Medicare Advantage in Massachusetts

Medicare Advantage is an alternative approach to delivering Medicare benefits, which has become increasingly popular since it was first introduced in 2003. While Original Medicare splits service areas between the inpatient benefit (Part A), the outpatient benefit (Part B) and prescription drug coverage (Part D), Medicare Advantage combines them all into a single plan sometimes called Part C. Part C coverage is paid for by the beneficiaries’ own Medicare benefits but delivered via private insurers authorized in each state.

Private insurers offer a variety of Part C plans, but all authorized policies have to include the same coverage as Original Medicare Parts A and B. Most Medicare Advantage Plans go beyond this basic level of coverage by offering at least some prescription drug coverage, as well as benefits not usually covered by Medicare, such as dental care, vision exams and hearing aids. These benefits are rolled together under a single monthly premium, which in some cases may be as low as $0, depending on the details of individual risk pools.

Medicare Advantage has gained significant popularity among eligible seniors in Massachusetts. In 2022, 28% out of 1,385,967 eligible enrollees opted for a Medicare Advantage Plan. As of 2023, there was a growth of 2.50% in eligible enrollees from the previous year, resulting in 30% of Massachusetts’ Medicare enrollees choosing to receive their benefits through this method. This reflects a 7.23% increase in new enrollees selecting Medicare Advantage within a single year, slightly above the national rate of 6.9%.

This guide goes over the top Medicare Advantage Plans available in Massachusetts. It lists costs and enrollment data, as well as customer reviews, to give seniors and their families a good starting point when researching Part C plans in the Bay State.

The Top 10 Medicare Advantage Plans in Massachusetts

Massachusetts has a large number of Medicare Advantage Plans available for seniors to choose from. These plans are offered by multiple private companies, which offer a variety of specific plans with varying coverage options and premiums, with different share of cost options and coverage types. Enrollees can choose between HMO plans, PPO plans and special coverage options for chronic illnesses. The figures in the following table are accurate as of July 2023, with cost ranges offered as an average. Enrollment numbers are a combination of all enrollees from each provider. Readers can visit Medicare.gov to learn more about their benefits.

How Medicare Advantage Plans Work in Massachusetts

It’s important to know how the Medicare Advantage program works before shopping for the ideal plan. Each insurance plan may offer multiple plans or plan types, which include Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. Each plan type has different requirements regarding eligibility, which providers plan members may see, coinsurance requirements and which medications the prescription drug plan covers. Below is a review of the four primary types of Advantage plans and how they’re different from each other. 

What Medicare Advantage Plans Cover in Massachusetts

The law requires Medicare Advantage plans to cover everything covered by Original Medicare (Parts A and B), except hospice care. An Advantage plan covers preventative care, lab tests, emergency care, treatment at an inpatient facility, outpatient procedures and medical equipment and supplies. Insurers that offer Advantage plans might also include dental, vision and hearing along with discount programs for gym memberships, meal programs and other wellness services. 

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Massachusetts

Before seniors can qualify for the Medicare Advantage program, they must first enroll in Original Medicare Parts A and B. They must live in the plan’s service area and meet the other eligibility requirements for the plan they select. Medicare is only available to qualified adults over the age of 65 or who have a disability that allows them to enroll in Medicare. Only U.S. citizens or legal residents may enroll in Medicare. 

Seniors can only sign up for Medicare during an active enrollment period, so it’s important to know when each year’s enrollment window is. Once enrolled, seniors may change their plans whenever they choose, as long as it’s during the next enrollment period. Some circumstances allow people to qualify for a special enrollment period. The list below provides more information about enrollment timing. 

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Massachusetts

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources