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Medicare in Massachusetts

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 affordable hospital and medical insurance under Original Medicare, Part A and Part B, and private health insurance under Medicare Advantage (Medicare Part C) and Medicare Part D (prescription drug coverage).

Original Medicare for Massachusetts beneficiaries

Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) are together referred to as Original Medicare. Massachusetts residents, as it is for residents of other US states, usually don’t pay a monthly premium for Medicare Part A coverage if you or your spouse 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 residents receive, among others benefits, the following 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.
  • You receive disability benefits, have end-stage renal disease, or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals can get 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 for private insurance under Medicare, through Medicare Advantage (Medicare Part C). Medicare Advantage in Massachusetts is 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 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.

Medicare beneficiaries in Massachusetts concerned about the out-of-pocket expenses associated with Original Medicare, like coinsurance, copayments, and deductibles, can get help paying for those expenses by enrolling in a Medigap plan, also referred to as a Medicare Supplement plan. While most states offer 10 standardized Medigap plans, Massachusetts offers two special versions of Medicare Supplement plans, customized for Massachusetts beneficiaries. Get more information about Medigap plans in Massachusetts.

In addition, Massachusetts residents eligible for Original Medicare, Part A and Part B, may also enroll in Medicare Part D, which offers stand-alone prescription drug plans through private insurance. Find out about Medicare Part D plans in Massachusetts.

Remember that private Medicare plan benefits 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: