Categories: Medicare

Underserved Seniors in Massachusetts Need our Help.

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 US managed healthcare insurance, came on the scene with the Balanced Budget Act of 1997. With its annual out-of-pocket maximum benefits (a cap on the most one can pay for medical expenses covered by the plan), Medicare Advantage brought valuable financial protection to the seniors in the US and is the most affordable for those with limited resources.

According to Aetna in 2018, Medicare Advantage enrollment is 50% among eligible seniors in at least five states. The average across all states is 30%. In Massachusetts only 18% of eligible seniors are enrolled in a Medicare Advantage plan. 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. 

A Senior Care Option (SCO) Special Needs Plan (SNP) 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 Medicare Advantage SCO SNPs offer a proactive healthcare model that include a team that is tailored to their specific goals and needs.  There are exceptions, but generally one is eligible for a SCO SNP if one:

  • Is age 65 or older and,
  • Has MassHealth Standard (lowest level of Medicaid) and,
  • Is entitled to Medicare Part A and is enrolled Medicare Part B and,
  • Does not have End Stage Renal Disease and,
  • Lives in the plan’s service area

If one qualifies for a SCO SNP, 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 as as a senior.  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. MassOptions can connect our seniors to valuable community resources. Prescription Advantage is the state-sponsored prescription drug assistance program for seniors. 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 licensed, expert help to navigate the Medicare system there are local and licensed agencies such as North Shore Senior Healthcare.  

For more information contact:

Thank you in advance for your support.


Bill Bullen


North Shore Senior Healthcare, LLC

Licensed Insurance Agency #2180772

O: (781) 596-0174

Twitter: @Medicare_Update


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