Massachusetts law about Medicare

Laws, web sources, and print sources on Medicare law.

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Best bet

Massachusetts laws

MGL c. 176K Medicare supplement insurance plans

MGL c. 112, § 2 Prohibition against “balance billing”  if the doctor accepts Medicare patients
“The board shall require as a condition of granting or renewing a physician's certificate of registration, that the physician, who if he agrees to treat a beneficiary of health insurance under Title XVIII of the Social Security Act, shall also agree not to charge to or collect from such beneficiary any amount in excess of the reasonable charge for that service as determined by the United States Secretary of Health and Human Services.”

Federal laws and regulations

Federal law

42 USC §§ 1395 et seq. Federal Medicare law

Federal regulations

42 CFR 405 et seq. Medicare Program

Frequently asked questions related to coverage criteria and utilization management requirements in CMS final rule [Memo], Centers for Medicare & Medicaid Services (February 6, 2024).
Artificial intelligence cannot be used by health insurance companies to deny coverage.

Selected cases

Massachusetts Medical Society v Dukakis, 815 F. 2rd 790 (1987)
An overview of  balance billing, the practice by which a doctor bills a patient for the balance of the doctor's fee over and above the amount that the Medicare program has determined to be a "reasonable charge."

Web sources

Centers for Medicare and Medicaid Services
Includes links to general information, the appeal process, and more.

Finding a doctor,
Enter your address and the specialty in the search boxes and you will get a list of providers.

Getting started with Medicare,
Walks you through the process of signing up, what to do if you want to work past 65, and how much you will need to pay.

Health insurance counseling
The Massachusetts SHINE Program (Serving the Health Insurance Needs of Everyone) provides free health insurance information, counseling, and assistance to all Massachusetts residents with Medicare. 

Late enrollment and penalties,

Get answers to general questions including coverage availability while living or traveling out of the country.

Medicare, MassLegalHelp.
Answers questions from how to apply for Medicare, to how much it costs.

Medicare open enrollment,
Dates for signing up for Medicare, Medigap, nd Medicare Advantage.

Medicare Part B sign up, U.S. Social Security Administration.
Sign up if you have Part A and now want Part B or if you lost your job/benefits and need to sign up.

Medicare Rights Center
Includes "Medicare Interactive," a source for information on any topic related to Medicare. Search, research, or ask a question.

Medicare supplement plans in Massachusetts, 2021 with costs. 

Medigap in Massachusetts,

  • Coverage on state mandated items not covered by Medicare
  • Coverage chart for the different policies
  • Easy to use search for particular item coverage

One Care, Mass Health.
One Care is a way to join MassHealth and Medicare benefits together and is designed for people who currently have MassHealth and Medicare, are 21 to 64 years old, and don’t have other health insurance.

Prescription drug plans in your state,
After you answer basic questions, like your zip code, lists plans available in Massachusetts with premiums, contact information, and links to providers.

Resources on the Medicare prescription drug benefit, Kaiser Family Foundation.
Includes "key Foundation resources and data on the Medicare drug benefit."

Social Security: Medicare benefits, U.S. Social Security Administration.
Learn how to apply for Medicare only online, if you don't want to start receiving Social Security yet.

Will all doctors accept my Medicare coverage? And other questions answered.  

Print sources

Estate planning for the aging or incapacitated client in Massachusetts, 5th ed., MCLE. Chapter 12, Medicare coverage and major Medicare-related coverage options for elders and persons with disabilities.

How to win Medicare appeals, American Bar Association, 2020.

Medicare and Medicaid claims and procedures, West, with supplement.

Primer & update on the Medicare secondary payer act, MCLE, 2019.

Social Security, Medicare & government pensions : get the most out of your retirement & medical benefits by Joseph L. Matthews, Nolo, 2022. (2023 ed. eBook available here with library card).

Contact for Massachusetts law about Medicare

Last updated: February 12, 2024

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