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Getting coverage through Medicare Massachusetts may feel like a challenge. Parts A, B or C — what do they all mean? What is a Medicare Advantage plan and how does it differ from original Medicare? We’ve reviewed the top Medicare companies in Massachusetts to help you make a confident decision for your health and wellness.
The Best Medicare Insurance in Massachusetts:
- Best Overall: Tufts Health Plan
- Most Affordable in Massachusetts: UnitedHealthcare
- Best for Prescription Drug Plans: UnitedHealthcare
- Best for Visits and Testing: BCBS
- Best for Well-ROunded Medicare Advantage Plans: Tufts Health Plan
What is Medicare?
Medicare is a federally-funded insurance program that covers health care expenses for those 65 and older. Medicare, like Social Security, is something that most U.S. citizens pay into over time. The money generally comes out of your paycheck before you receive it, so that you are making automatic contributions over time. Medicare is divided into various parts, each part covering a distinctive health care area.
Part A: Medicare Part A covers inpatient hospital care and a limited amount of care at a skilled nursing facility. It also provides for a limited amount of home health care and hospice care. As with other types of health insurance, Medicare won’t cover the entire cost of your hospital bill. You’ll likely pay a percentage of the cost as well as a deductible, before Medicare kicks in and pays the remainder.
Part B: Part B is medical insurance that covers things not related to a stay in the hospital. This can include doctor visits, outpatient hospital care, blood tests and x-rays. You typically pay a monthly premium for this part as well as a deductible before your Part B benefits become active. Assuming you go to doctors that accept Medicare, you’ll pay approximately 20% of the bill. However, Medicare generally covers the full cost of any lab tests ordered by your doctor.
Part C: Known as Medicare Advantage, this insurance is offered by private companies as an alternative to original Medicare (parts A and B). Medicare Part C enrollment is optional, but it is a cost-effective way to get all of your Part A and B expenses as well as possible prescription drug coverage bundled into one affordable plan. In addition, Medicare Part C may cover some additional benefits that original Medicare does not, such as dental, hearing and vision.
Part D: Medicare Part D plans cover prescription drugs. Like with Part C, enrolling in Part D is optional. You may have to pay a deductible as well as a flat copay for your prescription drugs or you may be subject to paying a percentage of the full cost of the drug. This is known as coinsurance.
Legalities of Medicare in Massachusetts
Medicare is administered by the U.S. Department of Health and Human Services division known as the Centers for Medicare and Medicaid Services. Medicare funding is provided through the Social Security Administration from our tax dollars. When you receive your paycheck, 1.45% of your earnings go into FICA, the Federal Insurance Contributions Act, while your employer pays 1.45%, which totals 2.9%.
Medicare coverage begins on the day you turn 65, but you don’t need to wait until then to sign up. You can enroll up to 3 months before you turn 65, or 3 months after, giving you plenty of time to compare prices and shop around for a plan that best fits your needs.
Types of Medicare Advantage Plans
Private insurers contract with Medicare in order to offer Medicare Advantage plans. This allows them to bundle your Medicare Parts A and B benefits with additional benefits like prescription drug, dental, vision and other types of coverage under one complete plan. Like with most insurance plans, Medicare Advantage plans can be broken up into 2 groups: HMO and PPO plans.
HMO: HMO stands for health maintenance organization. With an HMO plan, you choose to receive care from a predetermined network of hospitals and doctors in exchange for lower rates. You have a primary care physician who handles most of your care. For any care they cannot handle, you need a referral from them in order to see a specialist.
The exceptions to this rule are emergency care, out-of-area urgent care and out-of-area kidney dialysis, if applicable. If your doctor leaves the plan, you’ll be notified by the HMO and can choose another doctor. If you elect to go outside of the network for care, you’ll be responsible for the full cost of the bill.
PPO: A PPO (preferred provider organization) plan gives you a wider choice of participating doctors and hospitals, and you don’t need a referral to see a specialist. You’ll generally pay more by going outside of the network, but a PPO plan gives you greater flexibility than an HMO. Unless noted otherwise, prescription drugs are normally covered under PPO plans.
How to Sign Up for Medicare in Massachusetts
It’s important to note that signing up for Medicare in Massachusetts is not the same process as signing up for a Medicare Advantage plan. You may already be automatically enrolled in Part A Medicare depending on your specific circumstances around collecting benefits at age 65.
Here are quick facts:
- If you’re already collecting social security benefits or railroad retirement benefits when you turn 65, you’ll automatically be enrolled in Medicare Part A
- If at the time you signed up for retirement benefits, you also enrolled in Medicare Part B, you’ll be automatically enrolled in this part of Medicare as well.
- If you live outside the U.S. or D.C. (for example, if you live in Puerto Rico), you’ll automatically be enrolled in Part A, but you will need to enroll in Part B.
- Enrollment in Part A Medicare is generally automatic, but if you aren’t currently receiving retirement benefits and are within your enrollment period, you can enroll in Medicare and simply defer your benefits to a later time of your choosing.
- If you’re not yet eligible to receive retirement benefits, you won’t be enrolled in Medicare Part A or B, however you can still sign up for them during your enrollment period, you may just have to pay a premium for the same kind of care.
Average Cost of Medicare Advantage Plans in Massachusetts
The amount you’ll pay for a Medicare Advantage plan will depend upon whether or not you want to factor in the $135.50 Medicare Part B Premium. In the table below, this premium is not added, since it is entirely optional if you want this coverage. Depending on the individual plan, you may also have to pay a prescription drug deductible.
|Plan Name||Company||Plan Type||Health & Drug Costs|
|AARP Medicare Advantage Plan 1||UnitedHealthcare||HMO||$0.00 Medicare Advantage with drug coverage monthly premium.|
|Medicare Blue SaverRX||Blue Cross Blue Shield of Massachusetts||PPO||$0 Medicare Advantage with drug coverage monthly premium|
|Medicare Preferred Saver Rx||Tufts Health Plan||HMO||$0 Medicare Advantage with drug coverage monthly premium|
|Medicare Explorer Premier Plan||Aetna||PPO||$56 Medicare Advantage with drug coverage monthly premium|
|Medicare Preferred HMO Value Rx||Tufts Health Plan||HMO||$58 Medicare ADvantage with drug coverage monthly premium|
Best Medicare Insurance Providers in Massachusetts
There is no “one size fits all” Medicare insurance provider in Massachusetts. There are, however, several affordable options with large networks throughout the state. Depending on your healthcare needs, your budget and the amount of coverage you want, we found these companies to be among our top picks for Massachusetts Medicare Advantage plans.
1. Best Overall in Massachusetts: Tufts Health Plan
Tufts Health plans are one of the few Medicare Advantage plans in Massachusetts to win the coveted 5-Star rating from Medicare.gov.
With some of the lowest costs for diagnostic testing, plus a low drug deductible of $250 and no health plan deductible, Tufts Health Plan is an affordable option with a large and ever-expanding network of participating doctors, hospitals and healthcare facilities.
The out-of-pocket maximum may not be as low as with United Healthcare, but it’s still average for Massachusetts and there are a number of other benefits included, such as dental, vision, hearing, fitness benefits and even transportation benefits.
2. Most Affordable in Massachusetts: UnitedHealthcare
In partnership with AARP, UnitedHealthcare has long been a well-known insurance provider for seniors and their families.
With a $0 health plan deductible, and a low $250 drug deductible, their AARP Medicare Advantage Plan 1 is an HMO plan that’s worth considering if you have a doctor and hospital in the HMO network that you’d prefer to stay with.
There’s no cost to see your primary physician and just $45 per visit to see a specialist, making it an affordable option for Medicare supplemental insurance. The plan also offers vision, hearing and dental benefits as well as a fitness and wellness package to help you stay on track with healthy habits and exercise goals.
3. Best for Prescription Drug Coverage: UnitedHealthcare
If you want the freedom of a PPO to be able to choose your doctor and your network, but you still want to save money on prescription drugs, UnitedHealthcare’s Medicare Advantage plans are worth a closer look.
With low drug deductibles, a $0 health plan deductible and a low out-of-pocket maximum whether you’re in-network or not, these plans offer great flexibility, freedom and convenience.
4. Best for Physician Visits, Lab and Diagnostic Testing: Blue Cross Blue Shield
If you need to see your primary physician or have tests or blood work ordered on occasion, Blue Cross Blue Shield is an excellent option.
Although there’s no plan premium and a $15 fee to see your primary physician, many diagnostic tests and lab procedures are just $10. To qualify for this low rate, your physician must get advance approval for the plan, but otherwise, you do not need any prior authorizations to have the lab work done.
Certain dental care like an oral exam, cleaning and dental x-rays are also covered.
5. Best Well-Rounded Medicare Advantage Plan: Tufts Health Plan
For a well-rounded Medicare Advantage Plan that’s affordable and provides coverage of additional benefits like vision, hearing and dental, Tufts Health Plan has one of the highest ratings and features over 2,000 participating care providers across the state, so that you can get the healthcare coverage you need.
If you don’t yet have a primary physician, the Tufts Health Plan HMO network can help you find one. With this plan, you’ll enjoy a great deal of benefits along with a lower cost, making it one of our top picks.
Medicare Coverage in the Bay State
No matter where you live in the Bay State, getting affordable Medicare coverage that bundles original Medicare benefits with new options like dental, vision and hearing can help you stay healthy and on track well into your golden years.
Compare the plans and companies outlined above to help you save the most money while getting access to quality care from a large network of participating hospitals, physicians and health care facilities. Don’t hesitate to shop around to find the plan that best fits your needs.
Frequently Asked Questions
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.