Medicare Plans in Massachusetts: Coverage and Costs (2026)

If you're sorting out Medicare plans in Massachusetts, you're facing four parts, dozens of plan choices, and a standard Part B premium that runs $202.90 a month in 2026. Massachusetts also runs its own Medigap system, where no insurer may use your health to deny you a supplement plan or set its price, and the Part D coverage gap is gone for good, with out-of-pocket drug costs now capped at $2,100 a year.1,2

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 Plans in Massachusetts: Parts A and B
• Medicare Advantage Plans 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, so check Medicare's own costs page for the current figures. To talk any of it through with a person here in Massachusetts, call MassOptions at 1-800-243-4636 and ask for a SHINE counselor.5

Original Medicare Plans in Massachusetts: 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.1

The hospital deductible went up $60 from 2025.1 A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a SNF. 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.1,6

• Monthly premium: $202.90 (higher if your income is above $109,000 single or $218,000 married, under the income-related adjustment)1
• 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 qualifying for a Special Enrollment Period or a Medicare Savings Program 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.7

Medicare Advantage Plans 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 the 2026 plan year, CMS reports 103 Medicare Advantage plans available in Massachusetts, up from 96 in 2025, though how many you can actually pick depends on your county. 100% of people with Medicare in Massachusetts have access to a Medicare Advantage plan, and $0 is the lowest monthly premium on offer. Unlike much of the country, the average monthly Medicare Advantage premium here went up for 2026, from $32.74 to $38.03.8

That 103 is a statewide count, not the menu you personally see. Counting only plans open to general enrollment (leaving out special-needs, employer, PACE, and cost plans), KFF's analysis of the CMS landscape files puts the Massachusetts total at 63, and finds the average Massachusetts beneficiary can choose from 34 plans offered by an average of 7 insurers.8 Plans differ a lot on network and benefits, so the brand matters less than whether your own doctors and drugs are covered.

Here's something that sets Massachusetts apart: most people on Medicare in the state don't use Advantage at all. As of March 2026, CMS counted 1,508,292 people with Medicare in Massachusetts: 968,032 were still in Original Medicare, and 540,260 were in Medicare Advantage and other health plans.8 Roughly two-thirds stay on Original Medicare, often paired with one of the state's Medigap plans. Nationally the pattern runs the other way: KFF reports that more than half (55%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2026, so Massachusetts sits notably below the national norm.8

Enrollment does swing hard from county to county, but not along the east/west or urban/rural line most people expect. On Nantucket, 167 of 2,356 beneficiaries were in Medicare Advantage and other health plans as of March 2026, against 105,084 of 307,284 in Middlesex County and 50,025 of 110,048 in Hampden County out west.8 The only way to know your own options is to check your ZIP code.

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 and CMS says some may help pay all or part of the Part B premium itself.1,9
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors are in-network before you enroll.
• Every plan caps your annual in-network out-of-pocket spending. Original Medicare has no such cap. CMS puts it this way: there is no yearly limit on what you pay out of pocket unless you have supplemental coverage like Medigap, Medicaid, employer, retiree, or union coverage. With none of those, your exposure is open-ended.9
• 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.2 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).10
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.2 It was $2,000 in 2025, and the 2026 amount is the one specified in the CY 2026 Rate Announcement. The base premium is $38.99 a month, though actual plan premiums vary by carrier. 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 with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.

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 standardize Medigap their own way instead.3 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.

The benefit-by-benefit chart is where these plans actually differ, and it's the Massachusetts Division of Insurance that publishes the current version alongside the list of carriers and their rates. Read that chart, or have a SHINE counselor walk you through it, before you compare policies on price alone.

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, 2020.3,11

Why Massachusetts Medigap Is Different

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

Once your first six months on Medicare are up, the federal guarantee is spent, and an insurer can turn you down or charge you more for a Medigap policy based on your health unless state law says otherwise.12 Massachusetts doesn't allow that. Under state regulation 211 CMR 71, an insurer may never deny you a policy, condition its issuance, or discriminate in its pricing because of your age, health status, claims experience, medical condition, or genetic information, and no Massachusetts Medigap policy may carry a pre-existing condition waiting period.3 The state also runs a guaranteed-issue open enrollment every year from February 1 through March 31 for anyone who missed an earlier window, and individual insurers may elect to accept applications year-round on top of that, so ask the carrier you want whether it does.

Massachusetts also requires community rating, so an insurer can't price a plan by your age or your health and your rate won't climb just because you're getting older.3 That doesn't mean everyone pays the same. Premiums vary by insurer, and applying after your first six months on Medicare without continuous comparable coverage can add a surcharge of up to 15% a year for up to three years, so waiting still has a price. The Massachusetts Division of Insurance regulates these policies and publishes the list of carriers and their rates.

Medigap or Medicare Advantage?

While you're in a Medicare Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. 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' guaranteed-issue protections take some of the usual risk out of choosing Medigap, since no insurer can later refuse you or re-rate you on your health.

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.4

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.4 Second, the income limits are higher than the federal minimum.

MassHealth's own materials present SLMB and QI as that single band, which is how you'll apply for them.4 The regulation does split the band internally (SLMB runs to 210% of the federal poverty level, and QI picks up from there to 225%), but that's MassHealth's determination to make, not a separate application step for you.

QMB is the most generous, covering your Part B premium plus your deductibles and coinsurance, which can be worth thousands of dollars a year.4 These thresholds apply to your countable income after MassHealth's disregards, so your gross income can sit above the chart figure and you can still qualify. They also change every year on March 1, so confirm the current numbers with MassHealth before you rule yourself in or out. Apply through MassHealth or call 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. Under Extra Help the plan premium and the plan deductible are both $0, but the premium half comes with a condition worth knowing before you choose a plan: Medicare pays the premium subsidy against your service area's regional benchmark premium, so if you pick a plan that costs more than the benchmark, you owe the difference yourself.13

• Income limits: $23,940 a year for an individual, $32,460 for a married couple, which is 150% of the 2026 federal poverty guidelines. Not every dollar counts toward that test, so apply rather than rule yourself out on income alone13
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses13
• If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help; QDWI, the fourth Medicare Savings Program, does not confer it4

Apply through the Social Security Administration (SSA) at ssa.gov/medicare/part-d-extra-help or call 1-800-772-1213.13

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.14

• 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 adults who are ages 21 to 64 at the time they enroll. The other requirements are stricter than SCO's: you need a disability, Medicare Parts A and B, Part D eligibility, and either MassHealth Standard or CommonHealth, and you cannot have private health insurance or be taking part in a Home and Community Based Services (HCBS) waiver. Your area has to be served by a One Care plan too.

Call MassHealth at 1-800-841-2900 to learn more or enroll.14 For a closer look, see our guide to SCO and One Care in Massachusetts. If your needs are more intensive, the PACE (Program of All-Inclusive Care for the Elderly) 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:15

Changes you make during Annual Open Enrollment take effect the following January 1.15 That's when most people review their plan and switch. Medigap is different in Massachusetts: you are not health-screened when you switch supplement plans, and the state runs its own February 1 to March 31 guaranteed-issue window each year.

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.5

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; the line is staffed 9:00 am to 5:00 pm, Monday through Friday.5 You are not limited to that one number. Mass.gov publishes a SHINE counselor directory that lists a phone number and the SHINE Regional Office serving each Massachusetts city and town, so you can call your own regional office directly, and you can reach MassOptions online or through your local Council on Aging. For MassRelay, call 711 or 1-800-439-0183 (voice); the TTY line is 1-800-439-2370.5

Learn More

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.