Introduction to Medicare Part C in Massachusetts (Medicare Advantage)

Medicare Advantage (also known as Medicare Part C) is a type of Medicare supplement insurance policy which aims to protect you from the potentially expensive coverage gaps in Original Medicare. However, it does more than most supplements in that it effectively replaces your federal Medicare benefits with a more comprehensive policy. It is a private form of health insurance issued and underwritten by a private insurance company. This differs from other supplemental insurance in that you will only be managing the one policy, instead of your federal Medicare benefits alongside a separate supplement.

Federal Regulations for Medicare Advantage

To protect seniors like you from fraud, federal laws closely regulate the type of coverage which companies are allowed to offer you with a Medicare Advantage plan. Your policy must offer at least the same amount of coverage as Traditional Medicare (Parts A and B). They cannot legally offer you anything less. The good news is that most companies are happy to offer as good or better coverage – but the more coverage you add to your policy, the more expensive it will become.

Medicare Advantage Enrollment In Massachusetts

Advantage plans are fairly popular in Massachusetts. Around one-fifth of Medicare recipients (around 20%) are enrolled in Medicare Part C. Of those who have an Advantage plan, you can easily see in the chart below which policies are more popular than others:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Like most other insurance policies, there are a few basic things which will influence your overall rate: location, age, current health status, and so on. If you take a look at the chart below, you can get an idea of what you might expect to pay:

Most Popular Medicare Advantage Plans in Massachusetts

Not only do you have a wide variety of choice when it comes to Medicare Advantage providers, but you have even more variety when it comes to the type of Advantage plan to choose. The biggest difference between plans happens to be their provider networks. Restrictive networks, which are typical with HMO plans, give you fewer doctors and hospitals to choose from but cost less. Larger networks, on the other hand, give you more healthcare choices, but unfortunately cost more.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

For the most part, Medicare is almost universally accepted no matter what doctor or hospital you go to. Medicare Advantage, on the other hand, is not. Depending on your plan (and how much you are willing to pay for your policy), you may be forced to receive your medical care within a very restrictive network. Likewise, it is not uncommon for a doctor who is currently in your network to suddenly no longer be accessible to you. These are important details to keep in mind when considering a Medicare Advantage policy.

Doctor/Providers List

Drug, Vision and Dental Coverage

The inconvenience of the restricted provider networks is balanced out by the convenience of additional coverage options which an Advantage policy can provide. MAPD plans (Advantage plans which also include Medicare Part D prescription drug benefits) are very popular. Additionally, you can add dental or vision care coverage to virtually any Advantage plan you sign up for. For many seniors, it’s easier to manage their health care needs when everything is covered under a single, solitary policy. However, the costs of all that coverage can add up.

Enrollment Options & Best Time To Enroll

Enrolling in a Medicare Advantage policy can and should be done right around the same time that you enroll in Original Medicare. Once you start receiving benefits, and the closer to 65 years of age that you are, the easier it will be to get your policy approved by your provider of choice. Keep in mind though that serious pre-existing conditions, such as End Stage Renal Disease, could make it difficult to find a provider who is willing to accept you. For more options, feel free to contact your state department of insurance. Also, take a look at our Medicare Advantage Enrollment Options page to learn more.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

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