We reviewed top 26 Medicare Advantage Plans available in Franklin County, Massachusetts for 2024. Here's what we discovered:
- The average premium is $57.27 per month.
- The average out-of-pocket limit is $5,337 per year.
- The average drug plan deductible (for plans that include Part D) is $204.32 per year.
- The Centers for Medicare & Medicaid Services (CMS) rated 23% of all plans available in Franklin County 4 stars or higher.
- There are no 5-star plans available.
- There are 3 plan types to choose from, including PPO, HMO, HMO-POS, and possibly SNP plans, as well.
Franklin County, Massachusetts Medicare Advantage Plans
Franklin County, MA
Medicare Advantage Plan Information
Medicare Advantage (MA) plans provide an alternative to Original Medicare for people on Medicare living in Franklin County. The 26 plans available are offered by Medicare-approved private companies that agree to provide coverage by Medicare's rules. MA plans, also known as Medicare Part C, can offer additional benefits unavailable through Original Medicare.
Prescription medication coverage is often included as an additional benefit. Plans that include prescription coverage are called Medicare Advantage Prescription Drug Plans (or MAPDs). They help Franklin County people on Medicare reduce their premiums and/or out-of-pocket costs.
The highest-rated Medicare Advantage plans in Massachusetts have a CMS star rating of 4.0 stars or better. These plans are where many people start their search. See: medicarewire.com/medicare-advantage/massachusetts/
3 Plan Types Available in Franklin County
A notable advantage of Medicare Advantage plans lies in their diverse range of plan types. While the most prevalent options are HMOs and PPOs, several other plan types exist, although availability varies by region. In Franklin County, people on Medicare (beneficiaries) can access 3 distinct plan types, each offering unique benefits. Here's an overview of what each plan type provides:
Health Maintenance Organization (HMO) members usually receive services through the plan's local network of providers. Referrals are typically required to see a specialist and other providers. However, plans allow out-of-network care for emergencies and out-of-area dialysis. Prescription drug coverage is often included in HMO plans, and many plans include some coverage for dental, vison, and hearing.
Preferred Provider Organization (PPO) members can usually use in-network and out-of-network providers for care, including hospitalization. However, visits to non-network providers could cost significantly more. PPO plans often include prescription drug coverage and other benefits, and referrals are typically not required for specialist visits.
An HMO-POS (point-of-sale) plan offers the same features as an HMO plan. There is however one major difference. HMO-POS plans allow members to access healthcare providers outside of the plan's network to receive some or all of their services. In most cases, to go out of the plan's network a member will need to get a referral from their physician. Plus, there are separate deductibles for in-network and out-of-network services.
How-To Enroll in a Medicare Advantage Plan
The majority of residents aged 65 and above in County, Franklin, are eligible to enroll in a Medicare Advantage plan. Nonetheless, it's important to note that not all of the top-rated Medicare Advantage Plans in Massachusetts are accessible in the area.
You are only allowed to join, drop or change Medicare Advantage plans during a Medicare Election Period. The period between October 15 and December 7 is the Annual Enrollment Period. That's when most people join or change their Medicare Advantage and Medicare Part D plans or go back to Original Medicare.
You also have a 7-month Individual Election Period (IEP). Your IEP begins three calendar months before your 65th birthday and continues for three months after your birth month. If you get Social Security Disability Insurance (SSDI), your IEP starts on the 25th month of your benefits.
Adding Medicare Part D for Prescription Coverage
Some Medicare beneficiaries may be eligible for a standalone prescription drug plan. Also known as a PDP, or Part D plan, a standalone prescription plan provides coverage for prescription drugs to Original Medicare and Medicare Advantage plans that do not include Part D.
It is important to know that most Medicare Advantage plans include prescription drug coverage and may not allow members to sign up for a separate drug plan. Medicare rules do not allow you to be enrolled in plans that offer overlapping benefits.
Medicare Advantage Is Just One Option in Franklin County
If you are concerned that a private health plan may limit your care, or that the pros and cons of Franklin County Medicare Advantage plans are too confusing, Medicare Advantage is not the only way to get more coverage. Another option is to hold on to your Original Medicare and additional coverage with a Massachusetts Part D Plan (prescription coverage) and a Massachusetts Medigap plan to help cover some of your deductibles, copayments, and coinsurance.
If you are not aware of the benefits of Medicare Supplement Insurance, and how it helps pays medical bills from an extended illness or hospital stay, check out our Medigap page and compare Medicare supplement plans in your area. All Medicare supplements are standardized and regulated. That means you can go with the lowest cost policy and get all of the same benefits.
IMPORTANT: Medicare Advantage and Medicare Supplements are not compatible insurance. Medicare Supplements work with Original Medicare and cannot be purchased while you are enrolled in Medicare Advantage.
Franklin County Special Needs Plans (SNP)
Some Americans may have special circumstances, including institutional care, care for chronic health conditions, and dual eligibility for both Medicare and Medicaid. If you or a loved one have one of these special needs, look into the availability of a Medicare Advantage Special Needs Plan (SNP).
MedicareWire catalogs Medicare SNP plans available in Franklin County, Massachusetts in their own directory. We do this because Special Needs Plans are designed specifically for three types of people:
- People in a nursing home or receiving skilled nursing care at home;
- People with both Medicare and Medicaid benefits; and
- People with certain chronic health conditions.
The MA and MAPD plans on this page are available to people on Medicare enrolled in both Medicare Part A and Part B living in Ashfield, Bernardston, Charlemont, Colrain, Conway, Deerfield, Erving, Gill, Greenfield, Leverett, Millers Falls, Montague, Northfield, Orange, Shelburne Falls, Shutesbury, South Deerfield, Sunderland, Turners Falls, and all other areas of Franklin County, Massachusetts.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- CMS.gov, "2024 Medicare Part C Landscape Source Files", Last Accessed October 14, 2023
- CMS.gov, "2024 Part C and D Performance Data", Last Accessed October 14, 2023
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 18 June, 2022
- MedicareWire.com, "Special Needs Plans", Last Accessed 15 June, 2023
- Medicare.gov, "What's Medicare Supplement Insurance (Medigap)?", Last Accessed 22 May, 2023
Data & Statistics
The data presented on this page is derived from the 2024 Landscape Source Files and the Part C and D Performance Data published by CMS.
The average premium, average out-of-pocket limit, and average drug plan deductible statistics for Franklin County, Massachusetts are derived from the most recent Landscape Source Files, excluding employer, MMP and SNP plans. MedicareWire publishes Special Needs Plans here.
Star rating statistics are derived from the most recent Part C and D Performance Data, excluding employer, MMP, SNP, and plans that have not yet been rated by CMS.
Highest-Rated Medicare Advantage Plans
CMS publishes the Medicare Advantage and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by people on Medicare in Franklin County. MedicareWire highlights plans rated 4.0 or better as "highest-rated" or "top-rated" because they received the overall highest summary rating from CMS. According to CMS, "The Star Ratings system helps Medicare consumers compare the quality of Medicare health and drug plans being offered so they are empowered to make the best health care decisions for them."