Medicare Advantage Plans in Massachusetts

Medicare Advantage in Massachusetts is a way for members to bundle Original Medicare Plans Part A and Part B and work with private insurance companies.

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Top-rated Medicare Advantage Plan Providers in Massachusetts

  • Blue Cross of Massachusetts: This insurance company has HMO plans with 5-star ratings. They have enrolled 22 percent of the Medicare Advantage plans in Massachusetts.
  • Humana: We found no information on Humana star ratings in Massachusetts.
  • Tufts: Tufts has the highest market share with about 37 percent of the market, and they offer HMO Medicare Advantage plans that have earned star ratings of 5 stars too.

Popular Medicare Advantage Plan Types in Massachusetts

Those interested in Medicare Advantage in Massachusetts will have access to these PPO, HMO, or D-SNP Plans, depending on what your needs are:

Best Network Freedom: Medicare Advantage PPO

A Preferred Provider Organization (PPO) Plan offers members more flexibility in exchange for slightly higher premiums.

  • Premiums typically range from $0 to $100 per month.
  • You’ll have a more extensive network to choose from.
  • You don’t need a referral for specialists.
  • You may be able to choose an out-of-network doctor, but copayments will probably be higher.

Best for Lowest Out-of-Pocket: Medicare Advantage HMO Plan

An HMO Plan has lower coinsurance because of the referral network you will use.

  • Premiums will generally be $0 every month.
  • You might need a referral for a specialist.
  • You are covered for the use of out-of-network doctors for all emergencies.

Best for Low Income or Health Conditions: Medicare Advantage D-SNP

Dual Eligible Special Needs (D-SNP) Plans are available for individuals with specific needs:

  • In Massachusetts, you must have both Medicare and Medicaid.
  • You’ll pay lower out-of-pocket costs.
  • This plan is best for those with a limited income and chronic illness.

Massachusetts Enrollment Facts:

  1. Data shows that out of 1,349,512 enrolled in Medicare Plans in Massachusetts, 327,816 are Medicare Advantage beneficiaries.
  2. Number Enrolled by Plan
  • Local HMO: 165,773
  • Local PPO: 64,288
  • Regional PPO: 10,998
  1. Medicare Advantage accounts for 24% of beneficiaries enrolled in Medicare in Massachusetts.
  2. There are 23,467,152 current enrollments in Medicare Advantage nationwide.

How much does Medicare Advantage in Massachusetts cost?

The average monthly premium for Medicare Advantage in Massachusetts is $83.18. Plan availability is different from county to county.

Most counties have PPO and HMO plans with a $0 per month premium, but it’s becoming more common for PPOs to have premiums.

How much do Advantage Plans cost in Massachusetts?

PPO Plan $0.00 to $83.18

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

Initial Enrollment Period

This is a specific period during which you can enroll in an Original Medicare or Medicare Advantage plan as you become eligible. There are particular reasons you might be eligible:

You turn 65

You can enroll up to 3 months before or after you turn 65.

You have a disability but are under 65

You are eligible for Medicare after 24 months of Social Security or Railroad Retirement Board (RRB) disability benefits. You can enroll up to 3 months before or after you become eligible.

Open Enrollment Period – AKA Annual Election Period

This period is from October 15 through December 7. During this time each year, you can join, change, or drop your current Medicare coverage for your new plan, which will begin on January 1.

If you decide you’d like to enroll in the Medicare Supplement plan instead of the Medicare Advantage plan, you can take this period to drop your current plan coverage and make the switch.

Medicare Advantage Open Enrollment Period

This period is from January 1 through March 31, when you can join, change, or drop your Medicare Advantage Plan.

Special Enrollment Periods – Special Circumstances

Certain situations create opportunities to make changes to your plan during Special Enrollment Periods (SEP):

  • You move to another service area where your plan has no coverage or has more options
  • You leave your job or union lose your health insurance coverage
  • You are enrolled in a Special Needs plan and no longer have the condition that originally qualified you for that plan.

5-star Special Enrollment Period

If an MA Plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to switch to that plan.

This is an enrollment period that you can enter only once between December 8 and November 30.

Special Enrollment Periods if You Get “Extra Help”

Those receiving Extra Help and are eligible for both Medicare and Medicaid may join, change, or drop their Medicare Advantage Plan once during a set of specific Special Enrollment Periods. These periods are:

  • January–March
  • April–June
  • July–September

Medicare Advantage Highlights:

  • You won’t lose your Original Medicare Plan but are repackaging your plan to include Medicare Part A and Medicare Part B, as well as Part D in some cases.
  • Medicare Advantage Plans (called Medicare Part C) have become increasingly popular recently for their extra benefits and potentially low deductibles.
  • Medicare Advantage Plans (MA Plans) work with a specific network of doctors, hospitals, and other medical facilities.
  • You will still pay your Part B premiums. The standard monthly Part B premium is $163.90 in 2023.
  • The annual deductible for Medicare Part B beneficiaries is $226 in 2023.
  • All Medicare Advantage Plans cover emergency services anywhere in the US.
  • A private insurance company will that work with Medicare and is responsible for all claims, customer service, administration, and benefits.
  • Most plans include benefits that Original Medicare doesn’t offer, such as vision, dental, and hearing.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Call us today, or request a quote online to learn more about plan options.

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