Massachusetts law about Medicare

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

If you are unable to find the information you are looking for, or if you have a specific question, please contact our law librarians for assistance.

Best bet

Medicare.gov
The starting point for answers to most questions regarding:

• Getting started with Medicare
• Medicare coverage options and What it covers
• Enrollment periods and When coverage starts
• Finding doctors and clinicians near me
• Health care providers, services, and facilities
• Late enrollment and penalties
• Medigap in Massachusetts and Comparing Medigap plan benefits
• Prescription drug coverage

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

Public Law 119-21 FY2025 Budget Reconciliation Bill (2025)

• Health Provisions in the 2025 Federal Budget Reconciliation Bill, KFF.org (July 2025)
  Describes the law's health care provisions in four categories: Medicaid, the Affordable Care Act, Medicare, and Health Savings Accounts (HSAs). It also compares the provisions to an earlier draft of the bill passed by the House.

Federal regulations

42 CFR 405 et seq. Medicare Program

Filing a complaint or appeal

Claims, appeals, and complaints, Medicare.gov.
Explains the different avenues you can take if you need to request a payment for a service or item, are unhappy with a coverage decision, or are concerned about the quality of your care.

Selected cases

Massachusetts Medical Society v. Dukakis, 815 F. 2d 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.

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.

Get help paying Medicare costs, MassHealth.
You may qualify for help paying your Medicare costs through Medicare Savings Programs (MSPs), previously known as MassHealth Buy-In (MHBI). As of March 1, 2024, there is no asset limit for MSP eligibility. This means that MassHealth will not ask a person about their assets, such as home ownership or savings, when they apply.

Health insurance counseling, Executive Office of Aging & Independence.
The SHINE (Serving the Health Insurance Needs of Everyone) Program provides free health insurance information and assistance for Medicare eligible adults and their caregivers.

How and when to apply for Medicare, USA.gov.
Get answers to general questions including coverage availability while living or traveling out of the country.

Medicare, Mass. Legal Help.
A collection of pages that provide helpful information on the topic of Medicare, including:

• Medicare overview
• How to sign up for Medicare
• Medicare costs and help paying them
• What if Medicare will not pay for something?

Medicare open enrollment guide, Medicareresources.org.
Dates for signing up for Medicare, Medigap, and Medicare Advantage.

Medicare supplement plans offered in Massachusetts (2025), Mass. Division of Insurance.

One Care, MassHealth.
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.

Plan for Medicare, 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.

Will all doctors accept my Medicare coverage?, Medicareresources.org.

COVID-19

Medicare pays for COVID-19 doctor-ordered lab testing, Medicare.gov.

Medicare pays for the COVID-19 vaccine, Medicare.gov.

Print sources

Elder and disability law in Massachusetts, MCLE, 2023.

Estate planning for the aging or incapacitated client in Massachusetts, 5^th 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. (eBook available with library card)

Medicare and Medicaid claims and procedures, 4^th ed., West, 2005 with supplement.

Medicare handbook by  Judith A. Stein, Aspen Publishers, 2025.

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, 30^th ed., Nolo, 2025. (eBook available with library card)

What are ... Medicare appeals? by Jessica L. Gustafson, American Bar Association, 2021. (eBook available with library card)

Last updated:	August 5, 2025