What Are Medicare Advantage Plans in Massachusetts?
Medicare Advantage (MA) plans in Massachusetts are a bundled, all-in-one alternative to Original Medicare. These plans are offered by private insurance companies and include your Medicare Parts A and B benefits. Most MA plans also provide Medicare Part D (prescription drug) benefits and additional benefits such as dental, hearing, and vision care.1
What You Need to Know
Almost 90% of MA plans across the country have Medicare Part D prescription benefits.
The average cost for an MA plan in Massachusetts is $57.70 per month. This is more than double the 2021 national average of $21.
To enroll in an MA plan, contact the insurance company you’d like to sign up with or visit the Medicare Plan Finder.
What Types of Medicare Advantage Plans Are Available?
Several types of MA plans are available to Massachusetts residents, including:
- Health maintenance organizations (HMOs): These plans have a provider network, which is a group of hospitals, doctors, and other healthcare providers that have contracted with an insurance company. If you don’t want to incur extra costs, you must seek treatment from in-network providers, except in cases of emergency. You may also need a referral to see a specialist. HMOs are the most common type of MA plan.2
- Preferred provider organizations (PPOs): These plans also have a network, but you can see healthcare providers outside the network. However, you pay less if you’re treated by in-network providers. You typically don’t need a referral to see a specialist.
- Special needs plans (SNPs): These plans are for people on Medicare with specific healthcare needs. The three types of SNPs are:
- Chronic condition special need plans (C-SNPs): These plans are for people with chronic healthcare conditions, including diabetes, dementia, cancer, end-stage liver disease, and end-stage renal disease (ESRD) requiring dialysis.
- Dual eligible special need plans (D-SNPs): These plans are for people who are eligible for both Medicare and Medicaid.
- Institutional special need plans (I-SNPs): These plans are for people who live in an institution, such as a nursing home, or who need nursing care at home.
- Private fee-for-service (PFFS) plans: With this type of plan, you can see any provider who accepts the terms of the plan. Some PFFS plans have a network, but you can go to out-of-network providers who accept the plan’s terms. However, you’ll pay less if you see in-network providers.
- Medicare savings account (MSA) plans: These plans have two parts. First, you have a high-deductible MA plan. Your deductible is the amount you pay for covered services before the plan starts paying for those costs. The second part is an MSA, which is an account you can use to pay for your out-of-pocket healthcare costs. Your plan contributes to your MSA. If you use all the money in the MSA but you haven’t met your deductible, you are responsible for your Medicare-covered costs until your deductible is met. At that point, your plan pays for your Medicare-eligible healthcare costs.3
What Are Prescription Drug Options with Medicare Advantage?
Almost 90% of MA plans across the country have Medicare Part D prescription benefits.4 MSA plans and some PFFS plans don’t include prescription drug coverage, but if you purchase one of those plans, you can buy a separate Part D plan. However, if you join an HMO or PPO that doesn’t have prescription benefits, you can’t buy a Part D plan.5
Important note:t If you don’t have Part D coverage and you decide to enroll later, you may have to pay an ongoing late enrollment penalty.6
How Do You Choose a Medicare Advantage Plan?
There are several factors to consider when choosing a Massachusetts MA plan. First, there are the costs. Plans set their monthly premiums annually. Your premium is the amount you pay for your MA plan each month. Many plans have a $0 premium, but some have a cost. The average premium nationwide in 2021 is $21 per month.7
You should also consider your out-of-pocket costs, which include:
- Coinsurance: This is a percentage of a Medicare-covered service that you’re required to pay. For example, you might pay 20% of the cost of lab tests.
- Copayments: This is a set dollar amount you pay for a Medicare-covered service. For example, you might pay $20 for a visit to your primary care doctor.
- Deductibles: This is the amount you pay for Medicare-covered services before your insurance starts paying those costs. If your plan has a $500 deductible, you pay the first $500 in eligible healthcare costs. After that, your plan pays according to its terms.8
- Out-of-pocket maximums: This is the most you will pay out of pocket for covered healthcare costs each year.9
Your plan’s benefits are also important. In addition to healthcare, many plans offer vision, dental and hearing benefits along with other perks like fitness club memberships. Almost all plans offer telehealth benefits.10
Besides premiums, Medicare Advantage plan costs can include coinsurance, copayments, deductibles, and out-of-pocket maximums.
When and How Do You Enroll in Medicare Advantage?
To enroll in an MA plan, contact the insurance company you’d like to sign up with or visit the Medicare Plan Finder. You have several opportunities to enroll:
- Initial enrollment period: This period starts three months before the month you turn 65 and lasts for three months after your 65th birthday month. During this period you can sign up for an MA plan.
- Open enrollment period: From October 15 – December 7 each year you can drop, change or enroll in an MA plan.
- Medicare Advantage open enrollment period: From January 1 – March 31, you can switch to another MA plan or drop your MA plan and return to Original Medicare.
- General enrollment period: If you start Medicare Part B between January 1 and March 31, you can also enroll in an MA plan. Your plan would then start on July 1.11
- Special enrollment period: You’re entitled to switch, drop or enroll in a plan in certain situations, including:
- Moving out of the service area of your current plan
- Losing Medicaid eligibility
- Qualifying for new coverage through an employer or union
- Medicare terminating its contract with your current MA plan
- Other special circumstances such as moving into a nursing home12
How Much Do Medicare Advantage Plans Cost in Massachusetts?
The average cost for an MA plan in Massachusetts in 2021 is $57.70 per month. That is more than double the national average of $21.13
Bostonians have access to 34 MA plans from seven insurance companies. Thirteen plans have a $0 premium, 12 have premiums from $28 to $99, and four have premiums of over $200 per month.
By comparison, Worcester residents have access to 40 MA plans from eight insurance companies. Seventeen plans have a $0 premium, 11 have premiums from $20 to $99 and three have premiums of over $200 per month.14
What If You Want to Change Your Medicare Advantage Plan?
You have two periods to make changes to your MA plan each year. The first time is during the Medicare Advantage open enrollment period from January 1 – March 31. The second opportunity is during open enrollment, which is from October 15 – December 7. You can switch or drop your MA plan during both periods.15
What Are Medicare Resources in Massachusetts?
Massachusetts offers several healthcare resources to residents on Medicare, including:
- The SHINE Program: This service provides free health insurance counseling to Massachusetts residents, including those on Medicare.
- The Division of Insurance: This is where you can file a complaint about your insurance company.
- MassHealth: This is Massachusetts’ Medicaid program, which provides health insurance to those with low incomes and limited assets.
Massachusetts has several healthcare resources, such as the SHINE Program, which provides free health insurance counseling for state residents, including those on Medicare.
To find an MA plan that’s right for you, visit the Medicare Plan Finder or insurance company websites. Compare the premiums, out-of-pocket costs and maximums, and benefits of each plan. Choose a plan that’s affordable and provides the benefits you need.