Medicare & Medicaid in Massachusetts (MA)
2026 healthcare costs, coverage, and spending data for Massachusetts.
$12,166
Spending/Capita
1,992,808
Medicare Enrollees
2,690,411
Medicaid Enrollees
6.3%
Uninsured Rate
Medicare Premiums in Massachusetts
Part B Premium
$185/mo
Part D Premium (Avg)
$35/mo
Medigap Premium (Avg)
$141/mo
Medicaid Expansion: Yes - Massachusetts expanded Medicaid under the ACA
Procedure Costs in Massachusetts
Hospital
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Kidney Transplant | $131,993 | $105,594 | $26,399 |
| Liver Transplant | $131,736 | $105,389 | $26,347 |
| Heart Valve Replacement | $63,843 | $51,074 | $12,769 |
| Spinal Fusion | $60,647 | $48,518 | $12,129 |
| Coronary Artery Bypass Graft (CABG) | $59,313 | $47,450 | $11,863 |
| Defibrillator Implantation (ICD) | $53,532 | $42,825 | $10,706 |
| Total Hip Replacement | $35,088 | $28,070 | $7,018 |
| Total Knee Replacement | $35,011 | $28,009 | $7,002 |
| Laminectomy | $33,568 | $26,854 | $6,714 |
| Pacemaker Implantation | $32,255 | $25,804 | $6,451 |
| Hip Fracture Repair | $28,888 | $23,110 | $5,778 |
| Sepsis Treatment | $28,701 | $22,961 | $5,740 |
| Colectomy | $26,940 | $21,552 | $5,388 |
| Stroke Treatment (Acute) | $21,202 | $16,961 | $4,240 |
| Cardiac Catheterization with Stent | $20,706 | $16,565 | $4,141 |
Outpatient
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| TURP (Prostate) | $9,732 | $7,786 | $1,946 |
| Lithotripsy (Kidney Stones) | $7,465 | $5,972 | $1,493 |
| Endoscopic Sinus Surgery | $6,741 | $5,393 | $1,348 |
| Arthroscopic Knee Surgery | $6,708 | $5,366 | $1,342 |
| Hemorrhoid Surgery | $5,309 | $4,247 | $1,062 |
| Nasal Polyp Removal | $5,274 | $4,219 | $1,055 |
| Bunionectomy | $5,234 | $4,187 | $1,047 |
| Tonsillectomy | $5,213 | $4,170 | $1,043 |
| Dialysis Access Surgery | $4,521 | $3,617 | $904 |
| Septoplasty | $4,262 | $3,409 | $852 |
| Adenoidectomy | $4,181 | $3,345 | $836 |
| Carpal Tunnel Release | $4,090 | $3,272 | $818 |
| Cataract Surgery (Outpatient) | $3,839 | $3,071 | $768 |
| Pilonidal Cyst Surgery | $3,542 | $2,834 | $708 |
| Bronchoscopy | $3,385 | $2,708 | $677 |
Imaging
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| PET Scan | $3,737 | $2,990 | $747 |
| MRI Brain | $1,820 | $1,456 | $364 |
| Nuclear Stress Test | $1,772 | $1,418 | $354 |
| CT Angiography | $1,767 | $1,413 | $353 |
| MRI Hip | $1,616 | $1,293 | $323 |
| MRI Spine (Cervical) | $1,421 | $1,136 | $284 |
| MRI Shoulder | $1,400 | $1,120 | $280 |
| CT Scan Abdomen/Pelvis | $1,310 | $1,048 | $262 |
| MRI Spine (Lumbar) | $1,259 | $1,007 | $252 |
| MRI Knee | $1,221 | $977 | $244 |
| CT Scan Head | $999 | $799 | $200 |
| Bone Scan | $971 | $777 | $194 |
| CT Scan Chest | $908 | $726 | $182 |
| CT Colonography (Virtual) | $846 | $677 | $169 |
| Fluoroscopy | $681 | $545 | $136 |
Physician/Office
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Sleep Study Consultation | $282 | $226 | $56 |
| Allergy Testing | $277 | $222 | $55 |
| Psychiatry Visit | $257 | $206 | $51 |
| Mammogram (Screening) | $241 | $241 | $0 |
| Bone Density Test (DEXA Scan) | $234 | $187 | $47 |
| Annual Wellness Visit | $226 | $226 | $0 |
| Office Visit (New Patient) | $209 | $167 | $42 |
| Wound Care Visit | $173 | $138 | $35 |
| Occupational Therapy Session | $172 | $137 | $34 |
| Shingles Vaccination | $171 | $171 | $0 |
| Speech Therapy Session | $170 | $136 | $34 |
| Mental Health Counseling | $165 | $132 | $33 |
| Skin Cancer Screening | $155 | $124 | $31 |
| Vision Exam (Diabetic) | $154 | $123 | $31 |
| Office Visit (Established Patient) | $146 | $116 | $29 |
Laboratory
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Blood Type and Crossmatch | $57 | $45 | $11 |
| Blood Culture | $44 | $35 | $9 |
| BNP (Heart Failure Marker) | $44 | $35 | $9 |
| Glucose Tolerance Test | $43 | $34 | $9 |
| Liver Function Panel | $41 | $32 | $8 |
| Vitamin D Level | $39 | $31 | $8 |
| Troponin Level | $37 | $30 | $8 |
| Pap Smear Lab Processing | $37 | $30 | $7 |
| Iron Studies (Ferritin) | $35 | $28 | $7 |
| Complete Blood Count (CBC) | $34 | $27 | $7 |
| Thyroid Panel (TSH) | $34 | $27 | $7 |
| Comprehensive Metabolic Panel | $31 | $25 | $6 |
| PSA (Prostate-Specific Antigen) | $31 | $25 | $6 |
| Stool Occult Blood Test | $30 | $30 | $0 |
| Hemoglobin A1C | $30 | $24 | $6 |
Compare Massachusetts With Other States
Frequently Asked Questions
How much does Medicare spend per person in Massachusetts?
In 2026, the average Medicare spending per beneficiary in Massachusetts is $12,166.
How many people are enrolled in Medicare in Massachusetts?
Massachusetts has approximately 1,992,808 Medicare beneficiaries.
Did Massachusetts expand Medicaid?
Yes, Massachusetts expanded Medicaid under the Affordable Care Act.
What is the uninsured rate in Massachusetts?
The uninsured rate in Massachusetts is 6.3%.
What is the average Medigap premium in Massachusetts?
The average Medigap (Medicare Supplement) premium in Massachusetts is $141 per month.