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Guide to Massachusetts Medicare

We understand that your health and financial needs are different than the other 13 million Medicare beneficiaries in Massachusetts. Fortunately, there are several plans options throughout the state. The abundance of information can be overwhelming, but understanding Original Medicare, Medicare Advantage, Medicare Supplements, and Part D plans just got that much easier.

Click below to learn more about Massachusetts Medicare:

What does Medicare cover in Massachusetts?

Original Medicare (Part A and Part B) is regulated by the federal government and is the same regardless of which state you live in. Part A is hospital coverage, and Part B is medical coverage. Part A covers things like hospital stays, nursing homes, hospice, and home health services whereas Part B covers ambulance travel, medical equipment, mental health, partial hospitalization, lab tests, and x-rays.

Turning 65 and Medicare

Types of Massachusetts Medicare Plans

Once you enroll in Original Medicare, you need to enroll in some form of prescription drug coverage, or you may have a late-enrollment penalty down the road. You can do this through a Part D or Medicare Advantage plan. Some Medicare Supplement plans offer prescription drug coverage, but this is rare.

Part D plans provide prescription drug coverage and only prescription drug coverage. They are broken down into four basic parts: deductible, initial coverage phase, coverage gap, and then catastrophic coverage.

If you enroll in a Part D plan, your annual deductible will reset each year. The 2019 Medicare Part D deductible is $415. Plans can vary, and some may waive, reduce, or change the deductible upfront. Once you meet your deductible, your coverage will start. This is known as the initial coverage stage. During this time, you will be responsible for a copay for each prescription drug you purchase based on the plan's drug formulary (list of approved drugs). You will continue to pay these copays until you reach a spending limit, which is $3,820 in 2019.

Once you reach the spending limit, you will be in the “donut hole” and be responsible for 37% of your generic drug costs and 25% of your brand-name drug costs until your spending reaches $5,100. After this point, you reach the catastrophic coverage phase and 95% of your prescription costs will be covered. To learn more about Part D plans in your area, click here.

Massachusetts Medicare Supplements Plans

Most states have the same eight types of Medigap plans available, but three states (Massachusetts, Minnesota, and Wisconsin), operate their Medigap plans differently.

Massachusetts Medigap has two generic plans available: the “Core Plan,” and “Supplement 1.”

Both plans cover the following basic benefits:

  • Part A coinsurance for inpatient hospital care, plus 365 additional days
  • Part B coinsurance for medical costs
  • First 3 pints of blood per year
  • Part A hospice coinsurance/copayments

The Core Plan covers:

  • The basic benefits
  • 60 days per year of inpatient mental health care
  • State-mandated benefits such as:
    • Pap tests
    • Mammograms

The Supplement 1 Plan covers:

  • The basic benefits
  • Part A inpatient hospital deductible
  • Part A skilled nursing facility coinsurance
  • Part B deductible (no longer available in 2020)
  • Foreign travel emergency
  • 120 days per year of inpatient mental health care
  • State-mandated benefits such as:
    • Pap tests
    • Mammograms
Massachusetts Medicare Supplement Plans
medicare supplements | Medicare Plan Finder

Massachusetts Medicare Advantage Plans

If Medicare Supplements are not right for you, you may want to consider enrolling in a Medicare Advantage plan. MA plans are required to cover, at a minimum, the same benefits as Original Medicare. However, they offer additional benefits like hearing, vision, and dental coverage, non-emergency transportation, OTC drug allowance, and even group fitness classes like SilverSneakers.

Enrollment has increased every year and more than 20.4 million beneficiaries are taking advantage of these amazing benefits. If you want to learn more or meet with a licensed agent, fill out this form or call us at 833-438-3676.

Medicare Advantage | Medicare Plan Finder

Cost of Massachusetts Medicare

If you were employed and paid Medicare taxes for at least 39 quarters, you will not have a premium for Part A. If you only paid Medicare taxes for 30-39 quarters, you’ll pay $240 per month in 2019. If you did not pay Medicare taxes for at least 30 quarters, you’ll pay $437 per month in 2019.

The standard premium for Part B is $135.50 per month in 2019, but this can change based on your income. Part D, Medicare Advantage, and Medicare Supplement costs will vary based on plan benefits, carrier, and location.

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Can I Have Medicaid and Medicare in Massachusetts?

Medicare and Medicaid are both operated by the Centers for Medicare and Medicaid Services (CMS) and often easily confused. Massachusetts Medicaid is for low-income individuals and families whereas Medicare is for seniors and people with certain disabilities.

Approximately 9 million people are eligible for both programs. If you qualify for both programs you will likely be eligible for a Dual Special Needs Plan (DSNP). A DSNP is a special type of Medicare Advantage plan that provides extra benefits at lower costs. Plus, DSNPS qualify you for a Special Enrollment Period (SEP). SEPs give you the ability to enroll outside of the Annual Enrollment Period. Plus, if you qualify for a DSNP, you may be eligible for other programs like Medicare's prescription drug program Extra Help, or other Medicare Savings Programs.

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Massachusetts Senior Programs

The Department of Aging in Massachusetts offers programs that provide places where seniors, family members, caregivers, and healthcare professionals can find MA resources for the elderly and disabled. These programs include:

Central Mass Housing Alliance: The Central Mass Housing Alliance provides Elder Home Repair which is a program that helps low-income elders maintain a healthy home. They correct unsafe housing conditions and keep seniors safe from maintenance issues.

Family Caregiver Support Program: The Elder Services of Worchester Area provide a Family Caregiver Support Program that recognizes caregivers and helps them develop new ways of support.

Money Management: The Money Management Program helps manage personal finances for seniors who have failing eyesight, limited mobility, or forgetfulness. Volunteers are screened, trained, and insured.

Medication Management: The MCPHS Pharmacy Outreach Program helps seniors with any concerns or questions about their medications. They can provide information on pricing through state and federal assistance and even special generic drug pricing.

Protective Services: The Massachusetts Elder Abuse Hotline helps protect seniors against physical, emotional, and financial abuse. If you think you or a loved one is being abused, called the statewide abuse hotline 1-800-922-2275.

Massachusetts Medicare Eligibility

Anyone over the age of 65, or soon to be turning 65, is eligible for Medicare. However, aging-in is not the only way to qualify. If you have ESRD (end-stand renal disease) or ALS (Lou Gehrig’s Disease), you may qualify regardless of your age. Lastly, if you have been receiving SSDI (Social Security Disability Insurance) you will be automatically enrolled in Medicare during your 25th-month of SSDI benefits. If you have a question regarding your eligibility, fill out this form or give us a call at 833-438-3676.

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