In Massachusetts, as in other states, US citizens and permanent residents are eligible to enroll in Medicare to receive health coverage once they turn 65. Options include hospital and medical insurance under Original Medicare, Part A and Part B, and Medicare approved private health insurance under Medicare Advantage (Medicare Part C) and Medicare Part D (prescription drug coverage).
Original Medicare for Massachusetts beneficiaries
Together, Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) are referred to as Original Medicare. Massachusetts beneficiaries, as it is for beneficiaries of other US states, usually don’t pay a monthly premium for Medicare Part A coverage if they or their spouses paid enough Medicare taxes while working. Part A benefits include, but are not limited to, the following health services:
- Hospital care
- Skilled nursing facility care
- Nursing home care
- Hospice care
- Home health services
Original Medicare also covers medical insurance, under Medicare Part B. As in other states, most Medicare beneficiaries in Massachusetts have to pay a standard monthly premium for Medicare Part B. Medicare beneficiaries in Massachusetts whose annual income is above a certain amount may have to pay a higher premium. Under Medicare Part B, Massachusetts beneficiaries receive, among others benefits, the following covered services and supplies:
- Outpatient doctor visits
- Outpatient hospital services (such as outpatient surgery)
- Laboratory services
- Radiological services (such as x-ray)
- Ambulance services
- Durable medical equipment
- Mental health services
- Getting a second opinion before surgery
- Limited outpatient prescription drugs
Residents of Massachusetts may enroll in Original Medicare, Part A and/or Part B, during the following enrollment periods:
- Initial Enrollment Period: This is the period that begins three months before you turn 65, includes your birthday month, and ends three months after that month.
- General Enrollment Period: This period runs annually from January 1 to March 31, and the effective date of your coverage would be July 1. However, if you miss your Initial Enrollment Period and enroll later, you may have to pay a late-enrollment penalty in the form of higher monthly premiums.
- Special Enrollment Period: If you delayed your enrollment in Medicare Part A and/or Medicare Part B because you had coverage through an employer, you may sign up for Medicare during a Special Enrollment Period. You may not have to pay a penalty if you sign up for Original Medicare during a Special Enrollment Period.
You are eligible for Medicare in Massachusetts if:
- You’re age 65 or older.
- You’re a US citizen or permanent legal resident of at least five continuous years.
- You receive disability benefits, have end-stage renal disease, or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals may receive Medicare regardless of age, if they’re collecting disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board.
In Massachusetts as in other states, you can apply for Medicare through the SSA. If you are applying for retirement benefits, you can enroll in Medicare at the same time. You can apply:
- Online at the Social Security website. Individuals applying for Medicare only (as opposed to applying for SSA benefits as well) can use this application.
- By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778). SSA representatives can be reached Monday through Friday, from 7AM to 7PM.
- In person at a local Social Security office. To look up office locations in Massachusetts, click here.
Medicare private insurance in Massachusetts
Medicare beneficiaries in Massachusetts can opt to receive their Medicare benefits through Medicare Advantage (Medicare Part C) by enrolling in Medicare plans offered by Medicare- approved private insurance companies. Medicare Advantage plans are required by the government to offer at least the same coverage as Original Medicare, Part A and Part B. Some Medicare Advantage plans offer extra coverage not available under Original Medicare, like routine vision (for eyeglasses, for example) and hearing (if you wear a hearing aid), so be sure to compare all Medicare Advantage plans available in Massachusetts before you make your selection. Read more about Medicare Advantage plans in Massachusetts.
Medicare Advantage Prescription Drug Plans combine health and prescription drug coverage into one plan, and they’re also available to Medicare beneficiaries in Massachusetts. But Medicare beneficiaries in Massachusetts should be aware that even if they sign up for a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, they have to stay enrolled in Original Medicare and continue paying the Medicare Part B premium in order to keep their health coverage and avoid being disenrolled from Medicare.
If you decide to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Massachusetts offers two Medicare Supplement plans, specifically for Massachusetts beneficiaries. Get more information about Medigap plans in Massachusetts.
In addition, Massachusetts residents enrolled in Original Medicare, Part A and/or Part B, may also enroll in a stand-alone Medicare Part D Prescription Drug Plan offered by a Medicare-approved private insurance company to provide Medicare prescription drug coverage (sometimes referred to as Medicare Part D). Find out about Medicare Part D plans in Massachusetts.
Remember that private Medicare plan benefits may vary depending on the Massachusetts county in which you reside. If you live in Boston in Suffolk County, for example, you may have different Medicare plan offerings than a resident of Worcester in Worcester County. Considering the various Medicare insurance plans available in Massachusetts, it’s important to customize your search for plans based on your individual medical and prescription drug needs.
Massachusetts resources for Medicare beneficiaries
There are a number of resources designed to help Medicare beneficiaries in Massachusetts with Medicare-related issues and concerns. Here are some of the resources that may be helpful to you:
- State Health Insurance Assistance Program (SHIP)
- State Hospice Organization, 1420 Providence Highway, Suite 277, Norwood, MA 02062, http://www.hospicefed.org
- State Medical Assistance Office http://www.mass.gov/eohhs/gov/departments/masshealth/