Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage offers the benefits of Medicare Parts A and B under a single plan. Known as Medicare Part C, the program allows seniors and other eligible individuals to choose insurance coverage from private insurance companies instead of traditional benefits administered by the federal government. Advantage plans must provide all the same benefits as Original Medicare (aside from hospice care) but might also include dental, vision, hearing, medical transportation and access to senior wellness programs.
Under Original Medicare, seniors must enroll in Part D to obtain prescription drug coverage, but many Advantage plans also come with prescription drug coverage. While plans must meet the requirements set forth by the Centers for Medicare and Medicaid Services, Advantage plans may have specific rules regarding eligibility, referrals to specialists and the use of in-network providers.
Out of the over 1.3 million adults in Massachusetts eligible for Medicare, over 320,000 have chosen a Medicare Advantage plan. In 2020, the number of seniors enrolled in Advantage plans in the state represents only 24% of those Medicare users, but Medicare Advantage plans are steadily gaining in popularity. For comparison, the national average is 42%.
This guide reviews Medicare Advantage Plans in Massachusetts, what these plans typically cover, who’s eligible and how seniors can find a plan that suits their needs.
The Top 10 Medicare Advantage Plans in Massachusetts
There are several private insurance companies that offer Medicare Advantage plans in Massachusetts. This gives seniors eligible for Medicare a wide range of plans to select from. The following table lists the top 10 Medicare Advantage providers in the state based on the number of people enrolled in their Advantage Plans. Since the information includes those enrolled in multiple plans offered by each company, the table provides cost information as a range rather than an average. The included enrollment numbers and plan information are accurate as of April 2022. To get the most current information about the following plans, seniors may visit Medicare.gov.
Tufts Health Plan
Blue Cross Blue Shield of Massachusetts
Commonwealth Care Alliance, Inc.
Senior Whole Health
Health New England Medicare Advantage Plans
How Medicare Advantage Plans Work in Massachusetts
It’s important to know how the Medicare Advantage program works before shopping for the ideal plan. Each insurance plan may offer multiple plans or plan types, which include Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. Each plan type has different requirements regarding eligibility, which providers plan members may see, coinsurance requirements and which medications the prescription drug plan covers. Below is a review of the four primary types of Advantage plans and how they’re different from each other.
What Medicare Advantage Plans Cover in Massachusetts
The law requires Medicare Advantage plans to cover everything covered by Original Medicare (Parts A and B), except hospice care. An Advantage plan covers preventative care, lab tests, emergency care, treatment at an inpatient facility, outpatient procedures and medical equipment and supplies. Insurers that offer Advantage plans might also include dental, vision and hearing along with discount programs for gym memberships, meal programs and other wellness services.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Massachusetts
Before seniors can qualify for the Medicare Advantage program, they must first enroll in Original Medicare Parts A and B. They must live in the plan’s service area and meet the other eligibility requirements for the plan they select. Medicare is only available to qualified adults over the age of 65 or who have a disability that allows them to enroll in Medicare. Only U.S. citizens or legal residents may enroll in Medicare.
Seniors can only sign up for Medicare during an active enrollment period, so it’s important to know when each year’s enrollment window is. Once enrolled, seniors may change their plans whenever they choose, as long as it’s during the next enrollment period. Some circumstances allow people to qualify for a special enrollment period. The list below provides more information about enrollment timing.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Massachusetts
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Serving the Health Insurance Needs of Elders (SHINE)
SHINE is a nonprofit organization with more than 600 volunteers throughout Massachusetts who are trained to assist seniors who qualify for Medicare and Medicare Advantage coverage. Certified SHINE counselors provide free, unbiased advice and referrals for senior residents of the state who need help signing up for or managing their Medicare benefits. Education and community support are also available for caregivers, family members and other loved ones of seniors enrolled in Medicare.
Seniors who need assistance can call SHINE at 1-800-243-4636 to talk with a certified counselor. Volunteers live and work in every community in the state. Inquiries may be submitted online via the SHINE website’s contact form. Send mail to the address listed in the contact section of the program’s website.
Local Medicare Advantage Resources
Seniors aged 55 and over who live in and around the city of Boston can receive help with managing their Medicare benefits from Age Strong, a program of the city government. Age Strong counselors and case workers are trained to educate seniors about various free and low-cost services they may be eligible for. The program offers referrals and direct assistance with discount and free prescription drug programs, and case workers can help eligible seniors sign up. Age Strong counselors are also able to help seniors find and apply for other, non-Medicare or Medicare Advantage programs.
Seniors in the Boston area can call the Age Strong helpline at 617-635-4366. Inquiries and requests for counseling appointments may be submitted online or by mail to the Age Strong main office address shown on the program’s website.
Adults who live in the 25 cities and towns of the MetroWest area can get help from the MetroWest Meds Program in finding and applying for pharmaceutical company assistance programs. The MetroWest Meds program can also assist seniors with applications for MassHealth and various Medicare-related programs for people with limited incomes. Eligible seniors must meet program admission standards for income, assets and medical needs, as well as permanently reside in one of the Kennedy CHC’s service areas, which are listed on the program’s website.
Contact the program office by calling 508-270-5781. Walk-in applications are accepted at program offices, though mail is received at the Edward M Kennedy Community Health Center in Framingham.
Outreach Services of the Mansfield Council on Aging
The city of Mansfield’s Council on Aging (COA) offers outreach services to help local seniors understand and manage their Medicare and Medicare Advantage benefits. Mansfield seniors aged 60 and over, who have a diagnosed disability of any kind, can apply to the council for help signing up for patient assistance programs, finding benefits they may not know they are eligible for and obtaining financial assistance with Part D premiums and co-payments.
Call the COA application line at 508-261-7368 to schedule an appointment with a case worker. Applications and other correspondence may be mailed to: Mansfield Council on Aging – Town Hall 255 Hope Street, P.O. Box 232, Mansfield, MA 02048
Greater Lynn Senior Services
Greater Lynn Senior Services (GLSS) helps seniors aged 60 and over in the Lynn area, plus areas around Essex County, find free and discounted prescription drug programs. Eligible seniors must meet income and asset limits, generally capped at 200% of the federal benefits rate. Program coordinators can also help seniors find and apply for privately offered drug supplement programs, Extra Help federal aid for Part D benefits and several other aid programs relevant to residents of the GLSS service area.
Contact the Greater Lynn Senior Services by phone at 781-581-7557. Emails may be sent to [email protected]. Written communications, including application packets, can be mailed to 8 Silsbee Street, Lynn, MA 01901.
Seniors who reside in Essex or Middlesex counties may be eligible for assistance with their Medicare and Medicare Advantage programs through the Disability Resource Center (DRC) in Salem. The mission of the center is to inform local seniors, as well as younger adults with any kind of disability, about how Medicare benefits work together, and available extra assistance that they may be eligible for. Program caseworkers are able to offer unbiased advice, educational materials about each program the center works with and direct assistance filling out the necessary application forms.
Seniors may contact the Disability Resource Center by phone at 978-741-0077. Email inquiries can be sent to [email protected]. The DRC may be contacted by mail at the program headquarters address listed in the resource center website’s contact page.