Medicare in Massachusetts
Key Takeaways
- Medicare in Massachusetts is for all legal U.S. citizens or legal residents of five or more years, aged 65 or older. Some younger than 65 may be eligible.
- Medicare in Massachusetts is available in two ways: Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). .
- Original Medicare covers most hospital and medical services. Medicare Advantage usually bundles Parts A and B with Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. and other benefits.
If you live in The Bay State and are approaching Medicare eligibility, it’s a good idea to start asking questions about Medicare in Massachusetts before you turn 65. If you’re not sure what you need to know, GoHealth can help you get started. For example, do you know the kinds of Medicare are available in your area? Will your medications be covered? What is Medicare Advantage in Massachusetts?
To help answer questions like these, here is GoHealth’s guide to reviewing Medicare plans in Massachusetts.
Who Is Eligible for Medicare in Massachusetts?
You may be eligible to enroll in Medicare in Massachusetts if you’re a legal U.S. resident and:
- You’re 65 or older.
- You’re under 65 but have received Railroad Retirement Board (RRB) benefits or disability-based Social Security for two years.
- You’re under 65 and living with end-stage renal disease (ESRD) or Lou Gehrig’s Disease.
Let’s find your ideal Medicare Advantage plan.
How Much Is Medicare in Massachusetts?
There are some standard costs built in, but what you’ll pay for Medicare in Massachusetts will depend on your specific needs. To get you started, here are the costs you can expect to pay in 2025 if you’re enrolled in Original Medicare. These include premiums, copayments, coinsurance, and deductibles.
Medicare Part A
Premium:
- $0 if you or your spouse worked 10 or more years
- $285 a month if you worked between 7.5 and 10 years
- $518 a month if you worked fewer than 7.5 years
Deductible:
- $1,676 for each hospital benefit period
Copayment & Coinsurance:
- Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
- Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after
Medicare Part B
Premium:
- $185 monthly and up (income-based)
Deductible:
- $257 for each plan period
Copayments & Coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare Part D
Premium:
- Income-based; varies by plan
Deductible:
- No more than $590 in 2025
Copayments & Coinsurance:
- Plan- and drug-specific
How Do I Sign Up for Medicare in Massachusetts?
Looking to enroll in Medicare in Massachusetts? Here’s how:
- Online with the Social Security Administration
- In-person at a Massachusetts-based Social Security office
- Over the phone toll-free at 1-800-772-1213
- Did you work for a railroad company? You may need to enroll in Medicare through the Railroad Retirement Board (RRB). Call the RRB at 1-877-772-5772 for more information.
When to Enroll in Medicare in Massachusetts
Unless you qualify before 65, your first chance to enroll in Medicare is known as your Initial Enrollment Period. This includes your birth month, plus three months before and after. If you miss this window, you may have to pay enrollment penalties when you do sign up.
Here are the Medicare enrollment periods you’ll want to circle on your calendar:
- Initial Enrollment Period — Seven months around the month you turn 65
- Medicare’s Open Enrollment Period — October 15 to December 7
- General Enrollment Period — January 1 to March 31
- Medicare Advantage Open Enrollment Period — January 1 to March 31
Looking for a plan with prescription drug coverage?
How Does Medicare Work in Massachusetts?
You can receive your Medicare through Original Medicare (Parts A and B) or Medicare Advantage (Part C). Here’s a quick rundown of each:
Original Medicare (Parts A and B)
Parts A and B provide some hospital, preventive and medically necessary services. Out-of-pocket costs can be high, and you’ll need separate coverage for prescription drugs, hearing, vision, and dental. You can see any doctor that accepts Medicare.
Medicare Advantage (Part C)
Medicare Advantage (Part C) substitutes for Original Medicare (Part A and B), offering the same coverage. Along with Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision, and prescription drug coverage.
What Are the Types of Medicare?
Besides Parts A, B and, C, you’ll also want to know about prescription drug plans (Part D) and Medicare Supplement Insurance (Medigap). Why? If you’re enrolled in Original Medicare, you may be stuck with high out-of-pocket costs while still needing prescription drug coverage. Instead, many in Mass also enroll in Medicare Supplement Insurance and a Prescription Drug Plan (Part D).
Here’s how all the forms of Medicare in Massachusetts work:
Original Medicare (Parts A and B)
Original Medicare plans consist of two main Parts: A and B, which provide basic coverage.
- Part A: Helps cover your hospital stays, which may include inpatient services at nursing homes, skilled nursing facilities, and some home health and hospice care.
- Part B: Provides coverage for your preventive and medically necessary services.
Medicare Advantage (Part C)
As an alternative to Original Medicare, private insurance companies offer Medicare Advantage in Massachusetts. These plans often provide other services like vision, dental, hearing, and prescription coverage combined with Medicare Parts A and B benefits.
Medicare Prescription Drug Plan (Part D)
Medicare Part D is standalone drug coverage. Part D can be added to Original Medicare separately, while most Medicare Advantage plans in Massachusetts include prescription coverage.
Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance, also called Medigap, are health insurance policies that provide standardized benefits alongside Original Medicare.
If you choose to add a Medigap plan, it may pay for some or all costs not covered by Part A and Part B, including deductibles, coinsurance and copayments. If you have a Medicare Advantage Plan, you cannot add Medigap.
In MA, Medigap plans provide a different set of standard benefits. Medigap in Massachusetts offers a core plan, Supplement 1 plan, and Supplement 1A plan. Anyone enrolled in Medicare on or after January 1, 2020, can enroll in the Supplement 1A plan and is not eligible for the Supplement 1 plan.
What Is the Best Medicare Plan?
To answer this question, you’ll want to know how to assess your Medicare options in Massachusetts. That means looking more in-depth than just how much you’ll pay. You’ll want to know what to evaluate and how to find the information you need. To help, here are some tools we’ve put together to make sure you know what “best” means for you.
- Pros and Cons: Learn how to compare the different types of Medicare.
- Enrollment Checklist: Collect the info you need to make the right choice.
- Medicare Star Rating System: See what other policyholders think of their plans.
- Pro Tips: Little-known tips to make the decision-making process simpler.
- Call GoHealth: Still have questions about Medicare plans in Massachusetts? The licensed insurance agents at GoHealth will walk through your options and offer the impartial answers you need. Call us at 1-855-792-0088.
Your Ideal Medicare Plan is out there.
What Is the Most Popular Medicare Advantage Plan?
Here’s a list of the different kinds of Medicare Advantage plans in Massachusetts and how they work. That way, you’ll understand which option could be right for you.
- Health Maintenance Organization (HMO) plans use primary care physicians to manage care and limit you to a provider network.
- Preferred Partner Organization (PPO) policies use primary care physicians but offer some freedom to see out-of-network doctors.
- Private Fee-For-Service (PFFS) plans pay your providers each time you receive a service.
- Special Needs Plan (SNP) plans help enrollees living with specific health conditions. D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.
What Is the Downside to Medicare Advantage Plans?
All forms of Medicare have their pros and cons. Understanding the differences and how they all work can keep you from enrolling in a plan that doesn’t fit your needs.
For a high-level comparison, here are a few main characteristics to remember:
- Original Medicare allows you to see any doctor that accepts Medicare but often has higher out-of-pocket costs.
- Medicare Advantage typically has smaller networks of doctors and providers but often features lower out-of-pocket costs. Medicare Advantage often includes vision, dental, hearing, and prescription drug coverage.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,245,557 people are enrolled in Medicare Part A and B in Massachusetts. The total number of beneficiaries enrolled in Medicare Advantage increased from 354,811 to 383,644 year over year. Medicare Advantage participation in Massachusetts went from 29.10% to 30.80% year over year. If you’d like to dive deeper into how Medicare in Massachusetts breaks down across the state, we provide a glance at who is using Medicare and how.
1,245,557 Beneficiaries with Part A & Part B
383,644 Medicare Advantage Beneficiaries
30.80% Medicare Advantage Participation Rate
55.75% Female
44.25% Male
84.45% Non-Hispanic White
4.16% African American
5.25% Hispanic
6.13% Other/Unknown
24.69% Eligible for Medicaid
1.01 Average HCC Score
$11,551.52 Actual Per Capita Costs
19.72% Hospital Readmission Rate
28.45% % of Beneficiaries with an Emergency Department Visit
354,811 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
29.10% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
Executive Office of Health and Human Services
https://www.mass.gov/orgs/executive-office-of-health-and-human-services
What should I know about the Executive Office of Health and Human Services?
Tap into local Medicare Savings Programs, caregiver resources, and more.
MassHealth (Medicaid)
https://www.mass.gov/topics/masshealth
What should I know about MassHealth?
Massachusetts’ Medicaid system. Visit here to review and change your benefits, or get help from your local office.
Massachusetts Department of Public Health
1-617-624-6001 (TTY)
https://www.mass.gov/orgs/department-of-public-health
What should I know about the Massachusetts Department of Public Health?
Find local senior care options like Program of All-inclusive Care for the Elderly (PACE).
Massachusetts Department of Veterans’ Services
https://www.mass.gov/orgs/executive-office-of-veterans-services
What should I know about the Massachusetts Department of Veterans Services?
Find help paying bills and tap into other benefits.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in Massachusetts about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.