Medicare Advantage Plans in Massachusetts
Key Takeaways
- 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). in Massachusetts must provide at least the same benefits as Original Medicare (Parts A and B). Medicare Advantage plans may offer additional benefits such as vision, dental and hearing coverage that aren’t available with Original MedicareOriginal 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). .
- In 2023, at least one Medicare Advantage plan with a $0 monthly premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. was available to every Massachusetts resident eligible for Medicare.
- There are key enrollment periods when you can enroll in, or change, your Medicare Advantage plan.
The Medicare Advantage market has grown increasingly competitive. This can benefit you if you’re hoping to select or switch to a Medicare Advantage plan. But you’ll need to know some basics to get the most out of your plan, no matter which you choose.
Whether you are looking to save money or expand the services you receive, here’s what you need to know about Medicare Advantage in Massachusetts that can help you feel good about your insurance selection.
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Massachusetts Medicare Advantage Plan Coverage
Medicare Advantage is an alternative to Original Medicare. With Medicare Advantage, you choose an insurance company in Massachusetts to provide your Medicare benefits. Medicare requires that all Medicare Advantage plans offer at least the same benefits as Parts A and B of Original Medicare. And often, Medicare Advantage plans cover more services. For example, some Medicare Advantage plans offer dental, vision and hearing benefits. Traditional Medicare doesn’t provide coverage for these services.
Medicare Advantage coverage is region-specific. This means residents in Pittsfield have access to different plans than those in Boston or Worcester. However, all Massachusetts residents eligible for Medicare have access to at least one Medicare Advantage plan in 2024.
Medicare Advantage plans typically require members to use in-network facilities, doctors, and pharmacies. Read the coverage list carefully — you will experience the most cost savings by ensuring you choose medical providers that participate in your plan. You can also contact your doctors directly to ask if they accept a particular plan.
There are more than 100 different Medicare Advantage plans available in Massachusetts in 2024. A GoHealth licensed insurance agent can help pinpoint the plan that is the right fit for you.
You can’t have both a Medicare Supplement Insurance plan and Medicare Advantage. Medicare Supplement Insurance plans help pay out-of-pocket costs for those with Original Medicare. Also known as Medigap, these policies are also sold by private insurance companies.
MA Medicare Advantage Plan Costs
Medicare Advantage plans offer premiums as low as $0. However, the average monthly premium for a Medicare Advantage plan in Massachusetts is $37.53 in 2024.
When you enroll in Medicare Advantage, you’ll still pay your Part B premium. You will not pay a premium for Part A as long as you worked for 40 quarters and paid Medicare taxes in the United States. If you or your spouse did not work this long and pay Medicare taxes, you may have to pay a Part A premium — there are different premium amounts based on your work history.
When you consider costs with Medicare Advantage plans, you should look at a few key areas. These include:
- Monthly premium: You pay this fee each month to your Medicare Advantage plan. You’ll still pay a Part B premium to Medicare each month as well.
- Copayments: Medicare Advantage plans usually set a flat fee for what you will pay when you see a doctor or specialist. If you go to the doctor frequently, you may want to choose a lower number for this option.
- Deductible: This is how much money you will pay out of pocket for your care until your insurance company starts paying its share. The lower your deductible, the less you will pay out of pocket. But, plans with lower deductibles often have a higher premium. You have to decide how much you know you’re willing to pay for a monthly premium versus how much you may have to pay to cover your deductible if you have a hospital stay or require significant medical care.
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Medicare Advantage Plan Eligibility and Enrollment in Massachusetts
Most Massachusetts residents will qualify for Medicare beginning at age 65. You can sign up for Medicare during your Initial Enrollment Period (IEP) — the three months before, the month of, and the three months after you turn 65.
You may also qualify for Medicare based on special circumstances regardless of age, such as having end-stage renal disease or a qualifying disability.
If you already are enrolled in Medicare and thinking of switching to Medicare Advantage (or making other changes), you can do so during key times. These include:
- Medicare Open Enrollment Period: Begins October 15 and ends December 7 every year. During this time, you can switch, join or drop plans for the upcoming year. If you want to keep your plan, you don’t have to do anything.
- Medicare Advantage Open Enrollment Period: Begins January 1 and ends March 31. If you are already enrolled in a Medicare Advantage plan, you can switch at this time. You can also go back to Original Medicare. However, you can’t sign up for Medicare Advantage if you have Original Medicare during this time.
Are There Massachusetts Medicare Advantage Plans With Prescription Drug Coverage?
Most Medicare Advantage plans offer prescription drug or Part D coverage in Massachusetts. By bundling the benefits of Parts A and B with Part D coverage through a Medicare Advantage plan, you can receive all of these benefits in one plan.
Part D plans are also locally based. You should read each plan carefully. Part D plans offer a list of covered medications called a formulary. While Medicare requires Part D plans to cover several medication categories, you should look to see if the plan covers the specific medications you take.
In addition to considerations about your medications, you should also review covered pharmacies. Some plans may require you to use mail-order pharmacies. If you have an in-person pharmacy you prefer, you can read the in-network pharmacy list to ensure you can still get your medications there.
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
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Sources
- FACT SHEET. CMS.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.