Health Care Programs Many Massachusetts Older Adults Don’t Know They Might Qualify For: Help with Health Insurance Costs is Available 

Navigating health care coverage can feel overwhelming, especially for older adults trying to balance rising medical costs, prescription expenses, and the complexities of Medicare. The good news is that many Massachusetts residents may qualify for programs that can significantly reduce health care costs — even if they believe their income or savings are too high. 

From help paying Medicare premiums to prescription assistance and home care support, several state and federal programs are designed to make health care more affordable and accessible for older adults living in Massachusetts. Free benefits counseling and enrollment assistance can also help people identify programs and complete applications. 

SHINE: Free Medicare Help for Massachusetts Residents 

One of the most underutilized resources in Massachusetts is the SHINE program, which stands for Serving the Health Insurance Needs of Everyone. SHINE offers free, unbiased counseling to help people understand Medicare and compare coverage options. 

Many adults approaching age 65 don’t realize they must actively enroll in Medicare or review their options carefully to avoid penalties or gaps in coverage. SHINE counselors can explain: 

• Medicare enrollment rules  

• Medicare Advantage and Medigap options  

• Prescription drug coverage  

• Programs that help lower costs  

• How to avoid late enrollment penalties  

SHINE counselors are specially trained and certified by the Massachusetts Executive Office of Elder Affairs. 

More information is available through Mass.gov and Medicare.gov. 

MassHealth Isn’t Just for Very Low Income Residents 

Many older adults assume they earn too much or have too many assets to qualify for MassHealth, Massachusetts’ Medicaid program. In reality, there are several MassHealth programs with higher income limits and different eligibility rules. 

People often only think about MassHealth Standard or CommonHealth, but additional programs may provide support with: 

• Medicare premiums  

• Copayments and deductibles  

• Long-term services and supports  

• Home care services  

Some programs do not include an asset test, meaning savings and property may not automatically disqualify someone from receiving assistance. 

Massachusetts residents should not assume they are ineligible without speaking to a counselor or applying. 

Medicare Savings Programs Can Lower Health Care Costs 

The Medicare Savings Programs (MSPs) are among the most overlooked forms of financial assistance available to older adults with Medicare. 

MSPs are administered through MassHealth and help pay for: 

• Medicare Part B premiums  

• Deductibles  

• Coinsurance and copayments  

• Prescription costs in some cases  

Importantly, these programs are not insurance plans. Instead, they help reduce out-of-pocket Medicare expenses. 

According to MassHealth, Massachusetts residents with incomes at or below 225% of the Federal Poverty Level may qualify. Unlike some other programs, MSPs generally do not require an asset test. Another benefit is that eligibility is often determined individually rather than combining household income as a couple. 

Many people who never considered themselves eligible for public assistance may still qualify for substantial savings through an MSP. 

Understanding Medicare Advantage Plans 

Choosing how to receive Medicare benefits is an important decision that affects: 

• Monthly costs  

• Access to doctors and hospitals  

• Prescription coverage  

• Out-of-pocket expenses  

Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans provide all the coverage included in Original Medicare (Part A and Part B) and often include additional benefits such as: 

• Dental coverage  

• Vision services  

• Hearing benefits  

• Prescription drug coverage  

Unlike Original Medicare, Medicare Advantage plans include a yearly maximum out-of-pocket limit, which can provide financial protection from unexpectedly high medical costs. 

However, these plans may also: 

• Require members to use provider networks  

• Require referrals for specialists  

• Require prior authorization for some services  

Because plan benefits and costs can change yearly, Medicare beneficiaries should review their coverage annually during Open Enrollment, which runs from October 15 through December 7. 

Massachusetts residents who are new to Medicare Advantage may also have special “trial rights” allowing them to switch back to Original Medicare and purchase a Medigap plan within certain timeframes. 

Medigap Plans Help Cover Medicare’s Gaps 

Original Medicare does not cover every medical expense. Deductibles, copayments, and coinsurance can add up quickly. 

Medigap, also called Medicare Supplement Insurance, helps pay many of these out-of-pocket costs. These plans are sold by private insurance companies and are available to people enrolled in Original Medicare Part A and Part B. 

For some Massachusetts residents, Medigap can provide greater flexibility because it allows access to providers nationwide who accept Medicare. 

The Frail Elder Waiver Can Help People Stay at Home 

Despite its name, the Frail Elder Waiver is not limited to people who consider themselves “frail.” 

This MassHealth program helps older adults remain safely in their homes instead of moving into a nursing facility. Individuals who may be at risk of needing long-term care or who require certain home-based services may qualify. 

The program can provide support such as: 

• Personal care assistance  

• Home-delivered meals  

• Adult day health services  

• Homemaking support  

• Care coordination  

The Frail Elder Waiver also has higher income limits than many people expect, making it another important program older adults should explore before assuming they are ineligible. 

Prescription Advantage Helps Lower Medication Costs 

Prescription medications can place a major financial strain on older adults, even for those with Medicare Part D coverage. 

Prescription Advantage is a Massachusetts state-sponsored prescription assistance program that helps residents age 65 and older reduce medication costs and fill gaps in prescription coverage. 

The program may help: 

• Reduce copayments  

• Assist during Medicare Part D coverage gaps  

• Provide primary prescription coverage for some individuals not eligible for Medicare  

Many Massachusetts residents with incomes up to 500% of the Federal Poverty Level may qualify. 

Prescription Advantage is especially valuable because even middle-income older adults may still be eligible for assistance. 

Don’t Assume You Don’t Qualify 

One of the biggest barriers preventing older adults from accessing help is the assumption that they earn too much or own too many assets to qualify. 

Massachusetts offers a wide range of programs designed to help older adults remain healthy, independent, and financially stable. Even individuals with moderate incomes may qualify for assistance that saves hundreds or even thousands of dollars each year. 

If you or a loved one has questions about Medicare, MassHealth, prescription assistance, food assistance, or home care support, speaking with a SHINE counselor, a Benefits Enrollment Center, or an aging services professional can help identify options you may not know are available. 

For more information, visit: 

• Medicare.gov  

• Mass.gov  

• NCOA.org – Benefits Enrollment Centers 

• PrescriptionAdvantageMA.org