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Medicare Advantage (Part C) Plans in Massachusetts

Medicare Advantage plans are managed-care style health plans offered by private companies under contract to Medicare. (They are also called Medicare + Choice plans or Medicare Part C plans.)

You may enroll in a Medicare Advantage plan instead of the Original Medicare plan if you live in the plan’s service area. Enrollment is voluntary. People who join a Medicare Advantage plan do not need Medigap insurance.

Most Medicare Advantage plans have more benefits than standard Medicare. For example, Medicare Advantage plans often include dental services, eye care, and hearing tests. Most Medicare Advantage plans include prescription drug coverage, but some do not.

Medicare Advantage plans usually charge a monthly fee in addition to the Medicare Part B premium. Depending on your health care needs, Medicare Advantage plans may be less expensive overall than the Original Medicare Plan.

There are several types of Medicare Advantage plans. Not all types of plans are available in all areas. But here are the most common Part C plan available in Massachusetts:

  • Health Maintenance Organization (HMO) Plans: If you join a Medicare HMO, you must go to the doctors, hospitals, and pharmacies that are part of your plan’s network. You must choose a primary care doctor from your plan. You must get a referral to see a specialist or for hospitalization. Neither Medicare nor your HMO will pay for services outside of your plan’s network except for emergencies or urgently needed care. Your HMO may include additional benefits such as dental services, eye exams and eyeglasses, and hearing exams. Most HMOs include prescription drug coverage, but some do not. For most services, you pay a fixed copayment.
  • Preferred Provider (PPO) Plans: With a Preferred Provider plan, you may go to the doctors, hospitals, and pharmacies that are part of your plan’s network, or you may go to other Medicare-approved providers. You will pay extra if you get services outside of your plan’s network. You don’t need a referral to see a specialist, but you have to get plan approval for certain services. Your plan decides how much you must pay for services.
  • Medical Savings Account (MSA) Plans: Medical Savings Account plans have two parts: a very high deductible health insurance policy that pays for Medicare-covered medical and hospital expenses after you meet the deductible; and a tax-exempt Medical Savings Account that you can use to pay for qualified medical expenses before you meet the deductible. Medicare deposits money into your Medical Savings Account each year. If you don’t spend all the money, it stays in your account for future expenses. MSAs give you direct control of your health care spending.
  • Private Fee-for-Service (PFFS) Plans: With a Private Fee-for-Service plan, you may go to any Medicare-approved doctor or hospital that is willing to treat you and accepts your plan’s payment terms. You don’t need a referral to see a specialist, but you have to get plan approval for certain services.
  • Special Needs Plans (SNPs): Special Needs Plans offer specialized care for people with special health care needs. For example, there are SPNs for people in long-term care facilities, for dual eligibles, and for people with certain diseases. Special Needs Plans include prescription drug coverage.

You may join a Medicare Advantage plan if:

  • you have Medicare Part A and Part B
  • you live in the service area of the plan
  • you don’t have end-stage renal disease (ESRD)

Before you join a Medicare Advantage plan, make sure you know which doctors and hospitals are included, what rules you must follow, what extra benefits are offered, and what the costs will be. If the plan offers the doctors and services you want at a cost you can afford, it may be a good choice for you.