Medicare in Massachusetts

Jory Cross by Jory Cross | Licensed since 2012
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This article was updated on: 09/16/2018

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Original Medicare is the federal health insurance program for those aged 65 and older and individuals with certain disabilities or health conditions. You may qualify for Medicare regardless of age if you have amyotrophic lateral sclerosis or end-stage renal disease, or if you’ve been receiving Social Security or Railroad Retirement Board disability benefits for at least two consecutive years.

Original Medicare in Massachusetts works the same as it does in other states. Medicare coverage comes in two parts. Medicare Part A covers inpatient care, including hospital, skilled nursing facility, hospice, and some home health care. Medicare Part B covers outpatient care, including (but not limited to) doctor’s visits, preventive services, lab tests, and durable medical equipment.

Keep in mind that Original Medicare doesn’t include everything. It doesn’t come with prescription drug benefits, which are available through a Medicare prescription drug plan. You also won’t be covered for long-term care, homemaker services, routine vision or dental, hearing aids, and most health coverage out of the country. You may be able to get coverage for some of these benefits through a Medicare Advantage or Medigap (Medicare Supplement) plan.

Types of Medicare coverage in Massachusetts

Massachusetts beneficiaries may also have other Medicare plan options. Keep in mind that certain types of Medicare coverage, such as prescription drug benefits, are only available through private insurance companies that contract with Medicare. The specific benefits and costs may vary by location and among plans.

Here are the types of Medicare plans available in Massachusetts.

Medicare Part D is Medicare prescription drug coverage. If you have Original Medicare, you can add on stand-alone drug coverage by enrolling in a Medicare Prescription Drug Plan. If you have Medicare Advantage, your plan might already include prescription drug coverage, if it’s a Medicare Advantage Prescription Drug plan. If you’re not sure whether you have this coverage, check with your plan directly.

Medicare Advantage (Medicare Part C) is Medicare health insurance offered through private Medicare-approved insurance companies. These plans are required to cover everything that Original Medicare, Part A and Part B, does, but some can include other benefits, such as routine vision and dental, health and wellness programs, and prescription drug coverage. When enrolling in a Medicare Part C plan, you may want to explore all available options so you can find one that works with your needs. Keep in mind that, if you enroll in a Medicare Advantage Prescription Drug plan, you don’t need a stand-alone Medicare Part D Prescription Drug Plan (and if you enroll in one, you will be disenrolled from the Medicare Advantage plan and returned to Original Medicare). If you’re enrolled in a Medicare Advantage Prescription Drug plan, you get all of your Original Medicare and prescription drug benefits under a single plan.

If you’re enrolled in a Medicare Advantage plan, you need to continue paying your monthly Medicare Part B premium.

Medicare Supplement plans, also known as Medigap, are policies that cover “gaps” in Original Medicare coverage. A Medicare Supplement policy may cover out-of-pocket costs like deductibles, copayments, and coinsurance. The specific benefits will depend on the plan, and these plans only work with Original Medicare costs.

Massachusetts is unique when it comes to Medigap coverage because it is one of three states that offer their own versions of Medicare Supplement plans. Most states offer up to 10 standardized Medigap plans, with benefits that don’t change across each plan type, regardless of insurer. In Massachusetts, however, beneficiaries have two options when it comes to Medigap coverage: the Core Plan and the Supplement 1 Plan.

Both the Core Plan and Supplement 1 Plan cover state-mandated benefits and basic benefits, including:

  • Medicare Part A coinsurance for inpatient hospital care plus coverage for an extra 365 days after Medicare benefits have been used up
  • Medicare Part B coinsurance (generally 20% of the Medicare-approved amount)
  • First three pints of blood in a year
  • Medicare Part A hospice coinsurance or copayment

The Supplement 1 plan also covers additional benefits, including:

  • Medicare Part A hospital deductible
  • Medicare Part A skilled nursing facility coinsurance
  • Medicare Part B deductible
  • Foreign travel emergency health coverage
  • 120 days per year of inpatient days in a mental health hospital*
  • State-mandated benefits, such as annual Pap tests, mammograms, and more.

*The Core Plan covers 60 days per year of inpatient days in a mental health hospital.

Local resources for Medicare in Massachusetts

The Massachusetts SHINE program (Serving the Health Insurance Needs of Everyone) is a free health insurance counseling program for people with questions about Medicare and health coverage. You can reach the SHINE program at 1-800-243-4636 Monday through Friday, 8:45AM-5PM.

Applying for Medicare in Massachusetts

Applying for Original Medicare in Massachusetts works the same as in any other state. To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years. If you need to enroll in the program manually, you can apply through the Social Security office or the Railroad Retirement Board, if you worked for a railroad. To apply:

  • Visit the Social Security website.
  • Call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778), Monday through Friday, 7AM to 7PM.
  • Apply in person at a Social Security office.
  • If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9AM to 3:30PM.

As you can tell, you may have many options when it comes to your Medicare coverage in Massachusetts. Medicare Advantage plans may be a good way for Original Medicare enrollees to get benefits beyond Medicare Part A and Part B. If you need help deciding what might be a good fit for you, I’m here to answer any questions you may have. You can view my profile below to learn more about my experience. Then, if you’d like, use the links next to my profile to set up a time to speak by phone or have me email you some personal plan options. If you’d like to find plans on your own, you can start looking now by clicking on the Compare Plans button on this page.

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