Medicare Advantage 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 Medicare .
In 2023, at least one Medicare Advantage plan with a $0 monthly premium 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 benefits you, the consumer, 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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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 2023.
When you choose a Medicare Advantage plan in Massachusetts, you will choose a plan that will typically offer 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 2023. 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.
Some Medicare Advantage plans offer a $0 premium plan. However, the average monthly premium for a Medicare Advantage plan in Massachusetts is $44.26 in 2023.
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.
You should carefully review these costs before choosing any Medicare Advantage plan in Massachusetts.
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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.
You may qualify for a Special Enrollment Period if you move to or from Massachusetts, or you move to a different part of the state where your plan doesn’t cover you.
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 — and pay one premium.
Part D plans also are 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.
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