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Medicare in Massachusetts

What to know about Medicare in MA, including costs and eligibility

Reviewed by: Stephanie Demus, Licensed Insurance Agent. Written by: Aaron Garcia.

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 bundles Parts A & 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..

 

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 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:

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 and the plan you choose. But to get you started, here are the costs you can expect to pay, especially if you’re enrolled in Original Medicare. These are known as premiums, copayments, coinsurance and deductibles.

Medicare in MA: Part A

Premium:

  • $0 if you or your spouse worked 10 or more years
  • $259 a month if you worked between 7.5 and 10 years
  • $471 a month if you worked fewer than 7.5 years

Deductible:

  • $1,484 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 in MA: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & Coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in MA: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

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 [1]
  • In-person at a Massachusetts-based Social Security office [2]
  • 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 in Massachusetts is known as your Initial Enrollment Period (IEP). 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 (IEP): seven months around the month you turn 65
  • Medicare Part C & D Open Enrollment Period: Oct. 15 to Dec. 7
  • Medicare General Enrollment Period: Jan. 1 to Mar. 31
  • Medicare Advantage Open Enrollment Period: Jan. 1 to Mar. 31

How Does Medicare Work in Massachusetts?

While there are other details and parts to know, figuring out how Medicare in Massachusetts works starts with this: 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) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

What Are the 4 Types of Medicare?

Besides Parts A, B and C, you’ll also want to know about the prescription drug plan (Part D) and Medicare Supplement Insurance (Medigap). Why? If you’re enrolled in Original Medicare in Massachusetts, 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 and 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 in Massachusetts consist of two main Parts: A and B. Each work separately to provide basic coverage.

  • Part A: helps cover your hospital stays, which may include inpatient services at nursing homes, skilled nursing facilities, 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 also offer Medicare Advantage in Massachusetts. These plans often offer other services like vision, dental, hearing, and even prescription coverage combined with Medicare Parts A and B benefits.

Medicare Prescription Drug Plan (Part D)

Medicare Part D is stand-alone drug coverage. Part D can be added to Original Medicare separately, while some 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. [3]  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 for 2021?

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 TTY: 771.

What is the Most Popular Medicare Advantage Plan?

The truth is, the only opinion you should consider is your own. Picking a Medicare Advantage plan by its popularity can leave you with coverage that’s perfect for other people — not you. Instead, here’s a list of the different kinds of Medicare Advantage in Massachusetts and how they work. That way, you’ll understand which options will be popular with you.

What Is the Downside to Medicare Advantage Plans?

All forms of Medicare in Massachusetts have their pros and cons. Understanding the differences and how they all work can keep you from getting stuck with a plan that doesn’t fit your needs — which is the biggest downside of them all.

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 in Massachusetts often includes vision, dental, hearing and prescription drug coverage.

Still have questions about Medicare plans in Massachusetts? Give GoHealth a call. Our licensed insurance agents will go through your area’s options and see how they fit your needs. You’ll get honest answers, impartial advice, and peace of mind knowing you’re in a plan that’s right for you.

Medicare in Massachusetts by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,198,369 people are enrolled in Medicare in Massachusetts. The total number of beneficiaries enrolled in Medicare Advantage in Massachusetts is 334,274. The previous year, 311,339 enrolled in Medicare Advantage. Medicare Advantage participation in Massachusetts went from 26.5% to 27.89% 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.

Outline of Massachusetts
1,198,369
Beneficiaries with Part A & Part B
334,274
Medicare Advantage Beneficiaries
27.89%
Medicare Advantage Participation Rate
55.75%
% Female
44.25%
% Male
1
Average HCC Score
$11,930.3
Actual Per Capita Costs
25.92%
% Eligible for Medicaid
33.56%
% of Beneficiaries with an Emergency Department Visit
19.51%
Hospital Readmission Rate
84.72%
% Non-Hispanic White
4.31%
% African American
5.41%
% Hispanic
5.55%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

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.

Massachusetts Medicare Resources & Contacts

Beneficiaries spend an average of $11,930.30 each year on Medicare in Massachusetts. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Massachusetts-based resources, like these, may be able to help:

Executive Office of Health and Human Services

1-617-573-1600

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)

1-800-841-2900

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

1-617-624-6000

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

1-617-210-5480

https://www.mass.gov/orgs/massachusetts-department-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 an insurance agent that is licensed in Massachusetts about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in MA, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA 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

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.

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