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.,

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

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 the SHINE Program at 1-800-243-4636.

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.

Cost Amount
Monthly premium $0 for most people (40+ quarters of work history)
Hospital deductible $1,736 per benefit period
Hospital coinsurance, days 61-90 $434 per day
Lifetime reserve days $868 per day
SNF coinsurance, days 21-100 $217 per day

The hospital deductible went up $60 from 2025. 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's services, outpatient care, preventive services, durable medical equipment, and mental health services. 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 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.

Medicare Advantage Plans in Massachusetts (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They must cover all the medically necessary Part A and Part B services Original Medicare does, except hospice, which Original Medicare keeps covering, 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. That $0 floor is not a plan tucked away in one corner of the state: CMS says 100% of people with Medicare here will have access to a Medicare Advantage plan with a $0 monthly premium. Unlike much of the country, the average monthly Medicare Advantage premium here went up for 2026, from $32.74 to $38.03.

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, cost, and Medicare-Medicaid 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. 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 1,511,615 people with Medicare in Massachusetts: 971,518 were still in Original Medicare, and 540,097 were in Medicare Advantage and other health plans. 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.

Enrollment does swing hard from county to county, but not along the east/west or urban/rural line most people expect. On Nantucket, 169 of 2,382 beneficiaries were in Medicare Advantage and other health plans as of March 2026, against 105,063 of 307,979 in Middlesex County and 49,985 of 110,154 in Hampden County out west. The only way to know your own options is to check your ZIP code.

How These Plans Work

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 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.

Not sure which Part D plan fits your prescriptions? Chat with Brevy's care navigator at brevy.com.

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. 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.

Plan What it covers Who can buy it
Core The state's base supplement plan Anyone with Original Medicare
Supplement 1A The fuller of the two plans sold today; it does not cover the Part B deductible Anyone with Original Medicare
Supplement 1 Also covers the Medicare Part B deductible Only people eligible for Medicare before Jan 1, 2020 who haven't yet enrolled; current holders can keep it

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 no longer sold except to people who were eligible for Medicare before January 1, 2020 but haven't yet enrolled. If you already have Supplement 1, you can keep it.,

Why Massachusetts Medigap Is Different

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

Once the federal six-month Medigap Open Enrollment Period is over (it starts the first month you're both 65 or older and enrolled in Part B), 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. 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. 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. That doesn't mean everyone pays the same. Premiums vary by insurer, and an insurer may add a surcharge of up to 15% a year, for no more than three years, if you apply late or upgrade to a richer plan. You count as a late applicant if you apply more than six months after you first enrolled in Part B, lost employer coverage, or became a Massachusetts resident, unless you had continuous, comparable prior coverage, 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.

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.

Program Individual Couple What it pays
QMB, at or below 190% FPL About $2,527 About $3,427 Part A premium (if you owe one), Part B premium, deductibles, coinsurance
SLMB and QI, above 190% and up to 225% FPL About $2,993 About $4,058 Part B premium

MassHealth's own materials present SLMB and QI as that single band, which is how you'll apply for them. 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. The split does matter in one way: QI, and only QI, is capped by funding, so MassHealth can turn away an applicant who meets every QI rule once the state's yearly allocation is used up. Once you're approved, you keep QI for the rest of that calendar year as long as you keep meeting the rules.

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 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 deductible is $0, but the premium is covered only up to a regional benchmark, a condition worth knowing before you choose a plan: the premium subsidy is based on your service area's regional benchmark premium, so if you pick a plan that costs more than the benchmark, you owe the difference yourself.

  • 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 alone
  • Resource limits: $18,090 for an individual, $36,100 for a married couple living together. The lower limits of $16,590 and $33,100 apply only if you tell Social Security that none of your resources will go toward funeral or burial expenses
  • If you qualify for QMB, SLMB, or QI, you automatically qualify for Extra Help and don't need to file a separate application; QDWI, the fourth Medicare Savings Program, does not confer it

Apply through the Social Security Administration (SSA) at ssa.gov/medicare/part-d-extra-help 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 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. 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:

Period Dates What you can do
Initial Enrollment 7 months around your 65th birthday Sign up for Parts A, B, and D; pick MA or Medigap
Annual Open Enrollment Oct 15 - Dec 7 Switch MA plans, move between MA and Original Medicare, change Part D
MA Open Enrollment Jan 1 - Mar 31 Make one change if already in MA: switch MA plans, or return to Original Medicare and add a drug plan
General Enrollment Jan 1 - Mar 31 Sign up for Part B if you missed your initial window (coverage starts the month after you enroll)

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 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' State Health Insurance Assistance Program is SHINE (official page), short for Serving the Health Insurance Needs of Everyone on Medicare. It provides free health insurance information, counseling, and assistance to Massachusetts residents who are eligible for Medicare and their caregivers. Its counselors are certified and trained, and often volunteers, and mass.gov lists the program under the Massachusetts Executive Office of Aging & Independence (AGE).

A SHINE counselor can help you:

  • Get your Medicare options explained and clarified
  • Explore Medicare plan options, including Part D drug plans and Medicare Advantage plans
  • Find ways to save money on both health insurance and prescription drug costs
  • Check whether you're eligible for programs through Social Security, MassHealth, and Prescription Advantage that can help with premiums, copays, deductibles, and prescription drug costs

Call the SHINE Program at 1-800-243-4636. SHINE's 2026 Medicare Beginner's Guide says its trained volunteers will be glad to make an appointment with you to further explain and clarify your Medicare options.

Your next step Call the SHINE Program at 1-800-243-4636 to book a free appointment with a trained SHINE counselor who can explain your Medicare options and screen you for programs that may reduce your Medicare costs.

Frequently Asked Questions

What does Medicare cost in Massachusetts in 2026?

Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D premiums vary by plan (the base is $38.99), and many Medicare Advantage plans charge no extra premium. Your total depends on the plan you pick and the care you use.

Does Massachusetts use the standard Medigap plans like Plan G?

No. Massachusetts is one of three states that standardize Medigap their own way, so the federal A-through-N letters, including Plan G, aren't sold here. Instead the state offers the Core plan and Supplement 1A. Supplement 1 is no longer sold except to people who were eligible for Medicare before January 1, 2020 but haven't yet enrolled, and anyone who already has it can keep it. No insurer may health-screen you, and the state runs a guaranteed-issue window each year from February 1 to March 31.

How do I get help paying for Medicare in Massachusetts?

Apply for a Medicare Savings Program through MassHealth (1-800-841-2900), and apply for Extra Help with Part D through Social Security at 1-800-772-1213. Massachusetts has no asset limit for its Medicare Savings Programs and uses higher income limits than the federal minimum, so it's worth checking even if you've been turned down elsewhere. A SHINE counselor (1-800-243-4636) can screen you, for free, for programs through Social Security and MassHealth that may reduce your Medicare costs.

What happens if I have both Medicare and MassHealth?

You can enroll in a single plan that combines both: Senior Care Options if you're 65 or older, or One Care if you're 21 to 64 when you enroll. Your Medicare and MassHealth benefits then come through one plan, with one card and one care team.

Learn More

MedicareMedicare Plans by State: What Varies and What Doesn'tOriginal Medicare is the same in all 50 states. Medicare Advantage, Part D, and Medigap rules are not. See what changes by state, then open your state guide. MedicareMassachusetts Medicare Supplement (Medigap): Core, Supplement 1AMassachusetts Medicare Supplement (Medigap) guide: the non-standard Core, Supplement 1A and closed Supplement 1 plans, plus guaranteed-issue rights and rates. MedicaidSCO and One Care in MassachusettsMassachusetts Medicaid SCO and One Care changed on 1/1/2026: SCO now requires Medicare Part A and B, and One Care moved to a D-SNP platform. Plans and steps. MedicaidMassHealth Eligibility and Income Limits2026 MassHealth eligibility for seniors and people with disabilities: income limits, asset limits, the medically-needy spend-down, and savings programs. MedicaidMassHealth Asset Limits and Spousal Impoverishment RulesMassachusetts Medicaid spousal impoverishment 2026: the 100%-share CSRA rule, MMMNA $2,705.00-$4,066.50, income-first, and why the home is safe. MedicaidMassHealth Estate Recovery in MassachusettsMassachusetts Medicaid estate recovery in 2026: the 2024 LTC Act narrowing, the $25,000 auto-waiver, three hardship waiver categories, and probate-only scope. MedicaidMassachusetts MassHealth: Programs and CoverageMassachusetts MassHealth explained: 1634 + medically-needy state, $2,000 asset limit, $72.80 PNA, 100% spousal share to $162,660, Chapter 197 estate recovery. MedicarePrescription Advantage: How Massachusetts Helps Pay for Prescription DrugsMassachusetts Prescription Advantage stopped taking new applications after Sept. 11, 2026. Members without Medicare pay no premium and $7 to $50 copays.

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.

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