Medicare in Massachusetts is a federally-funded program designed to give more accessible health insurance coverage to people over 65, although younger applicants with specific disabilities may also be accepted into the program. The state of Massachusetts also offers various assistance programs for Medicare beneficiaries in the state.
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Massachusetts Medicare Insurance Trends
The Centers for Medicare & Medicaid Services (CMS) reported the following information on 2024 Medicare trends in Massachusetts:
- Medicare enrollees made up 1,416,501 of Massachusetts residents.
- In Massachusetts, the average Medicare Advantage monthly premium decreased from $43.73 in 2023 to $37.53 in 2024.
- In Massachusetts, there are 110 Medicare Advantage plans available in 2024.
- All Massachusetts beneficiaries can purchase a Medicare Advantage plan, including those with $0 premiums.
- 21 stand-alone Medicare prescription drug plans are available in 2024.
- The lowest monthly premium for a prescription drug plan in 2024 in Massachusetts is $0.50.
Medicare Offered in Massachusetts
The new Medicare plans in Massachusetts offer a variety of coverage, and it may not be easy to find the right one for you. You have many choices available that will best suit your needs, with options that come with varying levels of benefits based on what is most important to you.
Original Medicare
One way to obtain Medicare coverage is to apply for Original Medicare, administered directly by Medicare. This Original Medicare covers Part A (hospital services including inpatient care) and Part B (medical services including preventive services and durable medical supplies).
Medicare Part A typically does not require the payment of monthly premiums, but Medicare Part B does. Both parts have deductibles, coinsurance, and copayments.
Medicare Advantage
Medicare Part C refers to the Medicare Advantage Plans that are also available from private companies approved by Medicare. These come with a monthly premium, but they do not cover just the services covered by Medicare Part A and Part B.
They may offer additional benefits that are not part of Original Medicare. Some plans may also have Medicare Part D coverage for prescription medication.
In Massachusetts, several types of Medicare Advantage Plans are available commercially. These can be Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPO), Point of Service (POS), which may use out-of-network Medicare providers, Private Fee-for-Service (PFFS), or Special Needs Plans (SNPs). In Massachusetts, nearly half of the state’s Medicare population is enrolled in Medicare Advantage plans.
Massachusetts Medicare Advantage options typically include plans from the following private insurance companies:
- Aetna Medicare
- Blue Cross Blue Shield of Massachusetts
- Fallon Health
- Harvard Pilgrim
- Lasso Healthcare
- Tufts Health Plan
- UnitedHealthcare
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Medicare Supplement Plans
The beneficiaries of Original Medicare may obtain Medicare Supplement insurance, which is also known as Medigap. These are available from private carriers approved by Medicare.
These supplementary plans can provide additional coverage for health care services that Original Medicare does not cover. Other plans may also cover the out-of-pocket costs of Medicare, including deductibles and copays.
One type of supplemental plan is called Medicare Part D, which covers the costs of prescription medication. These are valuable additions to Original Medicare coverage, as they will cover the cost of outpatient prescription drugs.
The cost and out-of-pocket expenses will vary from company to company, depending on their price point.
Companies offering Medigap plans in Massachusetts typically include:
- AARP – UnitedHealthcare
- Blue Cross and Blue Shield of Massachusetts
- Fallon Health
- Harvard Pilgrim
- Tufts
Massachusetts Medicare Enrollment
Massachusetts residents are eligible for Medicare if they are U.S. citizens above 65 years old or are under 65 but are permanently disabled, have end-stage renal disease, or Amyotrophic Lateral Sclerosis. Use Medicare’s online eligibility tool if you are unsure if you qualify.
Requirements
- You are 65 or older, and you or your spouse worked and paid Medicare taxes for at least 40 quarters.
- You are under age 65 and collect benefits from Social Security or the Railroad Retirement Board for at least 24 consecutive months.
- You have ESRD or ALS.
Enrollment Period Dates
Initial Enrollment Period
This is a seven-month window that allows you to sign up for a plan
- Begins 3 months before the month you turn 65
- Ends 3 months after the month you turn 65
Medicare Open Enrollment Period
This is when you can sign up for a plan, switch a plan or leave a plan
- Begins Starts October 15th
- Ends December 7th
Special Enrollment Period
Special enrollment periods allow you to enroll outside the regular enrollment periods under specific circumstances.
General Enrollment Period
This is when you can sign up for Medicare Part A and/or Part B if you didn’t sign up when first eligible or if you’re not qualified for a Special Enrollment Period.
- Starts January 1st
- Ends March 31st
Medicare Advantage Open Enrollment Period
This is when you can switch or leave a Medicare Advantage Plan
- Starts January 1st
- Ends March 31st
Massachusetts Enrollment Tips & Advice
Medicare is a necessary but often confusing aspect of aging. When researching your options, make a point to note premiums and out-of-pocket expenses, medication needs, and plan networks.
Additional resources:
How Do I Enroll in a Medicare Plan?
If you want to learn more about your Medicare options, our licensed agents are here for you. We will discuss the different plans available and help find a plan that works best with your needs.
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