Medicare in Massachusetts

Resources for Massachusetts Medicare Beneficiaries 

Ready to start learning about the different parts of Medicare, enrollment periods, and how to compare and choose a Medicare plan? Let’s get started. 

Medicare Basics         Choosing the Right Medicare Plan         Enrolling in Medicare

Your healthcare plan choices impact your coverage costs, the services you can get, the doctors you can see, and the standard of care you receive. Because of how important this is, Medicare recipients can find information and advice from various places about choosing a Medicare plan. The Serving Health Insurance Needs of Everyone (SHINE) in Massachusetts, also known as the State Health Insurance Program (SHIP), is a resource available to residents of Massachusetts. They are available to give people in the Baked Bean State Medicare information and offer counselors that collaborate closely with neighborhood associations, public health groups, and Area Agencies on Aging (AAAs) unique to your county. 

Medicare Plan Options in Massachusetts  

If you live in Massachusetts, you have Medicare plan choices. If you are at least 65 years old or have a qualifying disability, you are eligible for Medicare, and you can apply for Original Medicare. With a wide range of plans available in New England, a Medicare Advantage plan may be a better option if you want more comprehensive coverage. Medicare Supplement Insurance and prescription drug plans are another two examples of Medicare programs available to you. 

Original Medicare (Parts A & B)  

Let’s first discuss Original Medicare. It is broken up into two parts: Medicare Part A was designed for hospital insurance, and Medicare Part B deals with medical insurance. The deductibles for Medicare Part A and Part B are distinct from one another and relate to specific medical services. Before Original Medicare begins to pay for your care, you must first meet specific requirements, such as Part A’s inpatient hospital deductible per benefit period (which applies each time you are admitted) and Part B’s yearly deductible. Things to think about if you are choosing Original Medicare: 

• If you want the flexibility to visit any location in the United States and seek treatment from physicians or hospitals that accept Medicare, enrolling in Original Medicare in Massachusetts is an excellent choice to consider. 
• There are no restrictions due to the presence of a pre-existing condition, no waiting periods, no copayments, and no networks.

Medicare Advantage (Part C)

An alternative to the coverage provided by Original Medicare is available via private insurance companies and is referred to as Part C, also known as Medicare Advantage plans. These plans cover at least what Medicare Parts A and B do, and the best part is that they often offer additional benefits as well. Most services are handled by a network of providers. Like a Health Maintenance Organization (HMO) plan, you may need a primary care doctor, a referral to see a specialist, and prior approval before you can get certain services, treatments, or medications. There are also other types of insurance, such as Preferred Provider Organization (PPO), HMO-POS (a mix of an HMO and a PPO), and PFFS (Private Fee for Service) plans. 

In Massachusetts, Medicare Advantage plans cover more of what you need. Check out our Medicare Part C Resource Page to find out more about Medicare Advantage. 

Medicare Prescription Drug Plan (Part D)  

Many Medicare Advantage plans include Medicare Part D prescription drug coverage by default. Part D coverage is provided independently by private insurance companies that have been approved by Medicare. You can also complement your Original Medicare or a Medicare Supplement Insurance policy with a stand-alone Prescription Drug Plan (PDP). Depending on the plan, each covered medications may be subject to a deductible, copay, or coinsurance.  

Medicare Supplement Insurance (Medigap)  

Medicare recipients in Massachusetts may choose to supplement their Original Medicare coverage with a Medigap policy. These plans exist to fill the financial “gaps” and provide additional coverage not included by Original Medicare. Clever, right? Coverage for medical treatment outside the United States, Medicare Parts A and B coinsurance, and deductibles are examples of such gaps. 

Since Original Medicare doesn’t cover all of your medical costs, the Massachusetts Division of Insurance (MassDI) also has information about how Medicare Supplement Insurance coverage might lower your out-of-pocket costs. 

Also, Medigap does not provide any coverage for Medicare Advantage. You cannot enroll in both a Medicare Advantage Plan and a Medigap policy at the same time. Suppose you have a Medicare Advantage plan and are also interested in purchasing a Medigap policy. In that case, the effective date of your Medigap policy must begin the day after the Medicare Advantage plan’s termination date.  

Medicaid 

Since 1965, there has been a public insurance program called Medicaid. This program assists low-income individuals, such as children, parents, pregnant women, the elderly, and those with disabilities, in obtaining health care. It is funded by both the state and the federal governments. Every state has a Medicaid program that is run in accordance with federal regulations. States have a lot of leeway to create and manage their own programs in accordance with federal requirements. Because of this, Medicaid eligibility and benefits can and often do differ from one state to the next. 

How and when to sign up for Medicare in Massachusetts

Most U.S. citizens begin their Medicare eligibility at the age of 65. The following conditions also make a person eligible for Medicare: 

• You are under 65 years old, permanently disabled, and have been getting Social Security disability benefits for at least 24 months. In another instance, you could seek disability payments from the Railroad Retirement Board as a previous railroad employee.  
• You’ve been diagnosed with End-Stage Renal Disease (ESRD). 
• You’ve been diagnosed with Lou Gehrig’s disease, AKA Amyotrophic Lateral Sclerosis (ALS). 

Medicare Advantage Enrollment Periods in Massachusetts and nationwide  

Here is a quick overview of the Medicare enrollment periods in which you can elect or change your Medicare Advantage plan.  

Okay, Bay Staters, time to celebrate. We’re nearly finished. Healthpilot understands that navigating Medicare may be difficult and that introducing enrollment deadlines might add to the burden. 

Want to know today’s most exciting piece of news? We would be delighted to do these time-consuming tasks for you. We will present our best Medicare plan recommendation for you after you respond to a few questions, then quickly and safely enroll online. 

We take care of this for you every year as long as you are a Healthpilot customer. When Healthpilot is on your side, enrollment periods don’t need to be committed to memory. 

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Key Stats

Some interesting facts about Medicare coverage in Massachusetts:   

• Medicare is used by 1,352,786 people in Massachusetts. This means that 20% of people have Medicare, which is slightly more than the average of 19% for the whole country. 
• About 48% of Medicare recipients in Massachusetts are enrolled in a private Medicare Advantage program, above the national average of 45%. 
• The average monthly premium for a Medicare Advantage plan in Massachusetts went from $50.94 in 2022 to $44.26 in 2023, a 13.1% decrease. 
• In Massachusetts, people with Medicare will have 24 separate prescription drug plans to choose from in 2023. 
• Don’t worry. We didn’t forget your fun fact about Massachusetts! You have a polka song! It’s called “Say Hello to Someone from Massachusetts” by Lenny Gomulka. And in 1998, it was chosen as the state song. 

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