Medicare Advantage Plans in Massachusetts

Medicare Advantage plans combine the benefits of doctor and hospital coverage included in Medicare Parts A and B and also provide a prescription drug benefit. Medicare offers the Medicare Advantage plans through private insurance companies. Prices and services can vary, depending on the provider and county of residence in Massachusetts. Prior to enrolling in a Medicare Advantage plan, participants must first enroll in Original Medicare, Parts A and B, and continue the coverage.

Medicare PPO Blue PlusRx

• Blue Cross Blue Shield of Massachusetts offers the Medicare PPO Blue PlusRx plan in Bristol, Worcester, Barnstable, Suffolk, Essex, Plymouth, Franklin, Norfolk, Hampden, Middlesex and Hampshire counties. The PPO plan provides a network of medical service providers, including doctors and hospitals. Members can use providers outside of the network, but could face higher costs. Blue PlusRx benefits pay for doctor visits, inpatient hospital services, outpatient surgery and laboratory services. The plan also includes preventive services, such as eye examinations and hearing tests. Copayments and coinsurance can apply to services. The prescription drug benefit offers medications with copayments starting at $10 for generic drugs and $40 for name brands, as of November 2010. The plan can also pay for services not offered by Original Medicare, including annual physical examinations, preventive dental care and worldwide emergency care.

Tufts Medicare Preferred HMO Prime RX

• Tufts Associated Health Plans sells the Tufts Medicare Preferred HMO Prime Rx program. Members can choose a primary doctor from a network of over 1,600 physicians. The HMO plan can cover major medical expenses, including doctor visits, emergency care and hospital stays. Members can also receive benefits not included in Original Medicare, such as a yearly eyeglass allowance, hearing and vision examinations, and a fitness allowance for membership to a health club. Copayments, coinsurance and deductibles can apply to medical services. The prescription drug benefit has three tiers of coverage, with copayments starting at $10 for a 30-day supply of a single medication. Tufts offers the Prime Rx plan in Barnstable, Worcester, Bristol, Suffolk, Essex, Plymouth, Hampden, Norfolk, Hampshire and Middlesex counties.

Fallon Senior Plan Saver Enhanced Rx HMO

• The Fallon Senior Plan Saver Enhanced Rx HMO plan, sold by Fallon Community Health Plan, can cover routine physical examinations, office visits, specialist services, inpatient hospital stays, dental services, emergency care and outpatient surgery. The plan also includes a free membership to a participating health club and a Weight Watchers membership at no extra charge. Fallon offers the plan in Worcester and Hampden counties, along with certain areas of Franklin, Norfolk, Middlesex and Hampshire counties. The Saver Enhanced Rx HMO plan does not require a yearly deductible, but members must pay copayments and coinsurance. The drug benefit pays up to $2,840 each year for medications, with copayments starting at $3. The plan requires members to receive care from network providers and purchase all medications from network pharmacies, except in emergency situations.