Understand Medicare in Massachusetts
Medicare, the United States federal medical insurance program, provides coverage for about 1 million people in Massachusetts who qualify for Medicare. You can get Medicare if you’re 65 or older or have a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income. There are 57 Medicare Advantage Plans in the state that are an alternative to Original Medicare. Learn more about your Medicare options in Massachusetts.
Medicare Plans in Massachusetts
| Compare ratings of Massachusetts’s Medicare plan providers: | |||||
| Insurance company | Medicare rating | A.M. Best rating | BBB rating | NCQA rating | J.D. Power ranking |
| Aetna | 4 stars | A | A+ | 2.5 to 4.5 stars | 5 out of 10 |
| Blue Cross Blue Shield | 4.5 stars | A | A+ | Not rated | Sixth out of 10 |
| Cigna | 4 stars | A- | Not rated | 2.5 to 4.5 stars | Seventh out of 10 |
| Humana | 4 stars | A- | A+ | 1.5 to 4.5 stars | Third out of ten |
| UnitedHealthcare | 3.5 stars | A- | A- | 4 stars | Fourth out of 10 |
Medicare Plan Options in Massachusetts
Residents of Massachusetts have multiple Medicare plans to choose from. Many are tiered to help Massachusetts residents find the plan that is best suited to your lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. Massachusetts’ Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.
| Original Medicare (Parts A and B) | Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
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| Medicare Advantage Plans (Part C) | Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
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| Medicare Prescription Drug Coverage Plans (Part D) | Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
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| Medicare Supplement Insurance Plans (Medigap) | Some Massachusetts seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
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Medicare in Massachusetts by the Numbers
| People enrolled in Original Medicare | Average plan cost | Annual state spending per beneficiary | Spending per beneficiary compared to the national average |
| 986,476 | Plan A: $0 to $499 per month* Plan B: $170.10 per month** | $10,243 | -2.00% |
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Massachusetts
Getting support can help when you’re making Medicare decisions. Massachusetts has numerous locations where enrollees can receive help through the State Health Insurance Program (SHIP), also known as Serving the Health Insurance Needs of Everyone (SHINE). SHINE has counselors throughout the state that work with local nonprofits and public health agencies, as well as Area Agencies on Aging (AAAs), to provide seniors with Medicare information.
Central Massachusetts Agency on Aging
The Central Massachusetts Agency on Aging offers information and resources in the 61 cities and towns in the state’s center. They also administer programs designed to help seniors 60 and older maintain their health and independence, including resources to guide you through the Medicare enrollment process, and the counselors will help you understand the available benefits fully.
Contact information: Website | (413) 527-7138
Massachusetts Division of Insurance
The state’s Division of Insurance protects consumers by ensuring that insurers adhere to regulations, and monitoring factors like licensure, rates, and reviews. The division also administers the SHINE program that offers free, unbiased Medicare guidance. e.
Contact information: Website | (617) 521-7794
Massachusetts Department of Human Services
The state’s Department of Human Services provides health benefits for qualifying individuals along with other resources.
Contact information: Website | (800) 841-2900
MassHealth Buy-In
This state program can help you pay for Medicare expenses if you qualify. You could also save on out-of-pocket costs like Medicare Advantage premiums.
Contact information: Website | ( 800) 841-2900
Kelly Blackwell
Certified Senior Advisor (CSA)®
As a health care professional since 1987, Kelly Blackwell has walked alongside and cared for seniors as they journey through the season of their fourth quarter of life. Blackwell holds a Bachelor of Science in nursing from the University of Northern Colorado, a Master of Science in health care administration from Grand Canyon University, an interprofessional graduate certificate in palliative care from the University of Colorado Anschutz Medical Campus and holds a Certified Senior Advisor® credential from the Society of Certified Senior Advisors.
Blackwell contributes to the University of Colorado-Anschutz blog and has been published in “The Human Touch” distributed by the University of Colorado Center for Bioethics and Humanities. She cowrote “Dying Is” for Pathways Hospice.
A registered nurse, Blackwell understands health insurance choices influence quality of life and are driven by values, goals, and beliefs. She’s passionate about engaging with, educating, and empowering seniors as they navigate the health care system. She’s equipped to lend an experienced, compassionate voice to beneficiaries seeking information about Medicare Advantage Plans.
As a CSA®, Blackwell has access to valuable resources for Medicare beneficiaries. Her work as a bedside nurse and clinical manager has given her the opportunity to see how Medicare rules, regulations, and benefits work when patients need them. With a passion to learn and to make a difference in the lives of seniors, Blackwell supports seniors through Medicare and fourth-quarter life decisions.
Kelly Blackwell
Certified Senior Advisor (CSA)®
As a health care professional since 1987, Kelly Blackwell has walked alongside and cared for seniors as they journey through the season of their fourth quarter of life. Blackwell holds a Bachelor of Science in nursing from the University of Northern Colorado, a Master of Science in health care administration from Grand Canyon University, an interprofessional graduate certificate in palliative care from the University of Colorado Anschutz Medical Campus and holds a Certified Senior Advisor® credential from the Society of Certified Senior Advisors.
Blackwell contributes to the University of Colorado-Anschutz blog and has been published in “The Human Touch” distributed by the University of Colorado Center for Bioethics and Humanities. She cowrote “Dying Is” for Pathways Hospice.
A registered nurse, Blackwell understands health insurance choices influence quality of life and are driven by values, goals, and beliefs. She’s passionate about engaging with, educating, and empowering seniors as they navigate the health care system. She’s equipped to lend an experienced, compassionate voice to beneficiaries seeking information about Medicare Advantage Plans.
As a CSA®, Blackwell has access to valuable resources for Medicare beneficiaries. Her work as a bedside nurse and clinical manager has given her the opportunity to see how Medicare rules, regulations, and benefits work when patients need them. With a passion to learn and to make a difference in the lives of seniors, Blackwell supports seniors through Medicare and fourth-quarter life decisions.
Learn More from Our Sources
- Medicare | How do Medicare Advantage plans work? | Last accessed November 2022
- Medicare | How to get prescription drug coverage | Last accessed November 2022
- Medicare | Medicare Advantage Plans cover all Medicare services | Last accessed November 2022
- Medicare | What Medicare covers | Last accessed November 2022
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed November 2022
FAQs
How do I get answers to Medicare questions? ›
Do you have questions about your Medicare coverage? 1-800-MEDICARE (1-800-633-4227) can help. TTY users should call 1-877-486-2048.
What is the best Medicare plan that covers everything? ›Medicare Supplement Plan G is the best overall plan that provides the most coverage for seniors and Medicare enrollees. Plan G will cover almost everything except the Medicare Part B deductible, which is only $226 for 2023.
What is the best company to go with for Medicare? ›- Featured Partner.
- Best Medicare Advantage Providers for 2023.
- Blue Cross Blue Shield.
- Humana.
- Anthem.
- United Healthcare.
- Cigna.
- Aetna.
Have additional Medicare questions? AARP can help. Call 877-634-8213 toll free, from 8 a.m. to 8 p.m. eastern time on weekdays, to speak to an AARP Help Center representative.
Can the Social Security office help with Medicare questions? ›Although the Centers for Medicare & Medicaid Services (CMS) is the agency in charge of the Medicare program, Social Security processes your application for Original Medicare (Part A and Part B). We can also give you general information about the Medicare program. We can also help you get a replacement Medicare card.
What are the 6 things Medicare doesn't cover? ›- Long-Term Care. ...
- Most dental care.
- Eye exams (for prescription glasses)
- Dentures.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.
What is the most basic Medicare plan? ›At age 65, most people in America qualify for Medicare Part A and B (Original Medicare), which is basic Medicare coverage. Basic Medicare coverage provides hospital and medical insurance but leaves out coverage for many things, including most prescription drugs you take at home.
Why do doctors not like to take Medicare? ›Can Doctors Refuse Medicare? The short answer is "yes." Thanks to the federal program's low reimbursement rates, stringent rules, and grueling paperwork process, many doctors are refusing to accept Medicare's payment for services. Medicare typically pays doctors only 80% of what private health insurance pays.
Why are people leaving Medicare Advantage plans? ›Unhappy with the additional benefits. A limited network of doctors. Unreasonable cost-sharing.
Why are Medicare Advantage plans being pushed so hard? ›
Advantage plans are heavily advertised because of how they are funded. These plans' premiums are low or nonexistent because Medicare pays the carrier whenever someone enrolls. It benefits insurance companies to encourage enrollment in Advantage plans because of the money they receive from Medicare.
Are most people happy with Medicare Advantage? ›The alliance commissioned a poll by Morning Consult in December that found, among other points, that 94% of seniors using Medicare Advantage reported being satisfied with their coverage, while 95% said they were satisfied with their Medicare Advantage network of doctors, hospitals, and specialists.
Why is Original Medicare better than an Advantage plan? ›Medicare Advantage plans typically require that you use care providers within a geographic service area, and once you get outside that area, you'll be covered for emergency care only. Original Medicare offers access to a national network of providers — no matter where you are in the U.S. Like to minimize risk.
Do Medicare Advantage plans pay 100 %? ›Medicare Advantage plans must limit how much their members pay out-of-pocket for covered Medicare expenses. Medicare set the maximum but some plans voluntarily establish lower limits. After reaching the limit, Medicare Advantage plans pay 100% of eligible expenses.
Do all seniors pay the same for Medicare? ›If you have a high income, your costs for Medicare will be more. If your modified adjusted gross income on your tax return is above $91,000 as an individual or above $182,000 on a joint tax return, you'll pay higher rates for Part B and Part D.
Is AARP good insurance for seniors? ›AARP is a good life insurance option for seniors with pre-existing conditions, but they have high rates for healthy seniors. Currently insured? It's free, simple and secure. AARP is a good life insurance option for seniors with pre-existing conditions, but they have high rates for healthy seniors.
Is AARP free after 65? ›All people age 50 and older are eligible for membership with AARP. As an AARP member, you will get a free secondary membership for your household, access to hundreds of carefully chosen discounts, programs and services, AARP The Magazine, and much more.
How much is taken out of your Social Security check for Medicare? ›For most people, finding out how much will be taken out of your Social Security check is very easy. If you have Original Medicare and collect retirement benefits, then the process is automatic. The amount deducted is your monthly Part B premium ($164.90 or higher in 2023).
Does everyone have money taken out of Social Security for Medicare? ›Yes. In fact, if you are signed up for both Social Security and Medicare Part B — the portion of Medicare that provides standard health insurance — the Social Security Administration will automatically deduct the premium from your monthly benefit. The standard Part B premium in 2022 is $170.10 a month.
How do you qualify for $144 back from Medicare? ›- Are enrolled in Part A and Part B.
- Do not rely on government or other assistance for your Part B premium.
- Live in the zip code service area of a plan that offers this program.
- Enroll in an MA plan that provides a giveback benefit.
What are three disadvantages of Medicare? ›
Hospital
You might not be able to choose when to be admitted. Medicare doesn't include ambulance service costs. Medicare won't cover you for private patient hospital costs, such as theatre fees and accommodation. It won't cover you for medical and hospital costs you incur in another country.
Disadvantages of Medicare
The treatment you require may not be covered, such as dental treatment or physiotherapy. You're could be subject to longer wait times. No choice of when and where you're operated on and who performs the surgery. You will have to pay more out-of-pocket fees if you are treated privately.
Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs.
Why is Medicare Advantage so cheap? ›The main reason why Medicare Advantage carriers can offer low to zero-dollar monthly premium plans is that Medicare pays the private companies providing the plans to take on your health risk. But not all Medicare Advantage plans have a low premium cost.
Is there a penalty to switch from Medicare Advantage to original Medicare? ›If you move away from your Medicare Advantage plan's service area, you can re-enroll in Original Medicare without penalty. This works even if other Medicare Advantage plans are available at your new address.
How do you lose Medicare eligibility? ›Most beneficiaries can only lose their Medicare coverage if they fail to pay their premiums. There are two scenarios in which you can join Medicare: You qualify because of a disability, or because you turn 65.
What is the Best Medicare Plan 2022? ›The Best Medicare Advantage Providers of 2022. According to MoneyGeek's scoring system, the top-rated Medicare Advantage plans are Blue Cross Blue Shield for preferred provider organizations and UnitedHealthcare for health maintenance organizations.
Which Medicare plan is better A or B? ›Part A is hospital coverage, while Part B is more for doctor's visits and other aspects of outpatient medical care. These plans aren't competitors, but instead are intended to complement each other to provide health coverage at a doctor's office and hospital.
Which Medicare does not require premium? ›You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if: You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
Do hospitals not like Medicare? ›Hospitals and doctors don't want them to, either. Private insurers typically pay medical providers a whole lot more than Medicare and Medicaid. And that's one of the main reasons why many hospitals and doctors oppose Medicare for all proposals that would eliminate or minimize private insurance.
What insurance do most doctors accept? ›
Across most specialties, the majority of physicians (at least 80%) accept new patients with Medicare and private insurance.
Do doctors treat Medicare patients differently? ›There is no definitive answer to this question as it varies from doctor to doctor. Some doctors may treat patients with private insurance differently than those with public insurance, while others may not discriminate at all. Ultimately, it is up to the doctor to decide how to treat each patient.
Who is trying to cut Medicare Advantage? ›Democrats Want to Cut Overwhelmingly Popular Medicare Advantage Program. A new report on Medicare shows that enrollment in the popular Medicare Advantage (MA) program has grown across the board, showing that more seniors are choosing privately-run, innovative options every year.
Can a Medicare Advantage plan turn you down? ›Generally, if you're eligible for Original Medicare (Part A and Part B), you can't be denied enrollment into a Medicare Advantage plan. If a Medicare Advantage plan gave you prior approval for a medical service, it can't deny you coverage later due to lack of medical necessity.
Is Medicare Advantage more expensive than Medicare? ›It is clear from Wakely's study that rather than being more expensive than original Medicare, MA is actually significantly less expensive, even accounting for all the extra benefits and services the program provides.
Which Medicare Advantage plan has the highest rating? ›For 2023, Humana has the overall best Medicare Advantage plans for most people because it has good ratings and affordable costs.
Who is the best person to talk to about Medicare? ›Do you have questions about your Medicare coverage? 1-800-MEDICARE (1-800-633-4227) can help. TTY users should call 1-877-486-2048.
What percentage of seniors have Medicare Advantage plans? ›Forty-five percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in 2022, a share that is projected to rise to more than 50 percent by 2025.
What is the biggest disadvantage of Medicare Advantage? ›The biggest disadvantage of Medicare Advantage plans is the closed provider networks, limiting your choice of which doctor or medical facility to use. Medicare Advantage costs are also largely based on how much medical care you need, making it more difficult to budget for health care costs.
Do you still pay for Medicare Part B with an Advantage plan? ›Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for all Part A and Part B services. Once you reach this limit, you'll pay nothing for services Part A and Part B cover.
What happens if I don't like my Medicare Advantage plan? ›
No, you can't switch Medicare Advantage plans whenever you want. But you do have options if you're unhappy with your plan. You can jump to another plan or drop your Medicare Advantage plan and change to original Medicare during certain times each year.
What is the cost of Medicare Advantage plans in 2022? ›The average premium for Medicare Advantage plans will be lower in 2022 at $19 per month, compared to $21.22 in 2021, while projected enrollment continues to increase. As previously announced, the average 2022 premium for Part D coverage will be $33 per month, compared to $31.47 in 2021.
What is the maximum out-of-pocket for Medicare 2022? ›Since 2011, federal regulation has required Medicare Advantage plans to provide an out-of-pocket limit for services covered under Parts A and B. In 2022, the out-of-pocket limit may not exceed $7,550 for in-network services and $11,300 for in-network and out-of-network services combined.
Where can I get unbiased information about Medicare? ›Medicare.gov, the “Medicare & You” handbook, and 1-800-MEDICARE (1-800-633-4227) are your official sources of unbiased information from the government. TTY users can call 1-877-486-2048.
Does Medicare have a chat? ›Need help beyond what's on Medicare.gov? You can talk or live chat with a real person, 24 hours a day, 7 days week (except some federal holidays.)
How do I get a Medicare manual? ›Call us at 1-800-MEDICARE (1-800-633-4227), and we can make sure you only get one copy mailed to you. Or, sign up to get your future “Medicare & You” handbook electronically. How to sign up for the eHandbook: Log into (or create) your Medicare account.
Why am I getting so many phone calls about Medicare? ›Many Medicare-eligible people report getting a high number of Medicare calls. Unfortunately, many of these calls are scams designed to encourage people to give up critical personal information, while the rest are Medicare sales calls from seasonal agents trying to sell specific plans.
What are the flaws in Medicare? ›The biggest issue impacting Medicare beneficiaries today are the high costs within the program. In general, the government pays 80% of the costs and beneficiaries 20%. There are major premiums each month (for Parts B and D) and deductibles (in Parts A, B and D) to deal with before the cost-sharing kicks in.
Can you call Medicare anytime? ›The Medicare general enquiries line is available 7 days a week, 24 hours a day.
Can I ring Medicare? ›calling Medicare general enquiries on 132 011.
Is there a do not call for Medicare? ›
To register, call from the phone which you want on the Do Not Call list. The phone number is 1-888-382-1222. You can also register your phone number online as well, but you'll need to be sure you have an email account to do so. Also, register both your cell phone and home phone to put an end to the calls.
What changes are coming to Medicare in 2022? ›Changes to Medicare Part B
The cost of Medicare Part B will go from $170.10 per month in 2022 to $164.90 in 2023, a decrease of $5.20 per month. The Medicare Part B deductible is also decreasing in 2023. The annual Part B deductible will go from $233 in 2022 to $226 in 2023, a decrease of $7.
- Medicare Part A: Hospital Insurance.
- Medicare Part B: Medical Insurance.
- Medicare Part C: Medicare Advantage Plans.
- Medicare Part D: prescription drug coverage.
What is the deductible for Original Medicare? In 2023, the Medicare Part A deductible is $1,600 per benefit period (an increase of $44 from $1,556 in 2022) and the Part B annual deductible is $226 (a decrease of $7 from the annual deductible of $233 in 2022).
How do I stop annoying Medicare calls? ›To do so, call (888) 382-1222. Be sure to call from the telephone number you want to add to the list. If you have an email account, you can also register for the Do Not Call Registry online. Once your telephone number has been on the list for 31 days, you can start reporting unwanted sales calls.
How do I get rid of senior benefits calls? ›To register, visit www.dmachoice.org and enter your information. There is a $2 fee to register online, but this registration lasts for 10 years. Caregivers also have the option to register on behalf of their care recipients to prevent them from receiving junk mail as well.
What is the best number to call about Medicare benefits? ›1-800-MEDICARE (1-800-633-4227)
For specific billing questions and questions about your claims, medical records, or expenses, log into your secure Medicare account, or call us at 1-800-MEDICARE.