Medicare in Massachusetts

Bay State has different standardization for Medigap plans

Resources for Massachusetts beneficiaries

State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.

In Massachusetts you can reach SHIP at 1-800-243-4636 or online here.

Snapshot of Medicare in Massachusetts

Total Medicare enrollment in Massachusetts

In 2015 there were 1,218,036 Medicare beneficiaries in Massachusetts, which is 18 percent of its total population. That compares with 17 percent of the United States population enrolled in Medicare.

The states with the highest percentage of beneficiaries are West Virginia and Maine with about 23 percent each. Those with the lowest percentage are Alaska (11 percent) and Utah (12 percent). In raw numbers, Alaska has the least recipients at 83,863 and California (which has about an eighth of the country’s population within its borders) has the most at 5.6 million (14 percent of its population). This doesn’t count the US Territories, which mostly have low total enrollment in Medicare (Northern Mariana Islands had just 2,075 Medicare enrollees in 2015).

Read about Medicare’s open enrollment period and other important enrollment deadlines.

Breakdown of the aged vs. disabled

Individuals who qualify by virtue of their age alone make up 83 percent of Massachusetts Medicare recipients. The balance — 17 percent — are on Medicare as the result of a disability. Kentucky has the highest percent of Medicare recipients listed as disabled (25 percent), followed by Alabama, Mississippi, West Virginia and Arkansas. Hawaii has the smallest percentage at 10 percent, followed by New Jersey, and North and South Dakota at 13 percent each.

Medicare spending per recipient

As of 2014, Medicare paid about $8,861 annually per enrollee in Massachusetts. That’s according to a standardized spending report from CMS, which eliminates spending differences that stem from strictly geographic differences in costs (eg, higher labor costs or overhead expenses in higher cost-of-living areas). The report only considers spending in Original Medicare, as opposed to Medicare Advantage.

Louisiana had the highest per-capita Medicare spending, at $10,754, while Hawaii had the lowest, at $5,967.

Medicare spending overall

In total Medicare spending, Massachusetts ranked #12 in 2009 with $11.7 billion per year. With the largest and smallest numbers of recipients, itʼs no surprise that California accounted for $50.6 billion of overall Medicare spending, while Medicare spending in Alaska was only $553 million. Total Medicare spending for all states and the District of Columbia was $471 billion in 2009 (latest available data).

Medicare Advantage in Massachusetts

Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but are not considered a wise option by some consumers who are concerned that government spends more per enrollee on the private plans than it does on Original Medicare. Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap.

In 2015 in Massachusetts, 19 percent of all Medicare recipients chose a Medicare Advantage plan. Nationwide, 31 percent of Medicare beneficiaries are enrolled in a Medicare Advantage program.

Minnesota is the only state where more than half (53 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska, with only 56 Advantage enrollees, is the only state to have zero percent enrolled in Medicare Advantage. Five more states have Medicare Advantage enrollment (as a percentage of the state’s Medicare enrollees) in the single digits: Wyoming with 3 percent, New Hampshire and Vermont with 7 percent, and Delaware and Maryland with 8 percent.

Medigap in Massachusetts

Medigap plans are supplemental coverage that fills in the “gaps” (out-of-pocket costs) in Original Medicare. The plans are standardized on a federal basis, so in most cases, the coverage doesn’t vary from state to state.

But Massachusetts is one of three states where Medigap plans are standardized differently. Rather than having 10 different Medigap plans, there are only two types of Medigap coverage in Massachusetts: the Core Plan, and the Supplemental 1 plan. All carriers that market Medigap plans in Massachusetts must standardize their plans to one of those two coverage levels.

Stand-alone Medicare Prescription Drug plans

Massachusetts had 577,413 Medicare beneficiaries – about 47 percent of the state’s total – enrolled in stand-alone prescription drug plans in 2015. The state has 26 plans with premiums ranging from about $18 to $127 per month.

Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers. But by the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries, including those who have Part D coverage as part of their Medicare Advantage plan).

For those under 65 in Massachusetts

Are you under 65 years of age? We have information on Massachusetts health insurance and the Massachusetts health insurance marketplace at our health insurance site.