Massachusetts has one of the most distinctive Medicare markets in the country. About 525,000 Massachusetts residents were enrolled in a Medicare Advantage plan in 2026, roughly 36% of the state's 1.46 million Medicare-eligible beneficiaries. That penetration rate is well below the national average of 54%, largely because Massachusetts has unusually strong consumer protections for Medigap (Medicare Supplement) plans, making Medigap a more viable long-term option here than in most states.
The state offers 103 MA plans for 2026, up from 96 in 2025. Average premiums run about $38 per month, higher than the national MA average of $14 but reasonable — for context on whether the Medigap vs Medicare Advantage route might suit you better, compare both tracks given the state's elevated healthcare costs and the richer supplemental benefits many plans include. At least one $0-premium plan is available in every Massachusetts county. Key carriers are UnitedHealthcare, Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, Fallon Health, Humana, and newer entrant Mass General Brigham Health Plan.
One critical distinction: MassHealth is the state's Medicaid program, not a Medicare Advantage plan. Residents who qualify for both MassHealth and Medicare are dual eligible and can enroll in a Dual Special Needs Plan (D-SNP) that coordinates both programs. This guide covers the 2026 Massachusetts MA market, key enrollment dates, how MA compares to the state's unique Medigap options, and what to look for when shopping. Annual Election Period is October 15 to December 7, 2026.
2026 Medicare Advantage Market Overview in Massachusetts
In 2026, Massachusetts has 103 Medicare Advantage plans available, with 525,000 beneficiaries enrolled (36% MA penetration). The average monthly premium is $38 and the statewide average Star Rating is 4.0.
Top Medicare Advantage carriers in Massachusetts (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| UnitedHealthcare | 18 | 4.3 | $29/mo |
| Blue Cross Blue Shield of Massachusetts | 12 | 4.5 | $107/mo |
| Tufts Health Plan | 15 | 4.0 | $151/mo |
| Fallon Health | 10 | 4.0 | $161/mo |
| Humana | 12 | 4.0 | $22/mo |
| Aetna | 10 | 3.8 | $18/mo |
| Mass General Brigham Health Plan | 6 | 4.0 | $45/mo |
| WellCare | 8 | 3.5 | $0/mo |
Source: CMS Medicare Plan Finder Q4 2025, KFF Medicare Advantage 2026 Spotlight, NerdWallet MA Medicare Advantage 2026, MoneyGeek MA Medicare Advantage 2026
Plan Types in Massachusetts: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in Massachusetts| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| HMO / HMO-POS | 55 | $42/mo | Lower MOOP, willing to use a defined network |
| PPO | 35 | $48/mo | Flexibility to see out-of-network providers at higher cost share |
| Special Needs Plan (SNP) | 10 | $0/mo | Dual-eligible (MassHealth + Medicare), chronic conditions, institutional care |
| Private Fee-for-Service (PFFS) | 3 | $18/mo | Provider flexibility without referrals; rare in MA |
HMO and HMO-POS plans make up roughly 53% of Massachusetts MA plans. PPO grew in 2025-2026 due to network disruption from Mass General Brigham's plan participation changes.
Source: CMS Medicare Plan Finder Q4 2025, MoneyGeek MA 2026
County-Level Variance in Massachusetts
Massachusetts has 14 counties and plan availability varies across them. Metropolitan areas around Boston (Suffolk, Middlesex, Norfolk) have the most carrier competition. Western counties (Berkshire, Franklin, Hampshire) have fewer options and somewhat higher premiums. County penetration rates range from 17% in Berkshire County to 44% in Worcester County.
Plan count and average premium by county in Massachusetts| County | Plans Available | Avg Premium |
|---|
| Suffolk County (Boston) | 45 | $32/mo |
| Middlesex County | 40 | $35/mo |
| Worcester County | 43 | $54/mo |
| Hampden County (Springfield area) | 18 | $28/mo |
| Berkshire County | 8 | $52/mo |
Plan counts are approximate based on CMS Medicare Plan Finder Q4 2025 data. County penetration figures from healthinsurance.org citing CMS state/county penetration data. Run a ZIP-code search at medicare.gov for exact plans available to you.
Source: CMS Medicare Plan Finder Q4 2025, healthinsurance.org MA Medicare
What to Look For in a Medicare Advantage Plan in Massachusetts
Choosing a Medicare Advantage plan in Massachusetts means weighing network access, cost structure, and the state's unique Medigap alternative. Here's what matters most in 2026:
- Provider network, including Mass General Brigham access. A major 2026 development: MGB primary care providers dropped out of UnitedHealthcare and BCBS MA MA networks. If MGB is your health system, verify your plan includes MGB physicians before enrolling. Tufts, Aetna, and MGB Health Plan remain in-network with MGB.
- Maximum out-of-pocket (MOOP). Massachusetts plans vary widely: Fallon Health averages $3,400 MOOP, while some UHC and Aetna plans set MOOP as high as $6,750. The federal MA in-network MOOP ceiling for 2026 is $9,250. Lower MOOP protects you if you need major care during the year.
- Prescription drug formulary. Most MA plans include Part D. The 2026 Part D annual out-of-pocket cap is $2,100 across all plans. Check that your specific drugs are on the formulary at a tier you can manage, especially for brand-name or specialty medications.
- Star Ratings. CMS rates plans 1-5 stars on care quality, member experience, and customer service. In Massachusetts, BCBS MA holds 4.5 stars and several UHC plans hold 5 stars. Higher-rated plans often provide richer supplemental benefits funded by CMS quality bonuses.
- Supplemental benefits (dental, vision, hearing, fitness). Original Medicare does not cover routine dental, vision, or hearing. Most Massachusetts MA plans include some level of these. Check annual dollar limits and whether the plan covers procedures beyond cleanings and exams.
- Prior authorization requirements. MA plans may require prior authorization for specialist visits, imaging, and surgical procedures. If you have a chronic condition or expect significant care, review the plan's prior authorization list and check CMS denial rate data before enrolling.
- MA vs Medigap comparison. Massachusetts is one of only a handful of states with continuous Medigap guaranteed issue, meaning you can apply for Medigap without medical underwriting during the annual February 1 to March 31 open enrollment window. If you value provider freedom and can afford Medigap premiums ($150-$300/month), that route is more viable in Massachusetts than in most states.
Key Medicare Dates in Massachusetts
Medicare enrollment windows are firm. Missing a deadline can delay coverage or trigger late-enrollment penalties.
- Annual Election Period (AEP): October 15 to December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change Part D plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 to March 31, 2026 — Existing MA enrollees only: switch to a different MA plan or return to Original Medicare. One switch allowed.
- Massachusetts Medigap Annual Open Enrollment: February 1 to March 31, 2026 — Massachusetts-specific: guaranteed issue period for Medigap. Apply for or switch between Medigap plans (Core, Supplement 1, Supplement 1A) without medical underwriting. All MA Medigap insurers also accept applications year-round.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your birthday month, includes the birth month, and runs 3 months after. Enroll in Medicare Parts A and B, then choose MA or Original Medicare plus Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving, losing employer coverage, qualifying for MassHealth (dual-eligible), or other life events. Dual-eligible beneficiaries can switch MA plans once per quarter in Q1, Q2, and Q3.
Notable Extras in Massachusetts Plans
Massachusetts has several state-specific features that make its Medicare market different from most states:
- Unique Medigap plan designs: Massachusetts uses three proprietary Medigap plan designs rather than the standardized A-through-N plans used in every other state: Medicare Core Plan, Supplement 1, and Supplement 1A. Supplement 1 provides the most comprehensive coverage. These non-standard designs mean you can't directly compare MA Medigap plans to plans in other states.
- Guaranteed issue Medigap (annual + continuous): Massachusetts requires an annual guaranteed issue window (February 1 to March 31) for Medigap enrollment and plan switching without medical underwriting. Beyond that, all Massachusetts Medigap insurers accept applications year-round with guaranteed issue for eligible applicants. Massachusetts also prohibits charging higher premiums to disabled Medicare beneficiaries under age 65. This makes Medigap far more accessible here than in most states.
- MassHealth and dual eligibility (D-SNPs): MassHealth is Massachusetts's Medicaid program. It is not a Medicare Advantage plan. Residents who qualify for both MassHealth and Medicare are dual eligible and can enroll in a Dual Special Needs Plan (D-SNP), which coordinates both programs into one plan, typically with $0 premiums and $0 copays for most services. WellCare and other carriers offer D-SNPs in Massachusetts for 2026.
- Mass General Brigham network disruption: Starting in 2026, Mass General Brigham primary care providers are no longer in-network with UnitedHealthcare or Blue Cross Blue Shield of Massachusetts Medicare Advantage plans. MGB remains in-network with Tufts Health Plan, Aetna, and Mass General Brigham Health Plan. If you see MGB providers, this network change is the single most important factor to check when choosing a 2026 MA plan.
Medicare Advantage vs Original Medicare in Massachusetts
Original Medicare (Parts A and B) plus a Massachusetts Medigap plan and a standalone Part D drug plan gives you broad provider freedom and no prior authorization for most services. Monthly cost for Medigap Supplement 1 (the most comprehensive plan) plus Part D typically runs $200-$350 per month in Massachusetts, depending on your age and the carrier. Medicare Advantage bundles hospital, medical, and drug coverage into one plan at an average of $38 per month statewide, but restricts you to a carrier network and often requires prior authorization for specialist visits, imaging, and surgeries.
Massachusetts is a stronger state for Medigap than most others. The annual guaranteed issue window (February 1 to March 31) and year-round acceptance by insurers mean you have more flexibility to switch between MA and Medigap over time than beneficiaries in states that use medical underwriting. This is why MA's penetration rate (36%) is substantially below the 54% national average: many Massachusetts beneficiaries choose Original Medicare plus Medigap for the long-term certainty.
The MA route wins on premium and extras. At $38 per month statewide average versus $200-$350 for Medigap plus Part D, Medicare Advantage saves $150-$300 per month for someone who stays in-network and doesn't use heavy care. MA plans also include dental, vision, hearing, and fitness benefits that Medigap does not. The calculus shifts if you need frequent specialist access, want to see MGB providers who are no longer in some MA networks, or spend time out of state.
Star Ratings in Massachusetts and how to use them
CMS publishes Medicare Advantage Star Ratings every October, scoring plans 1 to 5 stars on roughly 40 quality measures: preventive care rates, chronic disease management, member experience scores, drug safety, and customer service. Plans rated 4 stars and above receive quality bonus payments that carriers often reinvest as richer benefits the following year.
In Massachusetts, the 2026 market is well above average on Star Ratings. BCBS MA holds 4.5 stars. UnitedHealthcare's top plans hold 5 stars. Tufts Health Plan and Fallon Health sit at 4.0 stars. Mass General Brigham Health Plan also holds 4.0 stars. The one notable lower-rated carrier is WellCare, which focuses on dual-eligible enrollees. The statewide weighted-average is approximately 4.0, slightly above the national average of 3.8.
Plans with a 5-star rating trigger a Special Enrollment Period that lets you switch into them any time of year, not just during AEP. If UnitedHealthcare maintains 5-star status in 2026, that SEP applies. Check medicare.gov Plan Compare to confirm current year ratings before enrolling outside AEP.
How to enroll in Medicare Advantage in Massachusetts
Step 1: Confirm you're enrolled in Medicare Parts A and B. You must have both to join any MA plan. If you're approaching 65, enroll in Parts A and B during your 7-month Initial Enrollment Period centered on your birthday month. You can enroll at ssa.gov or by calling 1-800-MEDICARE.
Step 2: Compare plans on medicare.gov Plan Compare. Enter your ZIP code and your current prescription drugs to see the plans available in your area with accurate premium, copay, and formulary data. Massachusetts residents should also check whether their specific MGB, Partners, or other health system doctors are in-network under each plan providers are in-network with each plan being compared.
Step 3: Enroll during the right window. For most people, that's AEP (October 15 to December 7). New to Medicare: use your Initial Enrollment Period. Already in an MA plan and want to switch: use MA OEP (January 1 to March 31). Dual-eligible beneficiaries (MassHealth + Medicare): you can change MA plans once per quarter. Contact SHINE (Serving the Health Insurance Needs of Everyone) at 1-800-AGE-INFO for free Massachusetts-specific Medicare counseling.
How to enroll in Medicare Advantage in Massachusetts detail| Enrollment Window | Who Can Use It | Dates |
|---|
| Annual Election Period (AEP) | Any Medicare beneficiary | Oct 15 to Dec 7, 2026 |
| MA Open Enrollment Period (MA OEP) | Current MA enrollees only | Jan 1 to Mar 31, 2026 |
| Initial Enrollment Period (IEP) | Turning 65 / newly eligible | 7 months around 65th birthday |
| 5-Star SEP | Anyone; into a 5-star plan only | Year-round |
| Dual-Eligible SEP | MassHealth + Medicare enrollees | Once per quarter (Q1-Q3) |
Massachusetts SHINE program offers free unbiased Medicare counseling: call 1-800-AGE-INFO (1-800-243-4636).
Frequently Asked Questions
How many Medicare Advantage plans are available in Massachusetts in 2026?
Massachusetts has 103 Medicare Advantage plans available statewide in 2026, up from 96 plans in 2025. The exact number available to you depends on your county and ZIP code. Boston-area counties (Suffolk, Middlesex, Norfolk) have the most options, with 40 or more plans. Rural western counties like Berkshire may have 8 or fewer plans. Enter your ZIP code at medicare.gov Plan Compare to see your exact options.
What is the average Medicare Advantage premium in Massachusetts for 2026?
The statewide average Medicare Advantage premium in Massachusetts is about $38 per month in 2026, which is higher than the national MA average of $14. Massachusetts premiums are higher because the state has elevated healthcare costs overall and many plans include richer supplemental benefits. At least one $0-premium plan is available in every county. Premiums for PPO plans with broad networks run $45-$160 per month.
Which carriers offer Medicare Advantage plans in Massachusetts in 2026?
The main carriers offering MA plans in Massachusetts in 2026 are UnitedHealthcare, Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, Fallon Health, Humana, Aetna, Mass General Brigham Health Plan, and WellCare. BCBS MA and UHC carry the highest Star Ratings (4.5 and 5 stars, respectively). Fallon Health has the lowest average MOOP ($3,400), which matters if you need significant care during the year.
Is Mass General Brigham in-network with Medicare Advantage plans in 2026?
It depends on the plan. Starting in 2026, MGB primary care providers dropped out of the UnitedHealthcare and Blue Cross Blue Shield of Massachusetts MA networks. MGB remains in-network with Tufts Health Plan, Aetna, and Mass General Brigham Health Plan's own MA products. If you see MGB doctors or use MGB hospitals, verify in-network status before enrolling in any 2026 MA plan.
What makes Massachusetts Medigap different from other states?
Massachusetts is one of only a small number of states that standardizes Medigap differently. It uses three plan types: Medicare Core Plan, Supplement 1, and Supplement 1A instead of the A-through-N designs used in other states. More importantly, Massachusetts requires an annual guaranteed issue enrollment window (February 1 to March 31) and all MA Medigap insurers accept applications year-round without medical underwriting for eligible applicants. Massachusetts also cannot charge disabled Medicare beneficiaries under 65 higher premiums. This makes Medigap a stronger long-term option here than in most states.
What is MassHealth and how does it relate to Medicare Advantage?
MassHealth is Massachusetts's Medicaid program. It is not a Medicare Advantage plan. If you qualify for both MassHealth and Medicare (called dual eligible), you can enroll in a Dual Special Needs Plan (D-SNP), which coordinates both programs into one plan. D-SNPs typically offer $0 premiums, $0 copays for most services, and no drug costs. WellCare and other carriers offer D-SNPs in Massachusetts for 2026. Contact MassHealth at 1-888-665-9993 to check your eligibility.
When can I sign up for Medicare Advantage in Massachusetts?
The main enrollment window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage starting January 1, 2027. New to Medicare: use your 7-month Initial Enrollment Period around your 65th birthday. Already in an MA plan and want to switch: use the MA Open Enrollment Period (January 1 to March 31, 2026). Dual-eligible beneficiaries (MassHealth + Medicare) can switch MA plans once per quarter in Q1, Q2, and Q3. Anyone can switch into a 5-star-rated plan year-round under the 5-Star SEP.
Does Medicare Advantage cover prescription drugs in Massachusetts?
Yes, most Massachusetts Medicare Advantage plans include Part D prescription drug coverage built in (called MA-PD plans). The 2026 annual Part D out-of-pocket maximum is $2,100 across all plans (set by the Inflation Reduction Act). Insulin is capped at $35 per month. Always check the plan's formulary for your specific medications before enrolling. If your drugs are not on the formulary, you may face high costs or need to request a formulary exception.
