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.

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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.

Find doctors and clinicians near me, Medicare.gov.
Enter your address and the specialty in the search boxes and you will get a list of providers.

Get help paying Medicare costs, Mass.gov.
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 eligibility. This means that MassHealth will not ask a person about their assets, such as home ownership or savings, when they apply.

Getting started with Medicare, Medicare.gov.
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 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.

Late enrollment and penalties, Medicare.gov.

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

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

Medicare supplement plans in Massachusetts, 2024, with costs. 

Medigap in Massachusetts, Medicare.gov.

  • 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.

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.

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

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

Print sources

Elder and disability law in Massachusetts, MCLE, 2023.

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, 2024. (eBook available here with library card).

Contact   for Massachusetts law about Medicare

Last updated: June 24, 2024

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