Are You Eligible?
Visit the Social Security Frequently Asked Questions page to find out if you qualify for Original Medicare. We offer plans that provide benefits in addition to the benefits you get through Original Medicare. See below for the rules that go with each type of plan.
Am I Eligible?
You Are Eligible If..
You live in Massachusetts, and
You are entitled to Medicare Part A and enrolled in Medicare Part B, or
You are under age 65 and you qualify for Medicare coverage because of a disability, except for end-stage renal disease.
Medicare Advantage Plans:
You are entitled to Medicare Part A and enrolled in Part B.
You permanently live in Bristol, Barnstable, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, or Worcester counties in Massachusetts.
You don't currently have end-stage renal disease. If you initiated dialysis treatments for end-stage renal disease, but have recovered your normal kidney function and no longer require a regular course of dialysis to maintain life, or have had a successful kidney transplant, or are currently a member of Blue Cross Blue Shield of Massachusetts, you may still join the plan. In addition, if you were a member of a Medicare Advantage plan that terminated its services after December 31, 1998, and you currently have end-stage renal disease, you may still join the plan.
Medicare Part D / Prescription:
You are entitled to Medicare Part A and/or enrolled in Part B.
You permanently reside within the Blue MedicareRx service area, which is Massachusetts, Connecticut, Rhode Island and Vermont.
You aren't enrolled, or don't plan to stay enrolled, in another Medicare Prescription Drug Plan or Medicare Advantage plan with Part D prescription coverage.
What Medicare plans can I choose?
Medicare has three main parts:
Medicare Part A—Hospital Insurance
Medicare Part A helps cover your inpatient hospital care, including care received at critical access hospitals and skilled nursing facilities. Under certain conditions it even covers Hospice Care and some home health care.
When you enroll in Original Medicare, you are automatically enrolled in Part A (enrollment in Part B is optional). Most people don't pay a premium for Part A because they or their spouse already paid for it through payroll taxes while working. If you don't qualify for premium-free Part A, you can purchase it and have it automatically deducted from your Social Security checks.
Medicare Part B—Medical Insurance
Medicare Part B helps cover your doctors' services and outpatient surgery. It also helps cover some medical services that Medicare Part A doesn't cover, such as physical and occupational therapies, and preventive services like mammography and prostate screenings.
Enrollment in Medicare Part B is optional. However, to be eligible for a Medicare supplement or Medicare Advantage plan, you must continue to pay your Part B premium if not otherwise paid for under Medicaid or by another third party.
Medicare Part D—Prescription Coverage
Introduced in 2006, Medicare Part D is a voluntary prescription drug program available to help people with Medicare pay a portion (or all) of the cost of their prescription medications. Part D coverage, like Original Medicare, can protect you from high and unexpected costs, so plan ahead. Even if you don't take any prescriptions today, you may need them in years to come.
Medicare Part D plans can only be purchased through a private insurance company like Blue Cross Blue Shield of Massachusetts. To get Medicare Part D prescription coverage, you can purchase a standalone Part D prescription plan or you can enroll in a Medicare Advantage health plan with Part D prescription coverage.
Links to Helpful Sites
To learn more about your options for Medicare benefits and prescription coverage, helpful resources are available.
For additional information about other health plans for seniors available in Massachusetts, you can call the Massachusetts Executive Office of Elder Affairs at 1-800-AGE-INFO (1-800-243-4636), (TTY: 1-877-610-0241), Monday through Friday, 9 a.m. to 5 p.m. ET. You can also visit Mass.gov or the Massachusetts Division of Insurance.
The SHINE Program, Massachusetts' state health insurance program, provides free, one-on-one health insurance information, counseling, and assistance to Medicare beneficiaries of all ages. Call SHINE toll-free at 1-800-AGE-INFO (1-800-243-4636), and press "2" (TTY: 1-800-872-0166), Monday through Friday, 9 a.m. to 5 p.m. ET. Or learn more about the programs here.
For information anytime, 24 hours a day, seven days a week, the federal government has a Medicare information telephone line and website. Call 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048) or visit the Medicare website at Medicare.gov.
Social Security Administration
Finally, you can call the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778) for help with questions about eligibility and enrolling in Medicare, and for questions about help with the costs of a Medicare Part D prescription plan.