During Fall insurance reenrollment time, I am regularly asked for advice about what Medicare plan to choose. Certainly the options can be confusing, especially to anyone just going onto Medicare. But I do know the details and have a clear opinion.
Traditional Medicare Is World’s Best PPO
Original or traditional Medicare is about the best insurance you can get. And much of it comes to you close to free from Uncle Sam, since everyone who worked paid Medicare taxes (except apparently some billionaires). You can choose any physician or health care institution you want. Pretty much every provider accepts Medicare. You can use it anywhere in the country. It gives you emergency coverage when you travel abroad. It covers most any medical treatment or supportive care you are likely to need, including preventive care. And you don’t need referrals to see a specialist or get another opinion.
Medicare Part A covers hospital care, while Part B covers outpatient care and testing. Part D covers drugs. Part C refers to the Medicare Advantage plans. The monthly cost of Part A and Part B are deducted from your Social Security check. You may see additional Medicare deductions related to Parts B and D from the IRRMA charge (Income-Related Monthly Adjustment Amount), which is based on your taxable income from two years’ prior.
Secondary (“Medigap”) Insurance Needed
With original Medicare you do want to get secondary insurance, sometime called a Medigap policy. The reason is that Medicare pays 80% of most inpatient and outpatient care, after an initial annual deductible of $257, leaving a 20% copayment for you. For office visits that usually is not much. But for a hospitalization or MRI or outpatient surgery that easily can be thousands of dollars. And there is a sizeable deductible for each hospitalization, now $1676, even before the 80% payment starts. The Medicare secondary policies, which are state licensed, cover those deductibles and copayments. In Massachusetts they also cover mental health care by therapists who do not participate in Medicare, an important but little-known state-specific benefit.
Which Type of Medigap Policy to Get?
Effectively there are two choices of Medigap policy in Massachusetts. One is the Core Supplement policy, which covers the 20% copayments but does not cover the hospitalization deductible, nor nursing home deductibles, nor foreign travel. The monthly premium is moderately lower by perhaps $1000 annually, but not worth the risk, in my estimate.
The better choice is the Supplement 1A policy, which covers the hospitalization and nursing home deductibles as well as foreign travel. The only out-of-pocket expense you would incur under Medicare in Massachusetts with a Supplement 1A policy is the initial annual deductible, currently $257 and scheduled to increase to $288 in 2026.
Just to add a bit of confusion, it is still possible to get a grandfathered Supplement 1 policy that is identical to the 1A policy except that it also covers that annual deductible. The pricing of such policies is typically higher than Supplement 1 by much more than that amount, making it a losing economic decision even if you are old enough to be eligible for it.
Is There a Preferred Supplement 1A Policy?
Yes, there is a clear winner. All Supplement 1A policies in Massachusetts by law offer the identical coverage that I summarized above. So the choice is primarily by cost (and service, if one has experience that relates to this choice). Currently the Blue Cross Supplement 1A (which BC markets as “Sapphire”) is the cheapest available at $233.25 monthly for 2026. In addition, the Blue Cross Sapphire plan includes some cash benefits for fitness that are worth about a month’s premium. Other companies’ 1A policies cost $100-$250 more per year. For the record, the various grandfathered Supplement 1 plans are $600-$700 more per year.
Did We Forget Drugs?
Yes. Medigap policies do not include drugs. They are covered under Medicare Part D. There are about a dozen drug plans offered in Massachusetts. Excellent but low-cost plans include WellCare that cost about $14 monthly, with initial drug deductibles of about $500. These plans have an out-of-pocket maximum of about $2000 (going to $2100 in 2026). You have to evaluate their individual formularies if you take expensive name-brand drugs to determine your best economic deal. The Medicare.gov website is easy to use for just that purpose.
The Medicare Advantage Plan Advantage?
Medicare Advantage plans (officially Part C of the Medicare universe) incorporate Medicare inpatient (Part A), outpatient (Part B), and possibly drugs (Part D) coverage in one package. The subscriber may pay no monthly fee beyond the standard Medicare deductions from Social Security (adjusted by IRRMA). This is possible because such plans are reimbursed according to the perceived medical complexity of each person enrolled.
Some of these plans are currently under review because they were found trying to make their subscribers appear less healthy than they are (by adding various diagnoses to their files), so that they received unwarranted higher reimbursements.
They may also provide a wide variety of additional benefits to the subscribers, including dental, eye care, fitness programs, typically at some additional cost.
Medicare Advantage Disadvantage
All Medicare Advantage (MA) plans have specific restricted provider networks both in-state and out of state and related requirements. You need to have a primary physician, and you need referrals. You need to get your care within the insurer’s network or face substantial financial costs (higher copays and deductibles). You need referrals to authorize specialist consultations, which you don’t in traditional Medicare. For example, you may not be able to easily get to the Mayo Clinic or Memorial Sloan Kettering if you have some critical medical problem where expertise lies outside of Boston. And you are most likely to encounter these HMO-like restrictions should you get meaningfully ill, which is exactly when you want to have choice.
Medical Advantage Plans’ Costs Increase With Illness
While Medicare Advantage (MA) plans’ committed monthly costs nominally start $3000-$3500 per year less than traditional Medicare with the Blue Cross Sapphire plan, copays and deductibles can rapidly accumulate. If you actually have medical care needs of any complexity, they can be of sufficient scale that MA plans list annual OOP (out-of-pocket) maximums that range to $5000-8000 for 2026. By contrast, there are essentially no uncovered copays or deductibles with traditional Medicare and BC Sapphire or similar.
My Recommendations
For most of my Massachusetts readers, I recommend traditional Medicare with the Blue Cross Sapphire secondary insurance plan. That will cost you about $3000 yearly (including annual deductible) plus about $200 for a Part D drug plan. You have complete freedom of choice and zero copays or other deductibles (except possibly in drug costs). Certainly, if you have significant medical needs this is the right choice, as it is for anyone who simply wants freedom of choice of providers.
If you are healthy and expect to remain so and where the marginally higher front-end premium outlay is an issue, and you don’t mind HMO-type constraints, then Medicare Advantage plans are also a good choice. If you later develop medically complex issues, you can switch to a Medigap plan (with traditional Medicare) at any time during the year. In some states that switch might trigger underwriting by the Medigap provider to exclude coverage for your preexisting illnesses, but that is not permitted in Massachusetts.
To Sum Up
Stay healthy. But rest easy. There are no bad health insurance choices for Medicare recipients.