A little over 72% of Medicare beneficiaries in Cambridge, Massachusetts, have chosen to stick with Original Medicare over a Medicare Advantage supplement plan. But are they pairing their Medicare with a Medigap plan? If not, it could cost them a pretty penny.
Medicare plans in Cambridge, Massachusetts
Statistically speaking, most of the Cambridge retirees on Original Medicare in Massachusetts who are reading this right now are 72-year-old females.
Regardless of age or gender, taking care of your health during your golden years is important, and you should have a health plan that meets your needs.
Medicare Advantage plans
Around 40 different Massachusetts Medicare Advantage plans are available for purchase in Middlesex County. About 23% of Medicare beneficiaries in Cambridge are using those plans right now to meet their healthcare needs.
The MOOP in the chart below stands for “maximum out-of-pocket” expenditure. Out of Cambridge’s top five Medicare Advantage plans, Wellcare has the smallest MOOP at $6,500 per year. This means that once you spend that much, your insurance will start paying for more health care costs.
Tufts Health ties Fallon Health with the most expensive MOOP. Both companies have high customer service ratings, but Tufts has a perfect 5-star rating. Comparatively, Fallon Health has only four stars, which is still good.
Three of the top five plans have HMO medical networks, meaning you have less choice regarding doctors and facilities. On the other hand, BCBS of Massachusetts and are PPO networks. This means you won’t be charged as much for going out of network as you would with an HMO.
The average cost of Medicare Advantage plans in Cambridge, Massachusetts
| PLAN | PREMIUM | MOOP | Plan Type | Star Rating |
| BCBS of Massachusetts | $0 | $6,700 | LOCAL PPO | 4 |
| Tufts Health | $0 | $7,550 | HMO | 5 |
| Wellcare | $0 | $6,500 | HMO | N/A |
| $0 | $6,700 | LOCAL PPO | 3 | |
| Fallon Health | $0 | $7,550 | HMO | 4 |
Medicare Supplement plans
Medigap plans are smaller and simpler supplements compared to Medicare Advantage. This is because they’re meant to supplement Original Medicare truly. They aren’t meant to replace it the way Medicare Advantage plans are.
Although most states have standardized Medigap plans, Massachusetts Medigap plans are different. Your choices start with the Core Plan, which offers you the following basic benefits:
- Part A coinsurance plus 365 days in hospital after Medicare benefits end
- Part B Coinsurance
- Hospice coinsurance/copayments
- First 3 pints of blood each year
The Core Plan also offers:
- The basic benefits listed above
- 60 days of inpatient mental health hospital treatment
- State-mandated benefits
The Supplement 1 Plan offers the basic benefits and:
- Part A deductible
- Your Part A skilled nursing facility coinsurance
- Part B deductible
- Foreign travel insurance
- 120 inpatient mental health treatment days per year
- State-mandated benefits
It should be noted for Medicare beneficiaries who were not eligible to enroll before January 1, 2020, that from now on, you can only choose between the Core Plan and the Supplement 1A Plan. The only difference between the two plans is that the Supplement 1A Plan does not cover your Part B deductible.
The average cost of Medicare Supplement plans in Cambridge, Massachusetts
| PLAN | LOWEST PREMIUM | HIGHEST PREMIUM |
| CORE | $113.58 | $203.79 |
| SUPPLEMENT 1 | $205.70 | $329.84 |
| SUPPLEMENT 1A | $165.75 | $319.54 |
Medicare Part D prescription drug plans
If you do not have Medicare Advantage, the cheapest way to cover your Massachusetts prescriptions is through the Medicare Part D prescription drug program. You pay a monthly premium, fulfill an annual deductible, and your prescriptions are significantly discounted for the rest of the year.
Out of the top five plans listed below, all have at least a three-star customer service rating, including Aetna. While Aetna comes with an average deductible, it has the lowest monthly premium is $7.40.
Humana is the most affordable drug plan with a four-star customer service rating. It comes with an average $480 deductible but costs $22.70 per month in premiums.
Be sure to carefully calculate your anticipated costs before you decide on a plan. For example, UnitedHealthcare may look like the second most costly listed below, but its lower deductible means your annual upfront costs are only $661.60. Conversely, despite having a lower monthly premium, Humana will cost at least $752.40 per year because of the higher deductible.
The average cost of Medicare Part D plans in Cambridge, Massachusetts
| PLAN | PREMIUM | DEDUCTIBLE | STAR RATING |
| Aetna | $7.40 | $480 | 3 |
| Wellcare | $13.00 | $480 | 3 |
| Humana | $22.70 | $480 | 4 |
| $29.30 | $310 | 4 | |
| Cigna | $32.10 | $480 | 3 |
Special Needs Plans
If you have a chronic illness, you can qualify for a more affordable Special Needs Plan (SNP) through Medicare Advantage. To qualify in Massachusetts, your disease must be chronic and disabling, not just one or the other. The medical networks assigned to these plans may be limited, but they will help make your healthcare more affordable.
There aren’t many differences between the Special Needs Plans available in Cambridge, Massachusetts. The one that stands out among the rest is Tufts Health, which has a significantly smaller MOOP compared to the other plans.
All other plans, including Fallon Health and Commonwealth (among others), have identical MOOPs of $7,550 and dual-status eligibility requirements.
The average cost of Medicare Special Needs plans in Cambridge, Massachusetts
| PLAN | PREMIUM | MOOP | Plan Type | Eligibility |
| $0 | $7,550 | HMO | Dual | |
| Fallon Health | $0 | $7,550 | HMO | Dual |
| Commonwealth | $0 | $7,550 | HMO | Dual |
| Senior Whole | $0 | $7,550 | HMO | Dual |
| Tufts Health | $0 | $3,450 | HMO | Dual |
How to sign up for Supplemental Medicare plans in Cambridge, Massachusetts
Your Medicare benefits are great, but they don’t cover anything. So if you’re a resident of Cambridge, Massachusetts, and want a fixed monthly cost with everything covered, consider a Supplemental plan to make that happen.
You can use the expertise and time of our licensed insurance agents free of charge while getting excellent advice and being presented with all the options available to you.
Give us a call today. Or complete our online rate form to be connected with the best rates in your area.
