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Medicare in Massachusetts


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Medicare in Massachusetts

If you’re a Medicare beneficiary in Massachusetts, you may be wondering about how Medicare works and the different ways you can get your Medicare benefits. In general, Medicare in Massachusetts works in the same way as it does throughout the country. Medicare is a federal health-care program for seniors and certain disabled individuals. You’re eligible for Medicare benefits if you’re 65 or older; qualify through disability; or if you have certain health conditions, such as end-stage renal disease or amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). As of January 2018, Massachusetts had almost 1.3 million beneficiaries enrolled in Medicare.

Original Medicare, the government-run program, comes in two parts: Medicare Part A covers hospital and skilled nursing facility services, while Part B covers medical services, including doctor visits, lab tests, and durable medical equipment. If you stay enrolled in Original Medicare, you can also add on a stand-alone Medicare Prescription Drug Plan, since Original Medicare’s prescription drug benefits are limited. Another option is to purchase a Medicare Supplement (Medigap) insurance plan, which works with your Original Medicare coverage.

Another option for Massachusetts beneficiaries is to enroll in a Medicare Advantage plan instead, also known as Medicare Part C. You’ll get at least the same level of coverage as Original Medicare, Part A and Part B, through a Medicare Advantage plan. In addition, some Medicare Advantage plans may also cover additional benefits, such as routine vision or dental, hearing, or prescription drugs. You must continue to pay your Medicare Part B premium. Medicare Part C is an alternative way to get your Original Medicare coverage; it doesn’t replace it. Instead, you’re just getting your Medicare Part A and Part B benefits in a different way. In 2018, 24% of Medicare beneficiaries in Massachusetts has Medicare Advantage plans and other Health plans.

To help residents understand their Medicare coverage options in Massachusetts, the state offers a number of free resources specifically dedicated to Medicare and related insurance coverage issues. These resources are available through a number of locations throughout the state to provide easy access for every Massachusetts resident, so they can find the information necessary to manage their Massachusetts Medicare.

Medicare resources in Massachusetts

Executive Office of Elder Affairs: This state office was created to support the needs of seniors living in Massachusetts. The office provides a variety of programs and services for seniors to promote their independence and well-being. The Executive Office of Elder Affairs includes a number of specialized programs that offer information about Medicare options in Massachusetts:

  • SHINE – Serving the Health Information Needs of Everyone, also known as SHINE, is a statewide program that provides insurance information and counseling to Massachusetts residents, including seniors with Medicare.
  • Prescription Advantage – This is a program that provides supplemental prescription drug insurance for Massachusetts Medicare beneficiaries with limited income. If you’re a Medicare beneficiary, Prescription Advantage acts as a secondary payer and can help with certain Medicare prescription drug costs, such as cost sharing. Participation in the program is based on income eligibility.
  • Massachusetts Medicaid – Medicare beneficiaries in Massachusetts with limited income may qualify for help with certain Medicare costs. Medicare Savings Programs are run through state Medicaid programs and help with costs like premiums, copayments, coinsurance, or deductibles. To find out if you qualify and to apply, contact the Medicaid department in Massachusetts.

Executive Office for Health and Human Services: This office oversees dual enrollment for both Medicare and Medicaid for qualifying individuals. If you’re a disabled Massachusetts resident with Medicare, you may be eligible for One Care, a state health plan that combines Medicare coverage with MassHealth (the state’s Medicaid program). One Care gives disabled Medicare beneficiaries the option to get expanded health-care coverage under MassHealth through one coordinated health plan. To be eligible, you must be between 21 and 64 years old; have Medicare Part A and Part B; and be eligible for Medicare Part D. You must also currently have MassHealth Standard or MassHealth CommonHealth. Visit Mass.gov for more information.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
Benefits, premium and/or copayments/co-insurance may change on January 1 of each year.

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