Medicare in Massachusetts

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.

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.

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 in 2022, especially if you’re enrolled in Original Medicare. These are known as premiums, copayments, coinsurance and deductibles.

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 in Massachusetts 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

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:

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 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 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 standalone 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. 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.