Massachusetts is behind most states in Medicare Advantage enrollment among eligible beneficiaries. The result is many of our most vulnerable seniors are underserved. But there are ways to help.
Medicare Advantage, a type of United States managed healthcare insurance program with out-of-pocket maximum benefits, came on the scene with the Balanced Budget Act of 1997. Medicare Advantage brought valuable financial protection to the Medicare program and is most affordable for those with limited resources.
According to Aetna, in at least five states Medicare Advantage enrollment is 50% among eligible seniors. The average across all states is 30%. In Massachusetts only 18% eligible seniors are enrolled in Medicare Advantage. Regardless of the reason for this deficiency, there is a need for a greater outreach to help those seniors with limited resources learn more about their Medicare choices.
Dual Eligible Special Needs Plan (DSNP) serves beneficiaries eligible for both Medicare and MassHealth (Medicaid in Massachusetts). Those that qualify for these plans have zero cost options. Just as importantly these senior care option (SCO) programs offer a proactive healthcare model that include a team that is tailored to their specific goals and needs. There are exceptions, but generally you are eligible for Medicare Advantage Dual Special Needs Plans if you:
- Are age 65 or older
- Have MassHealth Standard (lowest level of Medicaid)
- Are entitled to Medicare Part A and are enrolled Medicare Part B
- Do not have End Stage Renal Disease
- Live in the plan’s service area
If one qualifies for DSNP Medicare Advantage plans, there is no deadline for enrollment; one can enroll year around. Many seniors I spoke with told me they received a letter stating they no longer qualified for MassHealth because they turned 65. They were unaware they could (and should) reapply for MassHealth. To help ensure all seniors in Massachusetts have the best healthcare available to them here are some resources you can use.
With the applicant present, to see if they qualify for Medicaid, call MassHealth. Other resources include our State Health Insurance Assistance Program (SHIP). In Massachusetts this is known as Mass Options. Massachusetts also has the SHINE (Serving the Health Insurance Needs of Everyone) Program which provides free health insurance information and counseling to all. For those that prefer in-home help to navigate the Medicare system, there are local and licensed agencies such as North Shore Senior Healthcare.
For more information contact:
Masshealth (800) 841-2900, http://www.mass.gov/eohhs/gov/departments/masshealth
Mass Options (844) 422-6277, www.masssoptions.org
SHINE: (800) 243-4636 press 3, or 5 if calling from a cell phone
Medicare (877) 829-1109, www.medicare.gov
North Shore Senior Healthcare (781) 596-0174, www.nsshealth.com