Medicare overview

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The Medicare Advocacy Project at Community Legal Aid, Greater Boston Legal Services, and South Coastal Counties Legal Services

Medicare is a national health insurance program. It is for people who are 65 or older and adults with disabilities. Medicare is divided into 4 parts: A, B, C, and D. In this article, learn more about Medicare and how it can help cover your health needs.

Can I get Medicare?

The Medicare program may be able to help pay for your healthcare if:

  • you are 65 or older; or
  • you have been getting Social Security Disability benefits (SSDI) for at least 2 years; or
  • you need a kidney replacement or dialysis, and you get SSDI. 

Also, you must be either a U.S. citizen or a legal permanent resident to get Medicare. 

Eligibility for Medicare is not based on income.  So long as you meet 1 of the above categories, Medicare should be available to you.

Is Medicare the same as Medicaid or MassHealth?

Medicare is different from Medicaid, the federal health insurance program for lower income people of all ages. For more information on Medicaid in Massachusetts, see MassHealth & Health Insurance.

What plans can I choose from?

Medicare is divided into four different parts: A, B, C, and D. Also, private companies offer Medigap policies.

Part A is called “Hospital Insurance.” It covers services like emergency room visits, hospital stays, short term rehab stays in a nursing facility, hospice for people who are dying, and home health services. You choose your own medical providers, and you do not need referrals.

Part B is called “Supplemental Medical Insurance.” It covers your outpatient costs, like primary care doctor visits, durable medical equipment, home health services, some ambulance transportation, and some preventive services. You choose your own medical providers, and you do not need referrals.

Parts A and B together are known as “Original Medicare” or “Traditional Medicare.” People often get Parts A and B together. The federal government runs Original Medicare through the Center for Medicare and Medicaid Services (CMS) and its subcontractors.

Part C is called “Medicare Advantage.” It is a type of coverage run through private insurance companies. Instead of having Original Medicare, you could choose to enroll in a Medicare Advantage plan. The plan a company offers must be approved by Medicare and cover the same services offered by Original Medicare. A Medicare Advantage plan may offer more coverage than Original Medicare. Usually, a Medicare Advantage plan includes Part D coverage. But, they may require you to use providers in their network or have other restrictions. There are pros and cons. It is best to work with a SHINE counselor or other advisor if you are considering enrolling in a Medicare Advantage plan.

Part D is called “Prescription Drug Coverage.” Unlike Part C, you may have a Part D plan in addition to Original Medicare. Private insurance companies, which Medicare has approved, run Part D programs. These plans cover your drug costs at the pharmacy (not while you are staying in a hospital). Again, it is best to work with a SHINE counselor when picking a Part D plan because there are many options. You should pick a plan that will cover your expected drug costs at the pharmacy. 

In addition to the four parts of Medicare, you may also be eligible for a Medigap policy. These policies are extra insurance from a private company that helps pay your share of costs in Original Medicare. Learn more about your costs. 


  1. You could have Original Medicare (Parts A and B) and nothing else.
  2. You could have Original Medicare with other plans, like a Part D plan and a Medigap policy. 
  3. You could have a Part C Medicare Advantage plan. 

The plans and options you have depend on your own personal circumstances. It is best to work with a SHINE counselor or other enrollment expert to figure out the best option for you. To compare plans, visit the Medicare website

Resource Boxes
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Programs that can answer your questions
Health_Medicare_SHINE and hotlines

SHINE (Serving the Health Information Needs of Everyone): 1-800-243-4636, press 3 
The SHINE (Serving the Health Information Needs of Everyone) Program provides free health insurance counseling services to Massachusetts residents with Medicare or who are about to become eligible for Medicare, and their caregivers. SHINE counselors are trained to handle complex questions about Medicare.

MCPHS University Pharmacy Outreach Program: 1-866-633-1617
The MCPHS University Pharmacy Outreach Program can review your information to find help for your prescription costs. It can also help you understand your Medicare prescription drug plan benefit.

Health Care For All’s Helpline: 1-800-272-4232
Call or fill out the online form. The Helpline is a free service that helps enroll Massachusetts residents into health insurance coverage. In English, Spanish, Portuguese, Haitian Creole, and French.

Get help from the Medicare Advocacy Project
Health_Medicare_Medicare Advocacy Project

The Medicare Advocacy Project (MAP) helps people who may have been unfairly denied Medicare. MAP can give you information, advise you, and sometimes represent you for free. Contact MAP via your local legal services office:

Greater Boston Legal Services (GBLS)
Serving Essex, Middlesex, Norfolk, and Suffolk counties: 617-371-1234; 800-323-3205

South Coastal County Legal Services (SCCLS)
Serving Bristol and Plymouth counties: 800-244-9023; 508-979-7150
Serving Fall River: 800-244-9023; 508-676-6265
Serving Barnstable, Dukes, Nantucket, and Plymouth counties: 800-244-9023; 508-775-7020

Community Legal Aid (CLA)
Serving Berkshire, Franklin, Hampden, Hampshire, and Worcester counties: 855-252-5342

Medicare, MassHealth, and Prescription Advantage Programs
Health_Medicare_Medicare, MassHealth, and Prescription Advantage Programs

Medicare: 1-800-MEDICARE
Medicare is a national health insurance program. It is for people who are 65 or older and adults with disabilities. 

MassHealth: 1-800-841-2900
The MassHealth program provides comprehensive health insurance — or help paying for private health insurance.

Prescription Advantage: 1-800-243-4636, press 2
Prescription Advantage is a prescription drug insurance plan for all Massachusetts residents age 65 and older, as well as younger people with disabilities who meet income and employment guidelines.


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