Medicare plays a key role in providing health and financial security to beneficiaries residing in Massachusetts. With more than 1.3 million Massachusetts beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Massachusetts. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Massachusetts?

Medicare covers most Massachusetts residents who are 65 or older, and it also covers disabled Massachusetts residents. Medicare enrollment in Massachusetts works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Massachusetts Medicare Enrollments

984,855

Original Medicare Plans
(Part A and B)

361,152

Medicare Advantage & Other Health Plans

720,258

Stand-alone Medicare
Part D (Drug plans)

1,346,007

Total Medicare Beneficiaries
in Massachusetts

Massachusetts Medicare Advantage Plans (Part C)

Nearly 25% of Massachusetts Medicare beneficiaries select Medicare Advantage plans. Most beneficiaries are enrolled in Original Medicare.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Massachusetts who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

As of 2020, 108 Medicare Advantage plans are available in Massachusetts. The average monthly Medicare Advantage premium is $71.80 in 2019 to $66.26 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Massachusetts.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 361,152 beneficiaries enrolled in Medicare Advantage and other plans in Massachusetts. Nearly 25% of Massachusetts Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

Massachusetts Medicare Supplement (Medigap) Insurance Plans

Since Massachusetts conducts its own Medigap standardization, there are only two plan designs available (as opposed to ten plans in most states).

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

As of 2020, there are 49 insurers that offer Medigap plans in Massachusetts. The majority of states have Medigap plans that are standardized under federal rules. However, Massachusetts is one of three states that has a waiver to allow the state to design different Medigap plans. Unlike most states that have ten different Medigap plans designs, Massachusetts only offers the Medicare Core Plan and the Medicare Supplement 1.

Along with conducting its own Medigap standardization, Massachusetts also has strong consumer protections in the Medigap market. Massachusetts is one of eight states where Medigap insurers are required to use community rating, which means premiums cannot vary based on age.

Moreover, Massachusetts has an annual Medigap enrollment period, which runs from February 1 to March 31 each year. This open enrollment period gives beneficiaries a guaranteed-issue opportunity to enroll in Medigap for the first time, if they missed their initial six-month enrollment window, or to switch from one plan to another.

Massachusetts Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of 2020, There are 720,258 Medicare beneficiaries in Massachusetts enrolled in stand-alone Part D prescription drug plans and 331,210 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 25 stand-alone Part D plans available in Massachusetts, with premiums ranging from about $14 to $128 per month. About 32% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Massachusetts

  • Age Strong: Seniors aged 55 and over who live in and around the city of Boston can receive help with managing their Medicare benefits from Age Strong, a program of the city government. Age Strong counselors and caseworkers are trained to educate seniors about various free and low-cost services they may be eligible for. The program offers referrals and direct assistance with discount and free prescription drug programs, and caseworkers can help eligible seniors sign up. Age Strong counselors are also able to help seniors find and apply for other, non-Medicare, or Medicare Advantage programs.
    Contact: Call 617-635-4366. Inquiries and requests for counseling appointments may be submitted online or by mail to the Age Strong main office address shown on the program’s website.

  • Serving the Health Insurance Needs of Everyone (SHINE): SHINE provides free health insurance information and counseling to all Massachusetts residents with Medicare and their caregivers. People who have Medicare or who are about to become eligible for Medicare can meet with a counselor to learn about benefits and options available. A counselor will review programs that help people with limited income to pay health care costs.
    Contact: Call 1-800-243-4636 or TTY/ASCll (800) 439-2370

  • MetroWest Meds Program: MetroWest Meds is designed to help eligible uninsured and under-insured individuals in the MetroWest area* receive medications through pharmaceutical company prescription drug programs. MetroWest Meds will work with you and your doctor to complete the application process required by the pharmaceutical companies. This service is free to eligible residents of the following towns: Ashland, Bellingham, Dover, Framingham, Franklin, Holliston, Hopedale, Hopkinton, Hudson, Marlborough, Medfield, Medway, Mendon, Milford, Millis, Natick, Needham, Norfolk, Northborough, Sherborn, Southborough, Sudbury, Wayland, Wellesley, and Westborough.
    Contact: Call 508-270-5781. Walk-in applications are accepted at program offices, though mail is received at the Edward M. Kennedy Community Health Center in Framingham.

  • Mansfield’s Council on Aging (COA): COA is a multi-faceted human services department that serves the needs of all residents aged 60 and over, their families, and caregivers. The COA oversees Social Services for all Mansfield residents. The mission of the COA is to protect, preserve and improve the ability of older residents of Mansfield to remain healthy, safely independent in their homes, socially engaged, physically active, and intellectually stimulated for as long as they wish and are able. This is to be accomplished through social services, nutrition, exercise, music, and artistic programs.
    Contact: Call 508-261-7368 to schedule an appointment with a caseworker. Applications and other correspondence may be mailed to: Mansfield Council on Aging – Town Hall, 255 Hope Street, P.O. Box 232, Mansfield, MA 02048.

  • Greater Lynn Senior Services (GLSS): GLSS is the nonprofit Aging Services Access Point and Area Agency on Aging serving people age 60 and older and adults living with disabilities in Lynn, Lynnfield, Nahant, Saugus, and Swampscott, MA.
    Contact: Call 781-581-7557 or email [email protected]. Written communications, including application packets, can be mailed to 8 Silsbee Street, Lynn, MA 01901.

  • Disability Resource Center (DRC): If you live in Essex or Middlesex counties you may be eligible for assistance with the Medicare and Medicare Advantage programs through the Disability Resource Center (DRC) in Salem. The mission of the center is to inform local seniors, as well as younger adults with any kind of disability, about how Medicare benefits work together, and available extra assistance that they may be eligible for. Program caseworkers are able to offer unbiased advice, educational materials about each program the center works with and direct assistance filling out the necessary application forms.
    Contact: Call 978-741-0077 or email [email protected]

  • Prescription Advantage: Prescription Advantage is the state-sponsored prescription drug assistance program for seniors and people with disabilities in Massachusetts. Prescription Advantage supplements prescription drug benefits by helping to pay for medications covered by Medicare Part D or creditable coverage plans**. Membership category determines when Prescription Advantage benefits begin. At that time, members pay no more than Prescription Advantage co-payment amounts. Click here for more detailed information.
    Contact: Call 1-800-AGE-INFO (1-800-243-4636) and press 3

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Massachusetts. Our process makes it easier for you to access your Medicare eligibility in Massachusetts so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 382-1192 anytime to get a free quote or to ask any questions.

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