An Introduction to Medicare in the State of Massachusetts

An Introduction to Medicare in the State of Massachusetts

Last updated on: November 10, 2022

Put simply, Medicare is a Federal Government health insurance program available to qualifying residents of Massachusetts. Medicare began in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services. It is a federal health program for people 65 years of age or older and, in the state of MA, people under 65 who have a disability. Some people with end-stage renal disease may also qualify for Medicare. The ages and reasons that someone may be eligible for Medicare can vary, so it is important to research this carefully.

2 Parts Of Medicare in Massachusetts

In Massachusetts, Medicare is broken down into two different parts, Part A and Part B. Part A is hospital insurance. It covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health care. Part B is medical insurance. It covers services such as office visits to doctors and other health care providers, outpatient care, home health care, durable medical equipment like wheelchairs and walkers, and many preventative services. To enroll in Part A and Part B, you can do so through the Social Security Office.

Other Parts of Medicare in Massachusetts

There are some medical services that neither Part A nor part B cover. To make up for some of these costs, if you live in MA you can also purchase Medicare Supplements. If you have only Part A and Part B and no other coverage in place (A Medicare Supplement or a Medicare Advantage Plan), this is called Original Medicare. 

In addition to Medicare Supplements, there is also Part C and Part D. Part C is also known as Medicare Advantage. Medicare Advantage is offered by private companies that Medicare has approved. The Advantage plan is basically a bundle that offers Plan A and Plan B together. It sometimes also includes Part D, the prescription drug plan available in Massachusetts. To enroll in anything other than Part A and Part B, you need to do so through a private insurance agent or agency. 

When Am I Eligible For Medicare?

  • Sixty-five years or older and a U.S. citizen or a permanent resident for the previous five years. 

    When you turn 65, you become eligible for Medicare. If you aren't receiving social security benefits, you can sign up online through the Social Security Administration website. You can apply three months before you turn 65. Once you are enrolled in Medicare, you will also have the opportunity to enroll in a Medicare Supplement Plan. Make sure you sign up for the Supplement plan on time, or there could be serious ramifications.
  • Some people with disabilities who are under the age of 65.

    You are also eligible for Medicare if you have end-stage renal disease (kidney failure), receive regular dialysis, or have had a kidney transplant. Additionally, if you've worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee, you are eligible for Medicare no matter what age you are. 

In Massachusetts, you also qualify if:

  • you're getting Social Security or Railroad Retirement benefits,
  • you're eligible for Social Security or Railroad Retirement benefits, or 
  • you're the spouse or dependent child of someone who meets either requirement listed above.

People who receive social security disability 

People who receive Social Security disability generally become eligible to enroll in Medicare after receiving those benefits for two years. If you are collecting disability benefits when you turn 65 years old, you will be automatically enrolled in Medicare Part A and Part B. If you want to enroll in Part D for prescription drug coverage, you will be eligible to buy a supplement on your own at this time. 

Signing Up For Medicare Due To Disability

Medicare coverage works a little differently if you become eligible due to end-stage renal failure (ESRF) or dialysis. It's important to know when your coverage starts so you can receive the most help possible.

I Have End-Stage Renal Failure. When Will My Coverage Start?

If you are eligible for Medicare due to end-stage renal failure (ESRF) but you don't enroll right away, your coverage will be retroactive once you do sign up.

Example: You are diagnosed with ESRF in March but don't sign up for Medicare until December. Your coverage actually begins in March and will be retroactive.

I'm On Dialysis. When Will My Coverage Start?

In the state of Massachusetts, when you become eligible for Medicare due to dialysis, your coverage usually starts on the first day of the fourth month that your dialysis treatments began. The four-month period will start even if you didn't sign up right away. 

Example: You started dialysis on January 1st. In this case, you will be eligible April 1st. Even if you didn't sign up for Medicare until November, your coverage still begins retroactively on April 1st. 

Another important thing to note is that you may be able to enroll in Medicare even sooner if you meet specific criteria. If you take part in a home dialysis training program within the first three months of your regular dialysis, and your doctor expects that you will finish the training and be able to do your own dialysis treatments, your coverage can begin the first month of the regular course of dialysis treatment. The training program must be offered by a  Medicare-certified training facilit.

What Medicare Does NOT Cover in Massachusetts

While Medicare covers many important services for people over 65 in Massachusetts, you should make sure you know what is not covered. The following is a list of items not covered by Medicare: 

  • Massage Therapy
  • Cosmetic Surgery
  • Routine Dental Care
  • Dentures
  • Routine Eye Care
  • Medical Care Outside of The United States
  • Hearing Aids
  • Long-Term Care

If you live in Massachusetts, Know Your Rights

There are certain rights you have once you are eligible for and enroll in Medicare. It's crucial that you know your rights so you can be the best advocate for yourself. Your health is one of the most important things you need to deal with. Listed below are some of the fundamental rights you have and should be aware of.

  • You have the right to be treated with dignity and respect at all times.
  • You have the right not to be discriminated against. Every single company that works with Medicare has to abide by this rule. They are not allowed to treat you differently due to age, race, color, religion, national origin, disability, or sex.
  • You have the right to privacy. Your personal and health information will not be shared. 
  • You have the right to receive healthcare in the language that you understand.
  • You have the right to appeal a claim if you disagree with the decision.
  • You have the right to file complaints or grievances about the quality of your healthcare. 

Medicare Doesn't Have To Be Confusing 

There are many different parts of Medicare, and all of the terminologies can sometimes be confusing. We hope to continue offering information to you in a way that's informative but also easy to understand. Medicare can be an excellent option for healthcare, especially if you know how it works and you're aware of your rights. We have local agents available to help you in Massachusetts. Just hit the "Find Rate" button to get matched up with one.


Categories: Medicare Articles, Turning 65, Medicare Coverage, What is Medicare?
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