How Medicare Works in Massachusetts

Medicare in Massachusetts works the same way it does everywhere else in the United States — the federal government runs the program, not the state. You become covered on the first day of the month you turn 65, or after you have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease. Massachusetts does not add extra state requirements or create a separate state version of Medicare.

What is different in Massachusetts is what happens after you have Medicare. The state runs its own Medicaid program called MassHealth, which can wrap around your Medicare coverage and pay costs Medicare does not cover. Many seniors in Massachusetts use both programs together. This guide focuses on the federal Medicare requirements that explore to you as a Massachusetts resident.

Key Takeaways

  • You become covered by Medicare automatically the month you turn 65 if you have already been receiving Social Security for at least four months.
  • If you are not yet receiving Social Security at 65, you must contact Social Security to enroll in Medicare yourself, or you will face a permanent penalty on your premiums.
  • Massachusetts residents can layer MassHealth coverage on top of Medicare to cover costs like deductibles and copayments that Medicare does not pay.
  • You have a seven-month window around your 65th birthday to enroll without penalty; missing this window costs you more money for life.
  • If you are still working at 65 and have health insurance through your job, you may be able to delay Medicare enrollment without penalty, but you must tell Social Security this is your situation.

The Age Requirement and When Coverage Starts

You are covered by Medicare starting the first day of the month you turn 65, with one condition: you must have already been receiving Social Security retirement benefits for at least four months before that month. If you turned 65 in March, for example, you need to have been on Social Security since November or earlier. If you meet this timing, Medicare starts automatically — you do not have to do anything.

If you turn 65 but have not yet started Social Security, you must contact Social Security yourself to enroll in Medicare. Call Social Security at 1-800-772-1213 or visit your local Social Security office. Do not assume you will be enrolled automatically. If you miss the important date, you will pay a permanent 10 percent surcharge on your Part B premium for every year you are on Medicare — that penalty never goes away.

The Seven-Month Enrollment Window

Your Initial Enrollment Period is a seven-month window: three months before the month you turn 65, the month you turn 65, and three months after. If you turn 65 in June, your window runs from March through September. During this window, you can enroll in Medicare Part A (hospital insurance) and Part B (medical insurance) without any penalty.

If you miss this window, you can still enroll later, but you will pay a permanent penalty. Part A has no penalty if you have worked long enough to may have access to, but Part B adds 10 percent to your premium for every 12 months you delayed. That surcharge stays on your bill for as long as you have Medicare. The only exception is if you were covered by a group health plan through your own job (not your spouse's) when you turned 65 — in that case, you have until eight months after you leave that job to enroll without penalty.

Work and Health Insurance at 65

If you are still working at 65 and your employer offers health insurance, you can delay Medicare enrollment without penalty — but only if your employer has 20 or more employees. You must tell Social Security that you are delaying because of current employment. Call 1-800-772-1213 and explain your situation. Social Security will note this on your record.

When you finally leave your job or lose that health insurance, you have eight months to enroll in Medicare without penalty. Do not wait longer than eight months. If you do, the Part B penalty applies. Your employer's health insurance will coordinate with Medicare once you enroll — Medicare becomes primary, and the employer plan pays secondary.

Part A and Part B Coverage in Massachusetts

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years (40 quarters). If you do not meet this requirement, you can buy Part A, but the cost varies based on how many quarters you have paid.

Part B covers doctor visits, outpatient care, lab tests, and medical equipment. Everyone pays a monthly premium for Part B — the amount depends on your income. In 2024, the standard premium is $164.90 per month, but higher-income seniors pay more. Massachusetts residents pay the same Part B premium as residents everywhere else. You also pay a yearly deductible ($240 in 2024) and 20 percent of the cost of most services after the deductible.

MassHealth and Medicare Together

If your income is low enough, you may be covered by MassHealth, Massachusetts's Medicaid program, at the same time you have Medicare. MassHealth can pay your Medicare premiums, deductibles, and copayments. This is called a "dual may be able to access" situation. You do not have to choose between them — you have both.

To learn about you may have access to for MassHealth, contact the MassHealth Customer Service Center at 1-800-841-2900 or visit mass.gov/masshealth. Income limits change each year, and they are higher in Massachusetts than in many other states. If you are already on MassHealth when you turn 65, your coverage will continue, but you must also enroll in Medicare Part A and Part B.

Part D and Prescription Drug Coverage

Part D is prescription drug coverage run by private insurance companies approved by Medicare. It is not automatic — you must choose a plan and enroll. You have the same seven-month window as you do for Part A and Part B. If you miss this window and do not have other drug coverage, you will pay a permanent penalty when you finally enroll.

In Massachusetts, you can compare Part D plans using Medicare's official tool at Medicare.gov. Plans change every year, so even if you enrolled last year, you should review your options each fall during the annual open enrollment period (October 15 to December 7). If your current plan no longer covers a medication you take, you may be able to switch plans outside the normal enrollment window.

Frequently Asked Questions

Do I have to enroll in Medicare if I am still working at 65?

Not if your employer has 20 or more employees and offers you health insurance. You can delay without penalty, but you must tell Social Security you are delaying because of current work coverage. Once you leave that job, you have eight months to enroll. If you work for a small employer (fewer than 20 employees), you should enroll in Medicare even if you have employer coverage.

What happens if I miss the seven-month enrollment window?

You can enroll later, but you will pay a permanent penalty on Part B (10 percent per year of delay) and Part D (1 percent per month of delay). These penalties never go away. The only exception is if you had group health insurance through your own job when you turned 65 — then you have until eight months after you leave that job.

Can I have both Medicare and MassHealth?

Yes. If your income is low enough to may have access to for MassHealth, you can have both programs at the same time. MassHealth will pay costs that Medicare does not cover, like deductibles and copayments. Contact MassHealth at 1-800-841-2900 to learn about you may have access to.

Do I need to do anything special to enroll in Medicare in Massachusetts?

No. The process is the same as anywhere else. If you are already receiving Social Security when you turn 65, you are enrolled automatically. If not, contact Social Security at 1-800-772-1213 or visit your local office. You can also enroll online at ssa.gov.

What if I am not a U.S. citizen but live in Massachusetts?

You must be a U.S. citizen or a lawful permanent resident (green card holder) who has lived in the United States for at least five years to may have access to for Medicare. If you meet these requirements, the enrollment process is the same. If you have questions about your immigration status and Medicare, contact Social Security directly.