Enrollment and Eligibility for Medicare Advantage in Massachusetts

The following information compliments of PayingforSeniorCare.com, an organization striving to provide up-to-date information about financial resources for seniors…


Prior to enrolling in Medicare Advantage (Part C), seniors must first be enrolled in Original Medicare. Anyone who is eligible for Medicare Parts A and B is also eligible to enroll in Medicare Advantage. However, certain Medicare Advantage plans may have additional eligibility requirements.

Medicare Advantage has specific enrollment periods. One can only join a Medicare Advantage plan during the following periods:

— Initial Coverage Election Period: This is the 7-month period during which everyone is eligible to enroll in a Medicare Advantage plan. The period spans from 3 months before the month of one’s 65th birthday to 3 months after one’s birthday month.
— Annual Election Period (AEP): Also referred to as the Open Enrollment Period, the Annual Election runs from October 15-December 7 each year. During this period, anyone can enroll in Medicare Advantage for the first time or change to a new plan.
— Medicare Advantage Open Enrollment Period: From January 1-March 31 each year, anyone who is already enrolled in Medicare Advantage can switch to a different plan, or disenroll and switch back to Original Medicare. This period is not open to anyone who is not currently enrolled in Medicare Advantage.
— General Enrollment Period: In some circumstances, one can join Medicare Advantage between April 1-June 30. This enrollment period only applies to those who enrolled in Medicare Part B for the first time during Medicare’s Open Enrollment Period (January 1-March 31).

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.

Prescription Drug Coverage: Prescription drugs are paid for through Part D plans, which are optional for seniors who qualify for Original Medicare. However, Medicare Advantage plans often have a Part D component as part of their unified plan coverage, though seniors are still free to purchase a separate prescription drug plan if they wish.

Medicare Advantage providers in Massachusetts offered 22 prescription drug plans in 2018, and nearly 1 million state residents participate in at least one of them. Premiums for Part D coverage in Massachusetts average $47.25 a month, which is nearly $5 less than the national average.

Prescription drug plans offered through Medicare Advantage plans in Massachusetts are allowed to charge a range of monthly premiums, though there is a cap on how much may be charged. Providers are also not permitted to discriminate against beneficiaries with preexisting conditions, or to charge more for high-risk participants.

Medicare and Medicare Advantage are invaluable resources for seniors. Plan details and rules for participating in Medicare programs can get confusing. Many seniors welcome help navigating the complex rules governing their coverage and the enrollment process. Probably the best source to educate Massachusetts seniors and help with understanding and managing their Medicare Advantage benefits is an organization called SHINE. Generally, SHINE counselors are located in your community’s Council on Aging/Senior Center facility.

Serving the Health Insurance Needs of Elders (SHINE): SHINE is a nonprofit organization with more than 600 volunteers throughout Massachusetts. These counselors 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.

JD Miller

About JD Miller

John D. Miller is the founder/owner of Home Care Partners, LLC, a Massachusetts business providing private duty, personalized in-home assistance and companion care services to those needing help in daily activities and household functions. Phone: (781) 378-2164 Email: [email protected] Website: https://homecarepartnersma.com

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