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Medicare Advantage Plans in Massachusetts

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What are Medicare Advantage plans in Massachusetts?

If you’re enrolled in Medicare in Massachusetts, you’re probably already familiar with Original Medicare, Part A and Part B. That’s the government-sponsored health insurance plan for people ages 65 and older and those of any age with certain disabilities or health conditions, such as end-stage renal disease or Lou Gehrig’s disease. Many Americans are automatically enrolled in Original Medicare when they turn 65 if they’re already receiving retirement benefits or after they’ve been receiving disability benefits for 24 continuous months. To be eligible, you must be either an American citizen or a legal permanent resident of at least five continuous years.

Medicare Advantage (Medicare Part C) is a program that offers an alternative way of receiving your Medicare Part A and Part B benefits, and often more. Medicare Advantage plans in Massachusetts, as in the other states, include all the same coverage as Medicare Part A and Part B (except hospice care, which Medicare still covers). Medicare Advantage plans, offered by private, Medicare-approved insurance companies, often provide additional benefits, such as coverage for hearing and vision care, dental services, and prescription medications.

There are several types of Medicare Advantage plans. Some popular plan types include:

  • Health Maintenance Organizations (HMOs): Beneficiaries choose providers from a network and typically need to 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 typically pay more for services from these providers. You generally don’t need a referral to see a specialist.
  • Private Fee-for-Service (PFFS): The PFFS plan, not Medicare, sets payment rates — including how much you pay for doctor visits and services, and how much your doctor and other providers are paid. With many PFFS plans, you can go to any Medicare-approved provider that accepts the payment terms of your PFFS, but you need to verify that the provider accepts these terms on a per-visit basis.

Availability of plans may vary within Massachusetts.

Prescription drug coverage with Medicare Advantage plans in Massachusetts

Many Medicare Advantage plans include coverage for prescription drug medications. These plans are known as Medicare Advantage Prescription Drug plans. With prescription drug coverage included, beneficiaries enjoy comprehensive Medicare health benefits in a single, convenient plan.

No matter what type of Medicare Advantage plan you may sign up for, you need to be enrolled in Medicare Part A and Part B to be eligible for Medicare Part C, and you must continue paying your monthly Part B premium. You’re still enrolled in Medicare when you have a Medicare Advantage plan.

Choosing a Medicare Advantage plan in Massachusetts

There may be several types of Medicare Advantage plans offered by a range of Medicare-approved insurance companies in your part of Massachusetts. You may want to shop and compare plans to find one that may fit your budget and medical needs.

When enrolling in a Medicare Advantage plan in Massachusetts (or in any state), understand that plans may vary in terms of cost and coverage details, depending on the company. Some plans may charge a premium as low as $0, but remember to compare all the plan’s out-of-pocket expenses: copayments, coinsurance, and deductibles, the monthly premium, and the out-of-pocket maximum amount. You also need to keep paying your Medicare Part B premium. Of course, you must also live within the plan’s service area, so feel free to enter your zip code in the form on this page to get started comparing plan options.

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