October 4th 2024
By Ari Parker
Choose the best Massachusetts Medicare Advantage plan based on your unique health and financial needs. Get help and enroll today!
When you first get Medicare, you enroll in Original Medicare, which is made up of Medicare Part A and Medicare Part B. Once you’re enrolled, you have additional coverage options: Medicare Supplement plans, Medicare Part D plans, and Medicare Advantage plans. Medicare Advantage plans are increasingly popular nationwide. In 2023, Medicare Advantage enrollment exceeded 50% for the first time. Medicare Advantage plans in Massachusetts aren’t quite as popular—enrollment is at 35% in 2024. Still, many people choose to enroll in a Massachusetts Medicare Advantage plan.
Whether you’ve decided you want to enroll in Medicare Advantage or want to understand your options, this guide will give you a complete overview of Medicare Advantage plans in Massachusetts. We’ll start with some quick facts and a general overview of Medicare Advantage. Then, we’ll share details about the Medicare Advantage plans in Massachusetts and the steps you should take to ensure you enroll in the best plan for your unique needs.
35% of Medicare beneficiaries in Massachusetts are enrolled in a Medicare Advantage plan.
There are a total of 81 Medicare Advantage plans in Massachusetts.
UnitedHealthcare offers some 5-star Medicare Advantage plans in Massachusetts, and several insurance companies offer 4.5-star plans.
When choosing the best Massachusetts Medicare Advantage plan, you need to consider your personal preferences and needs, including doctors, prescriptions, and extra benefits.
Below are some quick facts about the Medicare Advantage market in Massachusetts. Keep in mind that plan availability and enrollment rates vary by county.
35% of Medicare beneficiaries in Massachusetts are enrolled in a Medicare Advantage plan.
There are a total of 81 Medicare Advantage plans in Massachusetts.
A couple of counties (Nantucket and Dukes) only have one Medicare Advantage plan available to residents.
Worcester County, MA, has the most Medicare Advantage plans, with 53.
Most Massachusetts Medicare Advantage plans are either local HMOs or PPOs. There’s one regional PPO plan.
Medicare Advantage plans are offered by private insurance companies as an alternative to Original Medicare. By law, these plans must cover the same services and equipment as Original Medicare—but many people find these plans limiting due to their use of provider networks and prior authorization requirements. It’s important to understand all of your Medicare plan options in Massachusetts and the pros and cons of Medicare Advantage to ensure you get the coverage you need and avoid Medicare Advantage nightmares.
The biggest pros that come with Medicare Advantage plans are a maximum out-of-pocket spending amount and extra benefits, like dental, vision, and hearing coverage.
Maximum out-of-pocket amount
The costs of medical care are quite high. Insurance exists to limit patients’ costs when care is needed. Once you meet your Part B deductible, Original Medicare generally pays for 80% of the cost of care. The other 20% is your coinsurance (the amount you owe out of pocket), and there’s no out-of-pocket limit. This means that if you receive $100,000 worth of medical care in a year, you’ll owe about $20,000. Medicare Advantage plans have varying deductibles and coinsurance amounts, but they also come with out-of-pocket maximums that limit how much you can owe for medical care in a year.
Extra benefits
One of the reasons Medicare Advantage plans are so popular is because they provide extra benefits that Original Medicare doesn’t. If you value dental, vision, and hearing coverage, you’re likely considering a Medicare Advantage plan that will provide some coverage. Advantage plans can also provide benefits, like:
OTC cards to purchase over-the-counter health and wellness items
Transportation benefits to help you get to doctor appointments
Premium giveback benefits that give you a rebate on your Medicare premium
Telehealth services, which help people see the doctor when they’re physically unable to
These benefits are attractive, but before you sign up for a Medicare Advantage plan for special benefits, make sure you understand the cons that come with these plans.
We already briefly mentioned two of the biggest cons that come with Medicare Advantage plans above: provider networks and prior authorization requirements. While both of these elements are common among health insurance plans, they can limit your access to timely care.
Provider networks
If the doctors you have already been seeing are not in your plan’s network, you won’t receive full coverage for services you receive from them. We’ve also heard from some Medicare enrollees that finding doctors in a plan’s network who are accepting new patients can be challenging.
Prior authorization requirements
Original Medicare does not require prior authorization. This means that once your doctor recommends a treatment, you can receive that treatment. Medicare Advantage plans often do require prior authorization, especially for more expensive services. The prior authorization process can take time, especially if your prior authorization is denied and you need to appeal. This means you won’t get the treatment you need immediately. Furthermore, if your prior authorization is denied, you may not be able to get coverage for the treatment your doctor says you need.
Most people enroll in a Medicare Advantage plan when they first get Medicare or during the Medicare Open Enrollment Period. There are some Special Enrollment Periods that may allow you to enroll in a Medicare Advantage plan at another time.
There are specific windows of time in which you can change your Medicare Advantage plan:
5-star Special Enrollment Period
Other Special Enrollment Periods
Each year, the Centers for Medicare and Medicaid Services (CMS) assigns Medicare Advantage and Part D plans a rating from one to five. A 1-star rating is considered poor, and a 5-star rating is considered the best.
UnitedHealthcare offers some plans with 5-star ratings in Massachusetts. These plans aren’t available in every county.
Below are a handful of insurance carriers that offer 4.5-star plans in Massachusetts:
Humana
Aetna
Tufts
Fallon Health
Star ratings are only one thing to consider when choosing the best Massachusetts Medicare Advantage plan. Before you consider star ratings, you need to make sure that the plans you’re considering cover your needs. Ask yourself these three questions and take down notes to make sure you have a list of your priorities ready before you compare the plans available to you.
If you have doctors you’ve been seeing for years, who you’d prefer to keep seeing, jot their information down. This information is good to have handy when you’re looking at Massachusetts Medicare Advantage plan networks.
Most Medicare Advantage plans come with prescription drug coverage—it’s one of the perks! If you’re looking at plans that include prescription coverage, you should make sure that your prescriptions are covered, and that you’re able to save the most on those prescriptions.
Extra benefits are important to Medicare Advantage enrollees. If you’re healthy and could use some extra cash, the Part B giveback benefit and OTC cards might be important and can be redeemed on the OTC catalog app. Many people are interested in dental and vision coverage. Think about the different benefits Medicare Advantage plans can provide and write down those that are important to you.
Once you’ve made a note of all of your priorities using the questions above, it’s time to compare plans to find the best Massachusetts Medicare Advantage plan for you! Many people find it challenging to compare costs, networks, and prescription coverage across multiple plans. So, whether you need help understanding your options or comparing the options, we’re here to help! Give us a call at (855) 900-2427 or schedule a time to talk to get Medicare checked off your list today!
