Emily Vasquez is a content marketing writer based in Tampa, Florida. A graduate from the University of South Florida, Emily has worked as a copywriter, communications lead, and content strategist for high-growth start-ups and global brands and retailers. You can learn more at www.emvwrites.com
John Leach is an insurance content editor who has worked in print and online. He has years of experience in car and home insurance and strives to make these topics easy to understand for everyone. He has a linguistics degree from UC Santa Barbara.
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The Bay State is brimming with culture, historical sites, and a variety of Medicare Advantage plans.
If you’re searching for a Medicare Advantage plan in Massachusetts, you’re probably on a quest for a plan that offers additional benefits like vision, dental, hearing, and prescription drug coverage. These extra benefits are one of the prime advantages of a Medicare Advantage plan (a.ka. Medicare Part C) over Original Medicare (a.k.a. Medicare Part A and Part B).
The tricky thing about shopping for Medicare Advantage is that, unlike Original Medicare, each plan varies significantly in cost, coverage, service area, and more. Since MA plans are sold by private health insurance companies, you’ll have to carefully compare all the details to ensure you’re getting the best bang for your buck. According to the Centers for Medicare & Medicaid Services (CMS), there are 106 Advantage plans available in Massachusetts in 2021.
In this guide, we’ll walk you through the eight top-rated Massachusetts Medicare Advantage plans offered this year—which should be a helpful starting point for finding the best plan for you.
If you’re ready to start comparison shopping right now, remember that the Insurify comparison tool makes choosing a Medicare Advantage plan quick and easy. All you need is your ZIP code to get instantly matched with plans available in your area. Give it a try today!
What Are the Best Medicare Advantage Plans in Massachusetts?
Healthcare is a highly personal subject, and there is no one-size-fits-all plan that works best for everyone. Some people might find it frustrating to navigate all the options because it’s hard to be certain whether you’re truly getting the best value and the best coverage. Luckily, online Medicare comparison (like Insurify ) tools can take you step by step and make this task easier.
If you’re unsure what you should be comparing, take some time to think through your current state of health. For instance, if you regularly take prescription medication, you’ll benefit the most from a plan that offers great prescription drug coverage. If you’re generally healthy and don’t visit the doctor often, you may be more interested in a basic plan with great preventive services.
5. Erickson Advantage Signature with Drugs (HMO-POS) - Score: 74.31
6. Harvard Pilgrim Stride Value Rx (HMO) - Score: 73.43
7. Fallon Medicare Plus Orange (HMO) - Score: 72.59 (Tie)
7. Fallon Medicare Plus Central Orange (HMO) - Score: 72.59 (Tie)
Homing in on your personal preferences first will make comparing health insurance plans easy. That being said, as we review the eight highest-rated plans offered in Massachusetts, remember to keep your personal preferences in mind. Certain factors, like a low monthly premium, may look attractive at first glance until you start considering what you really want out of a plan. Let’s dive in.
1. Tufts Medicare Preferred HMO Basic Rx
Insurify Composite Score: 80.79
Monthly Premium: $61
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $225
Out-of-Pocket Maximum: $3,450
Counties: Essex, Suffolk
This plan includes low co-pays for generic prescription drugs, doctor visits (for both primary care physicians and specialists), diabetes supplies, and preventive dental. You’ll also find competitive rates for diagnostic procedures, lab services, and diagnostic imaging. Plus $0 copays for some vision care, mental health services, and rehabilitation services.
Although comprehensive dental is not included, you can choose to add that supplemental benefit for just $17 a month.
2. Tufts Medicare Preferred HMO Saver Rx
Insurify Composite Score: 80.09
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $250
Out-of-Pocket Maximum: $7,550
Counties:
Here’s a plan with a $0 monthly premium, plus $0 copays for Tier 1 drugs from preferred retailers. You’ll also find $0 copays for preventive care office visits, preventive dental care (except fluoride treatments)
However, this plan doesn’t offer much by way of comprehensive dental. Further, the out-of-pocket limit is set higher than several plans on this list. Even so, people who prefer “paying when using” vs “paying upfront” should take note of this top-tier plan.
While this plan certainly tops the list for monthly premium expenses, it keeps the cost of care low. You should first note that the out-of-pocket limit is much lower than the previous Tufts plan. There are also no or low-cost copays for all office visits (preventive, specialist, and primary care), urgent care, diagnostic services, hearing, routine vision, mental health, and rehabilitation services.
Where this plan is lacking is in the dental department. There’s no coverage for preventive or comprehensive dental. Not all is lost, though. You can find a low-cost comprehensive stand-alone dental plan to compliment this one.
4. Tufts Medicare Preferred HMO Value Rx
Insurify Composite Score: 75.23
Monthly Premium: $170
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $200
Out-of-Pocket Maximum: $3,450
Counties:
Yes, the monthly premium is one of the highest on the list. Yes, the drug deductible is moderate. And yes, $4 to $24 copays on Tier 1 and Tier 2 prescriptions isn’t the best deal (though far from the worst) we’ve seen. But this plan absolutely delivers low-cost healthcare.
What you pay for upfront is tons of low-cost medical care. Low or no cost copays for office visits (specialist, preventive, and primary care), diagnostic services, hearing, routine vision, mental health, podiatryMedicare Part B drugs, and diabetes supplies. The list does go on.
The main drawback is that this plan offers no dental coverage. Easily remedied (with an additional copay) by purchasing a stand-alone comprehensive dental plan.
Even so, for people who want to know exactly what their annual healthcare costs will be, this plan is an excellent option.
5. Erickson Advantage Signature with Drugs
Insurify Composite Score: 74.31
Monthly Premium: $199
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $2,600
Counties: Essex, Plymouth ** **
The hefty monthly premium may throw you for a loop, bu don’t forget this plan comes with $0 deductibles and an ultra-low out-of-pocket limit. The lowest on the list and one of the lowest in the country.
But this plan also delivers low-cost care. You’ll find $0 copays for in-network primary care and preventive care office visits, diagnostic tests and procedures, lab services, hearing exams, preventive dental, routine vision, and several mental health services. Not to mention $0 for podiatry, rehabilitation services, and days 1 to 100 at a skilled nursing facility. (Wow)
This plan also offers the flexibility of going out-of-network at a 30 percent coinsurance rate. Where the plan doesn’t deliver is on comprehensive dental. Prescription copays aren’t the lowest we’ve seen, either. Still, a lot to love and to keep costs low.
6. Harvard Pilgrim Stride Value Rx (HMO)
Insurify Composite Score: 73.43
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $445
Out-of-Pocket Maximum: $4,500
Counties:
7. Fallon Medicare Plus Orange (Tie)
Insurify Composite Score: 72.59
Monthly Premium: $29
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $300
Out-of-Pocket Maximum: $7,550
Counties: Barnstable, Berkshire ** **
This plan offers a ton of $0 copays. That’s $0 for prevent care office visits, diagnostic tests, lab services, outpatient x-rays, preventive dental, some comprehensive dental, contact lenses and eyeglasses, and diabetes supplies.
The main drawback is the higher out-of-pocket limit. But for people who prefer pay-as-you-go, this plan should not be missed,
7. Fallon Medicare Plus Central Orange (Tie)
Insurify Composite Score: 72.59
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $300
Out-of-Pocket Maximum: $7,550
Counties: Worcester ** **
The main differences between this Orange plan and the one above is location. That and a $0 deductible. This plan offers all the fantastic bells and whistles as the above, so if you’re in Worcester county, be sure to add this to your comparison list!
Ready to compare now? Head on over to the Insurify Medicare comparison tool. All you need to share is your ZIP code. Adjust coverage options and compare plans side-by-side. No spam calls or junk mail!
How Much Does Medicare Advantage Cost in Massachusetts?
The average monthly Medicare Advantage premium in Massachusetts is $57.70 in 2021. That’s a 7.77 percent decrease from the average premium of $62.56 in 2020! However, you may pay more or less than the state average depending on a few factors:
The way you set up your Medicare plans
The healthcare system in your location
How much care you receive over the year
As seen in the table below, the costs of Medicare Advantage will vary depending on the plan you choose. This table will give you a better idea of the overall annual costs of each of the best Medicare Advantage plans in Massachusetts.
Remember, it takes just a few minutes with the Insurify comparison tool to see plan costs in your area. Simply enter your ZIP code to view all your options.
Who Is Eligible for Medicare Advantage in Massachusetts?
Massachusetts residents are eligible for Medicare once they turn 65 as long as they are American citizens or legal residents of the past five consecutive years.
There are other circumstances where you may be eligible, which include:
Being diagnosed with end-stage renal disease (ESRD)
Being diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
Receiving Social Security disability or Railroad Retirement Board benefits for 24 consecutive months
If you are eligible for Medicare, then you can choose to enroll in a Medicare Advantage plan. However, there is a certain process to this.
First, you must first enroll in Medicare Part A and Medicare Part B during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after your 65th birthday. Enrolling during this period is incredibly important to receive Medicare benefits.
Once you have enrolled for Medicare coverage, you can later choose to switch to a Medicare Advantage plan. You can switch to an MA plan during the Open Enrollment Period, which occurs every year from October 15 to December 7.
If you have questions about your eligibility or the enrollment process, you can always call 1 (800) MEDICARE, or 1 (800) 633-4227; TTY users can call 1 (877) 486-2048.
What Types of Medicare Advantage Plans Are Available in Massachusetts?
In our overview of the top eight Medicare Advantage plans, you may have noticed a set of acronyms at the end of each plan’s name. These are plan types, and each operates a little differently.
Health Maintenance Organization (HMO)
HMO plans usually require beneficiaries to use in-network healthcare providers. There may be exceptions, such as for an emergency or urgent care. HMO plans are very popular. The only downside to this type of plan is that you are limited to providers within your network. If you’ve developed a relationship with a trusted physician, you will want to make sure they are a part of your new plan’s network before enrolling. Also, HMO plans typically require beneficiaries to get a referral from their primary care physician before seeing a specialist.
Preferred Provider Organization (PPO)
If you don’t like the idea of having to get a referral to see a specialist, then a PPO plan may be better suited for you. As long as the specialist is within your plan’s network, you are covered. While PPO plans tend to be a little more expensive than HMOs, the greater flexibility and freedom may be well worth it, depending on your personal preference.
Private Fee-for-Service (PFFS)
With a PFFS plan, you don’t need a referral to see a specialist, and you can see a much wider array of healthcare providers. While PFFS plans offer great flexibility and freedom, they aren’t as widely available as HMO or PPO plans.
Special Needs Plans (SNPs)
SNPs are available to a select group of people. This is because these plans have specific benefits tailored to fit the needs of the groups they are created for—such as mandatory prescription drug coverage. Usually, people with chronic long-term illnesses, such as HIV/AIDS, end-stage renal disease, or diabetes, qualify for an SNP.
FAQ: Massachusetts Medicare Advantage
No, you cannot enroll in both Medigap and a Medicare Advantage plan. Medigap, also formally known as Medicare Supplement Insurance, is only available to those enrolled in Original Medicare (Part A and Part B).
There are three key enrollment periods you should be aware of. First, is your Initial Enrollment Period that takes place three months before and three months after your 65th birthday. You will need to enroll in Original Medicare during this period, which gives you the ability to switch to a Medicare Advantage plan later. Once that is complete, Medicare beneficiaries can switch to a MA plan during the General Enrollment Period from January 1 to March 31, or during the Open Enrollment Period from October 15 to December 7.
Medicare is a program with several parts, including Parts A, B, C, and D. Medicare Part C is the formal name for Medicare Advantage. Medicare Part C usually, but not always, includes prescription drug coverage. It is also required to cover what Part A and Part B cover.
If you don't enroll in Medicare Part C, you can choose Medicare Part A and Part B (Original Medicare) and add an optional Part D (prescription drug coverage) plan. Although all these parts seem confusing at first, they are meant to allow beneficiaries to customize coverage based on their needs.
Conclusion: Save Time and Money by Comparing Medicare Advantage Plans Online
At first, the world of Medicare can be a little confusing to navigate. But taking charge of your healthcare decisions doesn’t have to be a stressful, time-consuming process. Here are three simple steps to get started:
Create a list of preferences and needs. Whether it’s a mental list or written out on paper, having a clear set of must-haves will be incredibly helpful.
Determine your budget. How much can you afford to spend monthly? What about annually? Remember that your healthcare costs will end up being more than just your premium—there will be co-payments and deductibles, too. This is why it’s important to think about what you can afford on an annual basis.
Compare Medicare Advantage plans online in mere minutes. Now that you’re clear on your needs and budget, you’re all set to start comparing plans. The easiest way to find available plans in your area is with the Insurify Medicare comparison tool.
If you’re ready to get started, all you need to do is enter your ZIP code here. You can get better Medicare today!
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Written by
Emily Vasquez
Insurance Writer
Emily Vasquez is a content marketing writer based in Tampa, Florida. A graduate from the University of South Florida, Emily has worked as a copywriter, communications lead, and content strategist for high-growth start-ups and global brands and retailers. You can learn more at www.emvwrites.com
John Leach is an insurance content editor who has worked in print and online. He has years of experience in car and home insurance and strives to make these topics easy to understand for everyone. He has a linguistics degree from UC Santa Barbara.
