Medicare Plans in Massachusetts: Coverage and Costs (2026)

If you're turning 65 in Massachusetts or helping a parent sort out Medicare, you're facing four parts, dozens of plan choices, and costs that reset every January. The standard Part B premium for 2026 is $202.90 a month, the Part D donut hole is gone for good, and Massachusetts runs its own Medigap system that lets you switch supplement plans any time of year without a health screening.

This guide walks through every piece of Medicare as it works for Massachusetts residents in 2026, what it costs, the plan options unique to this state, and how to get help paying for it.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Massachusetts (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Massachusetts: Core and Supplement 1
• Help Paying for Medicare in Massachusetts
• If You Have Both Medicare and MassHealth
• Medicare Enrollment Periods
• Free Medicare Help: SHINE
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Massachusetts SHINE at 1-800-243-4636.

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government, and it comes in two parts.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.

The hospital deductible went up $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave. Get readmitted after that, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It doesn't cover routine dental, vision, or hearing.

• Monthly premium: $202.90 (higher if your income is above $109,000 single or $218,000 married, under the income-related adjustment)
• Annual deductible: $283
• After the deductible: you pay 20% of the Medicare-approved amount for most services

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.

Medicare Advantage in Massachusetts (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, and most bundle in Part D drug coverage along with extras like dental, vision, and hearing.

For 2026, the average Medicare beneficiary nationally can choose from about 32 Medicare Advantage plans with drug coverage. Massachusetts has around 100 plans available across the state, though how many you can actually pick depends on your county.

Here's something that sets Massachusetts apart: most people on Medicare in the state don't use Advantage at all. About 36% of Massachusetts beneficiaries are enrolled in a Medicare Advantage plan, compared to more than half of beneficiaries nationally. Roughly two-thirds stay on Original Medicare, often paired with one of the state's Medigap plans. Penetration also swings hard by county, lower in the western, more rural parts of the state and higher around Boston and Worcester.

The Major Insurers in Massachusetts

The larger Medicare Advantage insurers in the Massachusetts market for 2026 include UnitedHealthcare, Tufts Health Plan (part of Point32Health), Blue Cross Blue Shield of Massachusetts, Aetna, and Humana. Plans differ a lot on network and benefits, so the brand matters less than whether your own doctors and drugs are covered.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium, though many plans charge $0 extra.
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors are in-network before you enroll.
• Every plan caps your annual out-of-pocket spending. Original Medicare has no such cap.
• Extras vary widely. Compare the dental, vision, hearing, and other benefits, not just the premium.

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone. Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with inflation. The base premium is $38.99 a month, though actual plan premiums vary, and increases are capped at 6% a year through 2029. People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Massachusetts: Core and Supplement 1

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.

Most states sell the federally standardized plans labeled A through N. Massachusetts doesn't. It's one of three states, with Minnesota and Wisconsin, that got a federal waiver to run its own set of Medigap plans. So if you've read a national Medicare guide that talks about "Plan G," that plan isn't sold here. Massachusetts has its own menu.

Supplement 1A is the fuller plan most people newly on Medicare will look at, since the older Supplement 1, which also paid the Part B deductible, is closed to anyone who became eligible for Medicare on or after January 1, 2020.

Why Massachusetts Medigap Is Different

The plan names are only half the story. The bigger advantage is when and how you can buy.

In most states, an insurer can turn you down or charge you more for a Medigap policy based on your health once your first six months on Medicare are up. Massachusetts doesn't allow that. The state has continuous, year-round guaranteed issue, so you can buy a Medigap plan or switch to a different one at any time, with no medical underwriting and no pre-existing condition waiting period. The state also runs a guaranteed-issue open enrollment every year from February 1 through March 31 for anyone who missed an earlier window.

Massachusetts also requires community rating. That means an insurer charges every policyholder the same premium for a given plan regardless of age or gender, so your rate won't climb just because you're getting older. Between year-round switching and community rating, Massachusetts gives Medigap buyers more freedom than almost any other state. The Massachusetts Division of Insurance regulates these policies and publishes the list of carriers and their rates.

Medigap or Medicare Advantage?

You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. Massachusetts' year-round guaranteed issue takes some of the usual risk out of choosing Medigap, since you're never locked into one carrier and can shop your coverage whenever you want.

Help Paying for Medicare in Massachusetts

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs

Massachusetts runs its Medicare Savings Programs through MassHealth, the state's Medicaid program. They pay some or all of your Medicare premiums and cost-sharing based on income.

Two things make the Massachusetts version more generous than the federal floor. First, there's no asset limit. The state dropped the resource test for these programs in 2024, so eligibility comes down to income alone, no matter what you've saved. Second, the income limits are higher than the federal minimum.

QMB is the most generous, covering your Part B premium plus your deductibles and coinsurance, which can be worth thousands of dollars a year. These income limits are tied to the federal poverty level and update each year, so confirm the current figures with MassHealth before you rule yourself in or out. Apply at mass.gov/MedicareSavings or call MassHealth at 1-800-841-2900.

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.

• Resource limits: $16,590 for an individual, $33,100 for a married couple
• If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help

Apply through Social Security at ssa.gov or call 1-800-772-1213.

If You Have Both Medicare and MassHealth

If you qualify for both Medicare and MassHealth, Massachusetts offers two programs that fold both into a single plan with one card and one care team, so you're not juggling two sets of coverage and benefits.

• Senior Care Options (SCO) is for dual-eligible adults age 65 and older. Most members pay no or low premiums and little to nothing out of pocket for covered services. Starting January 1, 2026, every SCO member needs both Medicare Part A and Part B and MassHealth Standard to stay enrolled.
• One Care does the same for dual-eligible adults ages 21 to 64. You can stay in One Care after you turn 65 as long as you still meet the other requirements.

Both programs are voluntary, and you can call MassHealth at 1-800-841-2900 to learn more or enroll. For a closer look, see our guide to SCO and One Care in Massachusetts. If your needs are more intensive, the PACE program is another fully integrated option in many parts of the state.

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. The key dates:

Changes you make during Annual Open Enrollment take effect the following January 1. That's when most people review their plan and switch. Medigap is the exception in Massachusetts: because the state allows year-round switching, you're not tied to these windows to change supplement plans.

Free Medicare Help: SHINE

You don't have to figure this out by yourself, and you don't have to pay a broker to help. Massachusetts runs SHINE, short for Serving the Health Insurance Needs of Everyone, which gives free, unbiased Medicare counseling. It's run by the Massachusetts Executive Office of Aging & Independence and delivered locally through community agencies, often by trained volunteers.

A SHINE counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for Medicare Savings Programs and Extra Help
• Sort out billing problems, denials, and appeals
• Work out how Medicare fits with MassHealth if you have both

Call MassOptions at 1-800-243-4636 and you'll be connected to a SHINE counselor near you.

Learn More

• SCO and One Care in Massachusetts
• MassHealth Eligibility and Income Limits
• MassHealth Asset Limits and Spousal Impoverishment Rules
• MassHealth Estate Recovery in Massachusetts
• Massachusetts MassHealth: Programs and Coverage

Find personalized help comparing your Medicare options in Massachusetts at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.