Medicare in Massachusetts

In this article...
  • Learn more about Medicare in Massachusetts. This guide includes a list of Medicare plans available and information about when you can enroll.

What Massachusetts Medicare Plans Are Available?

Massachusetts residents have a wide array of Medicare options available. In addition to basic coverage through the government's Original Medicare program, there are private insurance plans such as Medicare Advantage (Part C), prescription drug plans (Part D) and Medigap.

Here's an easy-to-understand guide to Medicare in Massachusetts to get you started.

Medicare Parts A and B

When you first join Medicare, you need to decide how to receive Part A and Part B coverage for medically necessary services.

  • Part A hospital insurance helps pay for inpatient costs when you're admitted to a hospital, rehabilitation facility, long-term care hospital or hospice.
  • Part B medical insurance covers doctor's visits, diagnostic tests, treatments and preventive services.

There are two ways to obtain Parts A and B. More than 1 million Massachusetts residents receive this coverage through Original Medicare, and about 328,000 people are signed up through Medicare Advantage.

Original Medicare 

Original Medicare is offered through the government and includes Part A and Part B insurance. You can enroll separately in a prescription drug plan and Medigap for out-of-pocket costs if you wish.

Original Medicare is more flexible than Medicare Advantage when it comes to choosing doctors and hospitals. You can receive treatment from any health care provider in the United States who accepts Medicare payment and can see a specialist without referrals from a primary care doctor.

You must pay monthly premiums to the government to keep coverage active. Most people qualify for premium-free Part A and pay a standard $148.50 monthly premium for Part B in 2021. Once you've met annual deductibles, you usually pay a 20% coinsurance for medically necessary costs. There's no limit to the costs you pay out of pocket.

Medicare Advantage  

Medicare Advantage, also known as Part C, is sold by private insurers. These all-in-one plans include Parts A and B and additional benefits such as prescription drugs, eyeglasses, hearing aids and dental care.

Most Medicare Advantage plans have rules about the health care providers you can use and require referrals to see specialists. There are four types of Part C plans:  

  • Health Maintenance Organizations  
  • Preferred Provider Organizations  
  • Private Fee-for-Service Plans  
  • Special Needs Plans  

Unlike Original Medicare, Medicare Advantage plans limit your annual out-of-pocket expenses.

Part D Prescription Drug Coverage

Once you've decided how to receive Parts A and B, you can explore prescription drug coverage. Part D plans are sold by private companies. Typically, you pay for your prescription medicine until you reach the plan's drug deductible and then pay a portion of the costs.

Drug plans can be standalone policies added on to Original Medicare or included as part of a Medicare Advantage plan. About 89% of those enrolled in Medicare Advantage receive drug coverage.

Medicare Supplement Insurance  

Medicare Supplement Insurance, also called Medigap, helps pay for copayments, coinsurance and deductibles. Medigap policies can only be sold to you if you receive benefits through Original Medicare and not Medicare Advantage. 

Medigap plans work differently in Massachusetts than most other states. In Massachusetts, new enrollees can choose from three types of Medigap plans.

Core Medigap covers:

  • Part A copayments for hospital stays
  • Part B coinsurance for medical costs
  • First three pints of blood each year

Supplement 1A covers:

  • Core Medigap benefits outlined above
  • Part A deductibles
  • Skilled nursing facility coinsurance
  • Foreign travel

Supplement 1, which covers:

  • Supplement 1A benefits outlined above
  • Part B deductibles

Supplement 1 is not available if you're new to Medicare on or after January 1, 2020.

Who Is Eligible for Massachusetts Medicare?

Medicare is available to Massachusetts residents who:

  • Are 65 and older
  • Are younger than 65 with certain disabilities
  • Have end-stage renal disease

You can only enroll in Medicare at certain times of the year.

Automatic Enrollment

You automatically receive Medicare if you've been getting Social Security retirement benefits for a minimum of 4 months before you turn 65 or disability benefits for 24 months.

Initial Enrollment Period (IEP)

If you aren't automatically registered in Medicare by Social Security, you can enroll during your IEP that begins 3 months before the month you turn 65 and ends 7 months later. After your IEP ends, you can't sign up for Medicare until another enrollment window opens.

General Enrollment Period

Medicare's general enrollment period takes place annually between January 1 and March 31. If you missed your IEP, you can sign up at this time but may incur late enrollment penalties. You must wait until July 1 for your coverage to begin.

Special Enrollment Periods

Some situations may cause you to enroll in Medicare outside of your IEP or general enrollment period — if you've been living outside of the country or had other health insurance coverage, for example. Medicare may grant you a special enrollment period if there are unique circumstances. 

Open Enrollment Period

Medicare's open enrollment period takes place annually between October 15 and December 7. You can make changes to existing Medicare coverage if you find a plan that better meets your needs. For example, you can sign up for Part C and Part D plans, switch between plans or drop plans and return to Original Medicare.

How Do I Enroll in Medicare in Massachusetts?

To enroll in Medicare, contact Social Security during the appropriate enrollment windows. 

Contact Information for Massachusetts Medicare, Medicaid and Insurance Help

Learn more about Medicare and health insurance options in Massachusetts through the following resources:

  • Medicaid: Visit the HelpAdvisor website for information about Medicaid for Massachusetts residents having difficulty paying for health care. 
  • SHINE (Serving the Health Insurance Needs of Everyone): Speak to a SHINE counselor for free, objective health insurance information and guidance in making your Medicare decisions. Trained counselors can answer questions, help you compare plans and identify income assistance programs if needed. To schedule an appointment with a SHINE counselor, call 1-800-243-4636.
  • Executive Office of Elder Affairs: Learn about Medicare Savings Programs and other initiatives for seniors in Massachusetts. 

Prescription Advantage: Read about eligibility and enrollment in Massachusetts' prescription drug assistance program for seniors and people with disabilities.