Choosing Between Massachusetts Medicare and Massachusetts Medicare Advantage: What’s the Difference?

Choosing Between Massachusetts Medicare and Massachusetts Medicare Advantage: What’s the Difference?

Last updated on: November 02, 2022

Established in 1965 by the Social Security Administration, Medicare is a medical health program for people 65 years and older. The Centers for Medicare and Medicaid Services now run the health program. Medicare is available to certain people under 65 with qualifying disabilities. There are many facets of the program to understand, including the two parts of Medicare and the addition of Medicare Advantage.

Comprehending and choosing all the different parts of the program can seem like a maze of details and paperwork. It is important to know what all of your options are before making a decision. Both Medicare and Medicare Advantage are useful tools for health insurance during the later years of life. But what is the difference between the two? Let’s take a look together at what each program is, what their advantages are, and how they differ.

What are the Different Parts of Medicare in Massachusetts?

In order to understand Medicare Advantage, it’s integral to first understand the ins and outs of Medicare. The program is open to seniors of retirement age, younger people with qualifying disabilities, and those with end stage renal disease. Each different part of Medicare covers a separate service, covering the various needs of continuing medical care.

  • Medicare Part A in Massachusetts - Medicare part A covers hospital insurance. It covers inpatient hospital care, hospice care, skilled nursing facilities, and some health care. Most people don’t pay a premium for this part of Medicare if they worked and contributed to funds for the required time frame.
  • Medicare Part B in Massachusetts - This covers a wider array of services such as preventative services, doctor’s fees, outpatient care, home health care, and medical equipment. Everyone pays a standard premium for part B, plus an adjusted cost for those who made above a certain amount.
  • Medicare Part D in Massachusetts - Part D is an optional addition that covers prescription drugs including some preventative and recommended vaccines. Part D must be enrolled through a private, Medicare-approved insurance company.

Medicare pays for a portion of the cost of covered medical services. Since it doesn’t cover all of it, you have the option to buy Medicare Supplement Policy. This helps cover your part of the bills. Without the supplement, you are responsible for services as you receive them. You pay an out-of-pocket deductible at the beginning of the year and the 20% of costs for approved procedures.

What Does Medicare Advantage Cover?

Medicare Advantage (MA) is considered the Part C of Medicare. It includes parts A and B, with the option of part D. This plan is still available to participants 65 years or older and younger people with qualifying disabilities. Up until 2021, those with end stage renal disease were unable to obtain Medicare Advantage. Now they may choose either option of Medicare or MA.

MA is a medicare approved plan from a private insurance company. It is an alternative to the original Medicare for your health and drug coverage. The Advantage plans cover everything the original Medicare covers except for hospice care. Medicare covers hospice no matter what plan you have. Certain MA plans offer services above and beyond the medicare plans like hearing, vision, and dental insurance.

It is important to note that MA plans are usually an additional cost atop the Part B premium. The providers are also allowed to change their costs every enrollment year as long as they provide prior notice. If you find that you aren’t happy with the plan you have or discover a cheaper option, you are not stuck with your current MA. At each enrollment period, you are allowed to switch coverage to whichever plan suits your needs. Supplemental insurances can’t be used simultaneously with Medicare Advantage. These policies are only there to help cover Medicare costs.

Insurances that provide MA plans are prohibited from refusing your application due to your health needs. They are also not allowed to charge you a higher premium, copays, or other costs based on preexisting health conditions.

There are several different types of Medicare Advantage Plans available in Massachusetts:

  • HMO- Health Maintenance Organization plans only allow you to go to doctors within the plan’s Massachusetts network. The exception to the rule happens during emergency situations. There is a chance you will be required to have referrals to get tests or see specialty doctors.
  • PPO- Preferred Provider Organization plans charge less if you see doctors within their provider network. Only service outside the Massachusetts network will cost extra.
  • PFFS- Private Fee for Service plans allow you to see any doctor or provider in Massachusetts as long as they accept the plan’s payment terms. The plan decides how much to pay and how much you will be required to pay.
  • SNP- Special Needs Plans are for providing specialized care for groups of people. Those who have Medicare and Medicaid, have chronic conditions, or live in nursing homes usually qualify.
  • HMO-POS- HMO Point of Service plans allow you to get a few services out of the network for higher copayment.
  • MSA- Medical Savings Accounts combine high-deductible plans with a savings account. Medicare puts money in an account that you can use to pay for health services, but not prescription costs.

Medicare Advantage Vs Medicare in Massachusetts

Both Medicare and MA are available in MA to cover health costs as you age, but what are the main differences? Each plan seems both the same and distinctly different, so let’s do some comparison.


●     Medicare

○     Includes both Parts A and B

○     Part D is a separate drug plan with its own policy

○     Does not cover vision, dental, and hearing

●     Medicare Advantage

○     Includes Parts A and B

○     Often includes Part D in the bundle

○     Can also cover vision, dental, and hearing

Health Network:

●     Medicare

○     Use any doctor anywhere in the country

●     Medicare Advantage

○     Usually requires you to see providers within their specific network


●     Medicare

○     Out of pocket costs can be expensive

○     Supplemental insurance plans (Medigap) are available to help cover costs

●     Medicare Advantage

○     Plans may have lower out-of-pocket costs

○     Medigap is not available to cover costs with MA

Insurance Provider:

●     Medicare

○     The government directly provides the policy and pays for services

●     Medicare Advantage

○     Provided by a private insurance company

○     Government supplements the company

Enroll Medicare Massachusetts

At Enroll Medicare, our goal is to make sure you have all the information you need about Medicare and its options in the state of MA. We want to help you to make the best decision for your future. Choosing the best plan at the best rate shouldn’t be a lonely and confusing path. If you have questions about what you are eligible for and what plan is best for you, compare plans available for you today.

Categories: Medicare Articles, Medicare Part C, Medicare Advantage Plan Types
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