f you're curious about Medicare, you’re not alone — 17% of the population of Massachusetts is 65 and over. That age group qualifies for Medicare, and many people have questions about how this health coverage works.
You might have questions like “How do I sign up for Medicare in Massachusetts?” or “How much is Medicare in Massachusetts?” This guide will answer the most common questions that Massachusetts residents have about Medicare. If you have specific concerns that are not covered in this guide, feel free to contact us anytime!
Here’s what you need to know about Medicare in Massachusetts.
Medicare is a federal health coverage focused on those who are less likely to have health insurance through an employer, such as retired and disabled Americans. Medicare exists in every state, and beneficiaries have the choice to carry Original Medicare or Medicare Advantage.
One of the first questions people ask is, “How much does Medicare cost in Massachusetts?” The answer will depend on the specific Medicare options you select, and some higher-income Americans will pay higher than the standard premiums.
Medicare has a variety of parts, each with its own benefits and costs:
When you have Medicare coverage, you’re able to use the benefits to help pay for your medical costs as long as your medical provider is part of the Medicare network. If you have Medicare Advantage, your provider will need to be part of that specific plan’s network.
In Original Medicare, you pay an annual deductible and then a copayment or coinsurance for your care. For example, for a doctor’s visit, you use Medicare Part B. The annual deductible is $233 in 2022, and then you pay 20% of the Medicare-approved amount. Medicare pays the rest.
For Medicare Advantage, you’ll also have an annual deductible and a copayment or coinsurance for each instance of medical care. However, the amounts will depend on the plan you choose. You can learn more about Medicare costs in this guide, and If you have specific questions, you can contact the insurance company that issued the plan directly.
Generally, your medical provider will bill Medicare or your Medicare Advantage plan for you. You’ll often receive a bill afterward for your portion of the costs.
Medicare covers a wide range of medically-necessary care and equipment. Many times your doctor will have to certify your medical need before Medicare will approve coverage. For example, if you need a walker or wheelchair, there are specific requirements that must be met before Medicare coverage applies.
Medicare Advantage plans are required to cover at least as much as Original Medicare, but they often offer additional benefits as well. For example, Original Medicare does not cover vision or dental care, but some Medicare Advantage plans in Massachusetts will cover those needs.
One of the reasons it’s so important to compare various Medicare plans is that you want to ensure you get the best benefits for your needs at a price that makes sense.
Can just anyone get Medicare? No, in order to get Medicare coverage you need to qualify. That means you need to be the right age or have qualifying medical conditions.
To qualify for Medicare coverage, you need to be a U.S. citizen or permanent resident who has lived in the US for at least five years, and one of the following conditions must also apply:
One common question about Medicare eligibility in Massachusetts is, “Do Massachusetts teachers get Medicare?” Massachusetts teachers have retirement benefits through the Massachusetts Teachers Retirement System (MTRS).
For a number of years, Massachusetts teachers did not contribute to Social Security so they were not eligible for Social Security benefits or Medicare. However, from 1986 onward, teachers have had a 1.45% Medicare tax removed from their pay. That means that at retirement, they qualify for Medicare if they have paid this tax for at least 10 years, although they still don’t get other Social Security benefits. However, they get retirement, disability, and survivor benefits through MTRS.
If you’re eligible for Medicare, how do you apply? It’s important to note that you cannot sign up for Medicare at any time — you have to use specific enrollment periods.
The first enrollment period happens when you’re first eligible. For example, if you’re close to 65, you’ll have a seven-month enrollment period that includes your birthday month. This timeframe gives you the opportunity to research Medicare plans and choose the right coverage for your needs.
If you don’t make any Medicare choices during your initial enrollment, it’s possible that you will be automatically enrolled in Original Medicare Part A and Part B. Those are the default options, but they aren’t the best choices for everyone. For example, having only Part A and Part B means that you don’t have any prescription drug coverage.
Some people have to manually enroll in Original Medicare. If that’s the case, you can take one of the following steps:
Many Americans decide that a Medicare Advantage plan makes the most sense for them. To enroll in Medicare Advantage, you’ll need to contact the plan provider directly either online or over the phone. There are many Medicare Advantage plans, so be sure to compare them carefully before making a choice.
There are more than 3.6 million people enrolled in a Medicare Advantage plan in Massachusetts. As we mentioned earlier, Medicare Advantage is a full replacement plan for Original Medicare. You’ll get at least as much coverage as Original Medicare, and in some cases there could be additional benefits depending on the plan.
Are there disadvantages to Medicare Advantage? One of the biggest differences between Original Medicare and Medicare Advantage is the medical network. Because Original Medicare is a national program and Medicare Advantage plans are locally-based, the medical network for your Medicare Advantage plan may be limited.
If you live in Massachusetts and have Original Medicare, you can spend the winters in Florida and still use your Medicare coverage there. However, a Medicare Advantage plan may not have in-network providers in Florida, so you would have to change your insurance plan to get coverage.
There are a variety of Medicare Advantage plans available to you in Massachusetts. How can you pick the one that’s best for you?
The first step is to think about where you spend time. You’ll want to make sure you can access your medical network easily. If you travel frequently, look for an Advantage plan with a less restrictive medical network or one that includes providers in multiple states.
Secondly, consider your medical needs. Make sure your doctors and specialists are part of the network on the Advantage plan you choose. Also, ensure that your prescription drug needs are part of the drug coverage in the plan.
Third, you’ll want to look at extra benefits. Do some Medicare Advantage plans include vision, dental, or other additional coverage? Can you get discounts on local activities or gyms? Are there wellness incentives that would work for you?
Finally, compare the prices. Some Medicare Advantage plans cost the same as having Medicare Part B, while others have a higher premium.
When you shop around in this way, you’ll be able to compare plans and choose the Medicare Advantage plan that makes the most sense for you.
This article addressed the most common questions we get about Medicare in Massachusetts, but you may have additional issues based on your unique circumstances. Perhaps you'd like assistance comparing plans.
A licensed agent can assist you in determining which plan is best for you by answering your questions and guiding you through the process of selecting a policy. Contact us today!