With more benefits and plan offerings than ever before, enrollment in Medicare Advantage (MA) continues to grow. In 2023, over one half Medicare beneficiaries had an Advantage plan. This page describes Medicare Advantage plans in Massachusetts and how to compare your options to ensure you get the best plan for your unique needs.
What is Medicare Advantage in Massachusetts?
Also known as Medicare Part C, Medicare Advantage plans must provide beneficiaries the same coverage they would get with Original Medicare. This includes:
- Medicare Part A, which covers inpatient services, such as you'd receive in a hospital
- Medicare Part B, which covers outpatient services, such as doctor visits, lab work, and durable medical equipment (DME)
Original Medicare does not cover prescriptions. You get that with Medicare Part D.
Most Medicare Advantage plans provide more robust coverage than just Parts A and B. For example, 90% cover prescription medications.
Massachusetts Medicare Advantage plans with prescription drug coverage
All-in-one policies that combine your Medicare Parts A, B, and D benefits are known as Medicare Advantage Prescription Drug plans (MA-PD).
Other benefits you may get with an Advantage plan include:
- Fitness programs
- Hearing aids
- Routine dental and vision care
Private insurance companies provide Medicare Advantage plans, which is why benefits and costs vary.
How do you qualify for Medicare Advantage in Massachusetts?
You qualify for Medicare Advantage in Massachusetts as soon as you enroll in both Parts A and B.
American citizens and permanent legal residents aged 65 or older qualify for Medicare once they turn 65. If you began collecting Social Security benefits at least 4 months before your 65th birthday, you will be enrolled automatically.
You also qualify for Medicare if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. In this case, enrollment occurs automatically in month 25.
When can you sign up for a Medicare Advantage plan in Massachusetts?
You may join a Medicare Advantage plan in Massachusetts during any of the following enrollment periods.
Your Initial Enrollment Period (IEP) lasts for 7 months, beginning 3 months before you qualify for Medicare. So, if your 65th birthday or 25th month of collecting disability occurs in April, your IEP lasts from January 1 to July 31.
If you didn't sign up for Part A and/or Part B your IEP, you can during the General Enrollment Period (January 1 through March 31). You may then join a Medicare Advantage plan from April 1 until June 30.
Medicare's Annual Enrollment Period (AEP) runs from October 15 through December 7 and allows current beneficiaries to make a variety of coverage changes. This includes joining an Advantage plan.
If you're currently enrolled in Medicare Part C, you may either join a new MA plan or return to Original Medicare during the Medicare Advantage Open Enrollment Period from January 1 through March 31.
If you experience certain life changes, you can sign up for Medicare Part C during a Special Enrollment Period. Medicare.gov has the full list of qualifying special circumstances.
Types of Medicare Advantage plans in Massachusetts
There are four main types of Medicare Advantage plans in Massachusetts.
- Health maintenance organizations: HMO plans use a provider network and rarely cover services received from an out-of-network provider. They also require members to choose a primary care doctor and obtain referrals before seeing a specialist.
- Preferred provider organizations: PPO plans also have provider networks. However, members may see an out-of-network provider for a higher copay. PPO plans also don't require members to choose a primary doctor or get referrals.
- Private fee-for service: PFFS plans set costs covered service. Most also use a provider network but, as with PPOs, members can use an out-of-network provider for a higher cost.
- Special needs plans: SNPs limit enrollment to people who meet certain criteria, with each plan setting its own guidelines. This means one of the following: qualifying for both Medicare and Medicaid (dual eligible), having a chronic condition (e.g. diabetes, HIV/AIDS, ESRD), or living in an institution.
How to choose a Medicare Advantage plan in Massachusetts
To ensure you get the best Medicare Advantage plan for your unique needs and budget, consider these four metrics:
- Costs: May include a yearly deductible, monthly premium, and copayments at time of service.
- Coverage: Benefit vary from plan to plan. Don't forget to review the drug formulary for MA-PD plans.
- Network: May include doctors, hospitals, labs, durable medical equipment providers (DME), and more.
- Ratings: Medicare publishes plan ratings every fall to help members compare their options during AEP.
It's easy to compare Medicare Advantage plans in Massachusetts with our Find a Plan tool. Just enter your location information and coverage start date to review the Medicare plan options in your area.
Find a Medicare Plan in your area
It’s FREE with no obligation