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Medicare Advantage Plans in Massachusetts

What are Medicare Advantage plans in Massachusetts?

Beneficiaries who wish to expand health care coverage beyond Original Medicare may choose to enroll in a Medicare Advantage plan in Massachusetts (also known as Medicare Part C). These plans are designed to work in place of Original Medicare, providing the same hospital and medical services coverage as Part A and Part B. However, Medicare Advantage plans often provide additional benefits, such as coverage for hearing and vision care, dental services, and prescription medications.

A Medicare Advantage plan in Massachusetts is offered by private companies in the state that have agreed to abide by federal regulations under Medicare. Plan types can vary widely and might include:

  • Health Maintenance Organizations (HMOs) - beneficiaries choose providers from a network and must obtain referrals from a primary care physician for specialty care
  • Preferred Provider Organizations (PPOs) - beneficiaries may choose to go outside the network for their medical care, but will pay more for services from these providers
  • Private Fee-for-Service (PFFS) - beneficiaries may choose to go to any provider and do not need referrals when seeking services from a specialist

When enrolling in a Medicare Advantage plan in Massachusetts, understand that they will fluctuate in terms of cost and coverage details depending on the company.

Prescription drug coverage with Medicare Advantage plans in Massachusetts

Some Medicare Advantage plans in Massachusetts will include coverage for prescription drug medications. These plans are known as Medicare Advantage Prescription Drug plans (MAPDs). When prescription drug coverage is included, beneficiaries enjoy complete health care benefits in a single, convenient policy.

If the Medicare Advantage plan in Massachusetts does not include prescription drug coverage, the beneficiary has the option of enrolling in Medicare Part D and a Medicare Advantage plan at the same time. However, beneficiaries are not eligible for enrollment in a Part D plan if the Medicare Advantage plan they choose already includes coverage for prescription medications. Additionally, some Medicare Advantage plans do not allow enrollment in a separate drug plan.

Choosing a Medicare Advantage plan in Massachusetts

There are 49 different Medicare Advantage plans available to beneficiaries in Massachusetts in 2013. These plans include a number of HMOs, PPOs, and PFFSs. It is important for beneficiaries to shop and compare plans to find the best health care coverage for their specific medical needs.

Cost of plans should also be compared. Out-of-pocket expenses might include copayments and deductibles, as well as the monthly premium for the plan. Some beneficiaries might find a Medicare Advantage plan with a $0 monthly premium (while still being responsible for paying the Part B premium), while others might pay a premium of $50 or more for their coverage.

Trends in Medicare Advantage plans in Massachusetts in 2012

  • The total enrollment in Medicare Advantage plans in the state was 196,939
  • That number made up 18% of the total Medicare population in Massachusetts
  • There were 155,154 beneficiaries enrolled in an MAPD plan
  • Most of the plans offered in the state (38) were HMOs
  • Local HMOs also saw the largest enrollment number of 164,741 beneficiaries

Data provided by the Henry J. Kaiser Family Foundation.

Medicare has neither reviewed nor endorsed this information.

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Medicare has neither reviewed nor endorsed this information.