Part D plans are best for: PDPs are always best even if you don’t take any medications. If you do not enroll when becoming eligible, you will be penalized for every month you do not have one.
|Plan name||Monthly premium||Yearly drug and premium cost||Deductible|
|SilverScript SmartSaver (PDP)||$6.60||$81.60||$505|
|Wellcare Value Script||$8.60||$103.20||$505|
|Humana Walmart Value RX||$34.10||$409.20||$505|
Plans calculated based on Boston ZIP code 02124.
Medigap plans are standardized plans sold by private insurance companies. These plans are designed to pick up costs where Original Medicare leaves off in coverage. There are 10 standardized plans available in Massachusetts. Those include the Medigap Core Plan, Medigap Supplement 1 Plan, and Medigap Supplement 1A Plan.
A Medigap Core Plan for a 65-year-old nonsmoking female in Boston ranges from $114 to $206 per month. You will also be responsible for the Part B deductible of $233.
Who Medigap plans are best for: Medigap is a good fit if you utilize benefits frequently, do not want to be restricted to a small coverage area, and prefer to choose your own provider. You should not choose a supplement if you cannot afford the monthly premium and you want extra benefits available with Medicare Advantage, such as having the PDP, dental, vision, and hearing benefits included.
If you are considering purchasing a supplement, always check to see if the company offers additional discounts for having people that live in your household or for nonsmoking.
|Plan name||Monthly premium range||Copays/coinsurance||Deductibles||Plan benefits|
|Medigap Core Plan||$114 to $216||$0||$0 hospital (Part A)
$0 medical (Part B)
|Medigap Supplement 1 Plan||$206 to $352||$0||$0 hospital (Part A)
$233 medical (Part B)
|Medigap Supplement 1A Plan||$166 to $341||$0 Generally your cost for approved Part B services||$0 hospital (Part A)
$233 medical (Part B)
Calculated based on a nonsmoking 65-year-old female in Boston ZIP code 02124.
Massachusetts residents have many plan options available. It is always good to make a list of pros and cons of the plans. Important things to consider are out-of-pocket costs, provider network, coverage area, insurance company ratings and the overall ability of the plan to meet your specific need.
|People enrolled in Original Medicare||Average plan cost||Annual Massachusetts spending per beneficiary||Spending per beneficiary compared to the national average|
|989,454||Part A: $0 to $506 per month*
Part B: $164.90 **
*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.
Making Medicare decisions can be overwhelming at times. It is good to utilize the resources and tools available in Massachusetts. The organizations have people knowledgeable in the programs specific to your state. Most of the services provided are free. An example is Serving the Health Insurance Needs of Everyone (SHINE) Massachusetts, which provides free Medicare counseling so you can gather information and guidance.
Never be afraid to ask questions. Get started with these Massachusetts Medicare resources:
|Organization||How you can get help||Contact Information|
|SHINE-Massachusetts Department of Elder Affairs||Free counselors are available with information, education, and guidance with Medicare and its programs.||Website | (800) 243-4636|
|Massachusetts Division of Insurance Regulations||Acts as an advocate to protect you from scams and helps with decisions about private insurance and Medicare plans. Can answer your questions about rules and regulations of insurance companies.||Website | (617) 521-7794|
|Massachusetts Senior Medicare Patrol (SMP)||The program educates you about Medicare and helps prevent health care errors, fraud, and abuse.||Website | (800) 892-0890|
|Massachusetts Attorney General’s Office||Services for elders include helping with financial exploitation, Medicare drug plan scams, investigating violations involving abuse, neglect, civil rights, and discrimination.||Website | (888) 243-5337|
|Massachusetts Department of Public Health||It promotes the health and well-being of all residents by ensuring access to high-quality public health and health care services, focusing on prevention and wellness, and health equity.||Website | (617) 624-6000|
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