Medicare Advantage Plans in Massachusetts

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans offer additional benefits like dental, vision, hearing, telehealth, fitness programs, and more.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first enroll in Original Medicare (Parts A and B). Most people qualify for Medicare enrollment at age 65, though some may qualify earlier due to a disability or conditions like ALS or ESRD. Enrollment timing is key to avoiding penalties or lapses in coverage. Massachusetts residents can enroll during:

• Initial Enrollment Period
• General Enrollment Period
• Special Enrollment Periods

What Types of Medicare Advantage Plans Are Available in Massachusetts?

Massachusetts residents can choose from the following Medicare Advantage (MA) plan types:

• Health Maintenance Organizations (HMOs): Require in-network care and often referrals for specialists. HMOs are the most common MA plan type in Massachusetts.
• Preferred Provider Organizations (PPOs): Allow out-of-network care at higher costs and generally don’t require referrals.
• Private Fee-for-Service (PFFS) Plans: Let you visit any provider who agrees to the plan’s terms. Some plans may include a network, which offers reduced costs.
• Special Needs Plans (SNPs):
  • C-SNPs: For people with chronic health conditions such as diabetes, ESRD, dementia, or cancer.
  • I-SNPs: For individuals living in institutions or needing in-home nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For people who qualify for both Medicare and Medicaid. These plans typically offer coordinated care and extra benefits at low or no cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible Medicare Advantage plan with a medical savings account funded by your insurer to cover healthcare expenses.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans in Massachusetts include Part D drug coverage. However, MSAs and some PFFS plans don’t. If your MA plan doesn’t offer drug coverage, you may:

• Enroll in a standalone Part D plan (only available with some plan types).
• Face a late enrollment penalty if you delay coverage and don’t have creditable insurance elsewhere.

Be sure to check your plan’s formulary to ensure your medications are covered.

How Do You Choose a Medicare Advantage Plan?

Before selecting a plan, it’s important to understand Medicare Advantage costs. Consider:

• Premiums: Some plans offer $0 premiums, while others charge a monthly fee.
• Deductibles, Coinsurance & Copays: These costs can vary based on the plan’s structure.
• Out-of-Pocket Maximums: This annual limit protects you from excessive spending.
• Extra Benefits: Many Massachusetts plans offer perks like dental, vision, hearing, over-the-counter allowances, gym memberships, and telehealth services.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during the following specific enrollment periods:

• Initial Enrollment: 3 months before to 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop an MA plan.
• General Enrollment (Jan 1–Mar 31): If you’re newly enrolled in Part B.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): If you’re already in an MA plan, you can switch plans or return to Original Medicare.
• Special Enrollment Periods: Triggered by events such as:
  • Moving outside your plan’s area
  • Losing employer or Medicaid coverage
  • Plan termination
  • Qualifying chronic condition

What If You Want to Change Your Medicare Advantage Plan?

You can make changes to your MA plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

These periods allow you to switch plans or return to Original Medicare.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system evaluates Medicare Advantage plans on a 1 to 5 scale, helping you compare quality and performance:

• 1 star: Poor
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

Ratings are based on factors such as customer satisfaction, preventive care, chronic condition management, and customer service.

What Are Medicare Resources in Massachusetts?

Massachusetts residents can access several support programs:

• SHINE Program: Offers free Medicare counseling through the Executive Office of Elder Affairs.
• Massachusetts SMP Program: Helps Medicare beneficiaries detect and prevent fraud and abuse.
• Massachusetts Division of Insurance: Accepts insurance complaints.
• MassHealth: Massachusetts’ Medicaid program assists with healthcare costs for low-income residents. Call 1-800-841-2900.

Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, help cover costs not paid by Original Medicare, such as copayments, coinsurance, and deductibles.

• You must be enrolled in Medicare Parts A and B.
• The best time to enroll is during your six-month Medigap Open Enrollment Period (starts when you enroll in Part B).
• These plans do not cover prescription drugs—you’ll need a separate Part D plan.
• Ten standardized plans are available, with Plans F, G, and N being the most popular.
• Medicare Supplement Plan G had the highest enrollment in 2023 and is among the fastest-growing.
• Plan F is no longer available to newly eligible beneficiaries after 2020.

Learn more about Medicare Supplement plans in Massachusetts.

Next Steps

If a Medicare Advantage plan in Massachusetts fits your healthcare needs and lifestyle, take time to compare plans available in your area. Evaluate provider networks, drug formularies, extra benefits, and total out-of-pocket costs. Then enroll during the appropriate enrollment window to get the coverage you need.