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Massachusetts Medicare Guide

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Explore your options

Compare options, including Medicare Advantage, Medicare Supplement, and prescription plans.

Enroll in Medicare

Get the help you need to enroll in Medicare, from Original Medicare to supplemental coverage.

Use your coverage

Receive extended support to help you use your plan effectively, find doctors, and get savings.

We’re here to help! Schedule a free consultation with one of our licensed Massachusetts Medicare Advisors or give us a call at (888) 604-0055 to get started.


Below you’ll find useful information to help you understand the basics of Medicare in Massachusetts, including your options and average pricing of some types of plans. 


Use this table of contents to jump to specific sections:


A Snapshot of Medicare in Massachusetts

Massachusetts has 1.4 million Medicare beneficiaries, making up 20% of the state’s total population. The majority of Massachusetts beneficiaries are on Medicare due to age, but about 14% are on Medicare due to disability. 24% of Massachusetts’s Medicare enrollees also receive full or partial Medicaid benefits. 


One big decision you need to make when you enroll in Medicare (which we’ll explain more in the next section) is to stay on Medicare or move to Medicare Advantage. In Massachusetts, 71% of Medicare beneficiaries choose to remain on Original Medicare and 29% choose to move to a Medicare Advantage plan (source).


Massachusetts Medicare Eligibility and Enrollment Steps

Eligibility is the same for all US citizens. You’re eligible for Medicare if you’re 65 or older or have certain disabilities like ALS or End-Stage Kidney Disease.


Massachusetts Medicare Enrollment Steps


1. Enroll in Original Medicare (Part A & Part B) 

Most people enroll in Medicare due to age, and can enroll as soon as their Initial Enrollment Period (IEP) begins. Your IEP is a seven-month period that starts three months before the month you turn 65 and ends three months after. Some people choose to delay their Part B enrollment because they are still working. If you choose to delay signing up for Part B, just make sure you’re eligible for a Special Enrollment Period when you stop working. 


2. Compare additional coverage options

We mentioned earlier that after you sign up for Medicare, you can choose to stay on Original Medicare or move to a Medicare Advantage plan. We’ll explain the pros and cons of both of these options below. We’ll also dive into the benefits of Medicare Supplement and Part D (prescription drug) plans, which can be stacked on top of your Original Medicare coverage. 


3. Get the best value from Medicare

There are two things you need to do in order to get the best value from Medicare. First, use your plan! Schedule preventive care appointments (like your annual wellness visit), share your new insurance information with your pharmacy and fill a prescription, and set up any additional benefits that may come with your coverage. Second, make sure to review your insurance each year during the Medicare Open Enrollment Period to ensure you’re still enrolled in the best coverage for your needs. Your healthcare needs may change and some Medicare plans change too! Always shop around to be sure you’re getting the most value from Medicare.


Massachusetts Medicare Advantage Plans

There are 81 Medicare Advantage (MA) plans available in Massachusetts. Plan pricing, benefits, and availability will vary from one county to the next. For example, Worcester County has 54 Medicare Advantage plans from twelve different insurance carriers and Nantucket County has three plans offered by two insurance carriers.


Advantage plans must provide at least the same coverage as Original Medicare, and often provide additional benefits, including:

  • Dental, vision, and hearing services

  • Prescription coverage

  • Flex cards

  • Fitness perks

  • Transportation services


MA plans often provide these extra benefits with no (or a low) additional premium each month. Extra benefits with no (or a low) additional premium sounds nice, so why isn’t everyone on a Medicare Advantage plan? Unfortunately, MA plans come with drawbacks, like:

  • Limited provider networks

  • Preauthorization requirements and denials

  • Higher out-of-pocket costs than coverage with Original Medicare + Medicare Supplement


To hear about and compare pricing and benefits for Medicare Advantage plans available in your county, give us a call at (888) 604-0055 or schedule a free consultation with one of our Massachusetts Medicare Advisors.


Massachusetts Medicare Supplement Plans

Medicare Supplement (Medigap) plans are intended to help beneficiaries cover the 20% of costs that Original Medicare doesn’t. In addition to much lower out-of-pocket costs, Medigap plans don’t have network restrictions and won’t ever require prior authorization for Medicare-covered services. These benefits cause many Medicare beneficiaries to elect for coverage including Original Medicare + Medigap + Part D. 


While most states have ten different plans, there are only three types of Medicare Supplement plans in Massachusetts:

  1. Core Plan

  2. Supplement 1 Plan (only available to those eligible for Medicare prior to 1/1/2020)

  3. Supplement 1A Plan


All three Massachusetts Medigap plans offer the following basic benefits:

  • Inpatient hospital stay costs

  • Medical costs

  • Cost of blood

  • Part A hospice coinsurance


Each Massachusetts Medigap plan covers different benefits, which may include:

  • Part A deductible

  • Part A skilled nursing coinsurance

  • Part B deductible

  • Foreign travel emergency care

  • Inpatient days in a mental health hospital

  • State-mandated benefits


Massachusetts has different types of plans, compared to most of the 50 states. It also has different rules for how and when you can enroll in Medicare Supplement plans. Medicare beneficiaries in Massachusetts have access to continuous open enrollment, with guaranteed issue rights throughout the year. Additionally, the state doesn’t allow insurance companies to establish waiting periods for pre-existing conditions for Medicare Supplement policies. 


Massachusetts Part D Plans

Original Medicare does not cover prescriptions. Medicare beneficiaries can receive Part D (prescription) coverage, either through a Medicare Advantage plan that includes it or through a stand-alone Part D plan. There are 24 stand-alone Part D plans available in Massachusetts. The specific plans available to you will depend on the county you live in.


If you don’t currently take any prescriptions, you should still consider enrolling in a low-cost Part D plan. This will help you avoid the Part D penalty if you need prescription coverage later in life.


If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Massachusetts Medicare Advisors or give us a call at (888) 604-0055. 


Get help paying for Medicare in Massachusetts

Healthcare expenses add up, especially as we age. If you have low income and resources, there are three programs that can help ease the burden of healthcare costs. 


Massachusetts Medicaid

Medicaid is a joint state and federal program that’s managed by individual states. Each program is a little different when it comes to eligibility and enrollment. So, when doing research, be sure to read information specifically from MassHealth, Massachusetts’ Medicaid program. 


Massachusetts Medicaid has a special program for seniors, called Senior Care Options (SCO). SCO is a comprehensive health plan that those eligible for both Medicare and Medicaid can voluntarily enroll in. SCO covers all of the same services that Medicare and Medicaid (MassHealth) would pay for and members have no copays. 


Medicare-Medicaid beneficiaries may also be eligible for Massachusetts Medicare Savings Programs. These programs help Medicare beneficiaries with low income and resources to pay their Medicare premiums, copays, and deductibles. There are three types of Medicare Savings Programs in Massachusetts:

  • Qualified Medicare Beneficiary Program (QMB)

  • Specified Low-Income Medicare Beneficiary Program (SLMB)

  • Qualifying Individual (QI) Program


Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with prescription drug coverage.


You automatically qualify for Extra Help if you:

  • Receive full Medicaid coverage from Massachusetts

  • Massachusetts pays your Part B premium

  • Are eligible for Supplemental Security Income (SSI)


If you don’t automatically qualify for Extra Help, you may still qualify. If you have questions, reach out to one of our licensed Massachusetts Medicare Advisors to get free support with your application.


Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:


You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.